Postnatal exposure to mercury and neuropsychological development among preschooler children

The impact of prenatal mercury on neurobehavioral functioning longitudinally assessed from a young age to pre-adolescence in a Spanish birth cohort

The objective is to investigate the relation between cord blood mercury concentrations and child neurobehavioural functioning assessed longitudinally during childhood until pre-adolescence.

METHODS

The study involves mothers and their offspring engaged in the Spanish INMA birth cohort (n = 1147). Total mercury (THg) was determined in cord blood. Behavioural problems were assessed several times during childhood using the ADHD-DSM-IV at age 4, SDQ at ages 7 and 11, CPRS-R:S and the CBCL at ages 7, 9 and 11. Covariates were obtained through questionnaires during the whole period. Multivariate generalised negative binomial (MGNB) models or mixed-effects MGNB (for those tests with information at one or more time points, respectively) were used to investigate the relation between cord blood THg and the children's punctuations. Models were adjusted for prenatal fish intake. Effect modification by sex, prenatal and postnatal fish intake, prenatal fruit and vegetable intake, and maternal polychlorinated biphenyl concentrations (PCBs) was assessed by interaction terms.

RESULTS

The geometric mean ± standard deviation of cord blood THg was 8.22 ± 2.19 μg/L. Despite adjusting for fish consumption, our results did not show any statistically significant relationship between prenatal Hg and the children's performance on behavioural tests conducted between the ages of 4 and 11. Upon assessing the impact of various factors, we observed no statistically significant interaction.

CONCLUSION

Despite elevated prenatal THg exposure, no association was found with children's behavioural functioning assessed from early childhood to pre-adolescence. The nutrients in fish could offset the potential neurotoxic impact of Hg. Further birth cohort studies with longitudinal data are warranted.

Early life exposure to mercury and relationships with telomere length and mitochondrial DNA content in European children

BACKGROUND

Telomere length (TL) and mitochondrial function expressed as mitochondrial DNA copy number (mtDNAcn) are biomarkers of aging and oxidative stress and inflammation, respectively. Methylmercury (MeHg), a common pollutant in fish, induces oxidative stress. We hypothesized that elevated oxidative stress from exposure to MeHg decreases mtDNAcn and shortens TL.

METHODS

Study participants are 6-11-year-old children from the HELIX multi-center birth cohort study, comprising six European countries. Prenatal and postnatal total mercury (THg) concentrations were measured in blood samples, TL and mtDNAcn were determined in child DNA. Covariates and confounders were obtained by questionnaires. Robust regression models were run, considering sociodemographic and lifestyle covariates, as well as fish consumption. Sex, ethnicity, and fish consumption interaction models were also run.

RESULTS

We found longer TL with higher pre- and postnatal THg blood concentrations, even at low-level THg exposure according to the RfD proposed by the US EPA. The prenatal association showed a significant linear relationship with a 3.46 % increase in TL for each unit increased THg. The postnatal association followed an inverted U-shaped marginal non-linear relationship with 1.38 % an increase in TL for each unit increased THg until reaching a cut-point at 0.96 μg/L blood THg, from which TL attrition was observed. Higher pre- and postnatal blood THg concentrations were consistently related to longer TL among cohorts and no modification effect of fish consumption nor children's sex was observed. No association between THg exposure and mtDNAcn was found.

DISCUSSION

We found evidence that THg is associated with TL but the associations seem to be time- and concentration-dependent. Further studies are needed to clarify the mechanism behind the telomere changes of THg and related health effects.

Postnatal methylmercury exposure and neurodevelopmental outcomes at 7 years of age in the Seychelles Child Development Study Nutrition Cohort 2

BACKGROUND

Consumption of fish yields many nutritional benefits, but also results in exposure to methylmercury (MeHg). The developing brain is known to be particularly susceptible to MeHg toxicity in high doses. However, the potential impact of low-level environmental exposure from fish consumption on children's neurodevelopment remains unclear.

METHODS

We investigated postnatal MeHg exposure at 7 years and its association with a battery of 17 neurodevelopmental outcomes in a subset of children (n = 376) from 1535 enrolled mother-child pairs in Nutrition Cohort 2 of the Seychelles Child Development Study (SCDS NC2). Each outcome was modeled in relation to postnatal MeHg exposure using linear regression, adjusting for prenatal MeHg exposure, levels of maternal polyunsaturated fatty acids (PUFA), and several other covariates known to be associated with neurodevelopmental outcomes.

RESULTS

Median postnatal MeHg exposure at 7 years was 2.5 ppm, while the median prenatal MeHg exposure was 3.5 ppm. We found no statistically significant associations between postnatal MeHg exposure and any of the 17 neurodevelopmental outcomes after adjusting for prenatal MeHg exposure and other covariates.

CONCLUSIONS

These findings are consistent with previous cross-sectional analyses of the SCDS Main Cohort. Continued follow-up of the entire NC2 cohort at later ages with repeated exposure measures is needed to further confirm these findings.

Dietary Exposure to Toxic Elements and the Health of Young Children: Methodological Considerations and Data Needs

Concerns have been raised regarding toxic-element (arsenic, cadmium, lead, and mercury) contamination of commercially available infant foods around the world. Young children are vulnerable to the effects of toxic elements, based on higher absorption levels and potentially poorer detoxification capacities. Toxic-element exposures in early life exact high societal costs, but it is unclear how much dietary exposure to these elements contributes to adverse health outcomes. Well-designed epidemiological studies conducted in different geographical and socioeconomic contexts need to estimate dietary toxicant exposure in young children and to determine whether causal links exist between toxicants in children's diets and health outcomes. This commentary outlines the methodological considerations and data needs to advance such research.

Associations of maternal food safety-related risk perceptions and protective behaviors with daily mercury intake and internal doses of Taiwanese women and their preschool children

Mercury (Hg) is a well-known toxicant that can affect children's neurodevelopment. This study attempted to evaluate the internal dose of Hg in hair and fingernails and external Hg exposure from dietary consumption in 283 pairs of mothers and their children aged under 6 years in Taiwan. Mean Hg levels in hair and fingernail samples were 1.07 ± 0.67 and 0.42 ± 0.34 μg/g for mothers, and 1.11 ± 1.22 and 0.36 ± 0.26 μg/g for children, respectively. Our results showed that 42% of mothers and 41% of children had hair Hg levels exceeding the US Environmental Protection Agency recommended value of 1 μg/g. Hg exposure in children was greater than that of their mothers. Estimated daily intake (EDI) levels of Hg among preschool children were 3.3-times higher than those of their mothers. A sensitivity analysis indicated that fish consumption was the main potential factor of Hg exposure among both mothers and their children. External Hg exposure using estimated daily dietary ingestion by mothers was a surrogate for internal hair Hg concentrations. However, poor correlations were found between EDI Hg levels and hair Hg levels among children aged 4-6 years. Exposure sources from food and other media, such as soil and dust, need to be considered to arrive at more-valid risk assessments for younger children's exposure to Hg. Children of mothers who did not have food safety-related risk perceptions or protective behaviors had significantly higher hair Hg concentrations compared to children whose mothers had risk perceptions and protective behaviors. Hg exposure of women of childbearing age and preschool children in Taiwan is still an area of great concern. Providing food safety information and risk-benefits of fish consumption for mothers may avoid harm to the developing nervous systems of their children.

Methylmercury Risk Assessment Based on European Human Biomonitoring Data

A risk assessment (RA) was conducted to estimate the risk associated with methylmercury (MeHg) exposure of vulnerable European populations, using Human Biomonitoring (HBM) data. This RA was performed integrating published data from European HBM surveys and earlier EFSA approaches (EFSA 2012). Children/adolescents (3 to 17 years old) and women of childbearing age (18 to 50 years old) were selected as relevant study population groups for this RA. Two types of HBM datasets were selected: HBM studies (n = 18) with mercury (Hg) levels (blood and hair, total Hg and/or MeHg) in the general population in different EU countries and the DEMOCOPHES harmonized study in child–mother pairs (hair, total Hg) in 17 EU countries as a reference. Two approaches were included in the RA strategy: the first one was based on estimations of the fraction of children/adolescents and women of childbearing age, respectively, from the EU general population exceeding the HBM-I value established by the German Human Biomonitoring Commission, measured as Hazard Quotients (HQ); and the second approach was based on estimations of the fraction of the two population groups exceeding the Tolerable Weekly Intake (TWI) (or their equivalent to Tolerable Daily Intake (TDI)) defined by EFSA in 2012. The HQ approach showed that for both groups, the risk varies across EU countries and that some EU areas are close to or exceeding the exposure guidance values. This is the case of Spain and Portugal, which showed the highest HQ (GM and/or P95), probably due to their higher fish consumption. Results from the EFSA approach show that hair values of children/adolescents and women of childbearing age (both in selected HBM studies and in DEMOCOPHES study) are below the TDI of 1.9 µg/g; therefore, in general, the European population does not exceed the daily average/intake dose for MeHg and/or Hg. A possible risk underestimation was identified in our assessment since for many studies no data on P95 were available, causing loss of relevant information for risk characterization on the upper bound. In addition, data from other European countries also with high seafood consumption, such as France, Greece or Iceland, were not available. For this reason, further RA refinement is needed with harmonized and more widespread HBM data to account for differences in European exposure and associated risks, so that interventions to protect vulnerable citizens, can be applied.

Associations between time-weighted postnatal methylmercury exposure from fish consumption and neurodevelopmental outcomes through 24 years of age in the Seychelles Child Development Study Main Cohort

PURPOSE

Methylmercury (MeHg) is a known neurodevelopmental toxicant in sufficient dosage and is universally found in fish. Current fish advisories for children are based on epidemiology studies examining prenatal exposure with a premise that MeHg exposure resulting from children eating fish could also be neurotoxic and have long-term consequences. However, the evidence that this assumption is true is limited. We investigated postnatal MeHg exposure from regular fish consumption using time weighted Hg measurements to determine if there are neurotoxic consequences.

METHODS

We examined 85 neurodevelopmental outcomes measured from ages 9-24 years in the Seychelles Child Development Study Main Cohort (n = 312-550) and examined their association with time-weighted measures of postnatal MeHg exposure in childhood and early adulthood. Postnatal MeHg exposure measured in the first cm of participants' hair samples collected at seven evaluations were used to create two time-weighted (TW) average MeHg exposure metrics, one for childhood (TW-C) and the other for early adulthood (TW-A). TW-C was based on Hg measures at three ages between 6 months and 5.5 years, and TW-A was based on Hg measured at up to four ages between 17 and 24 years. We examined the association between each of these exposure metrics and the neurodevelopmental outcomes using linear regression with adjustment for covariates known to influence neurodevelopmental outcomes.

RESULTS

There were 14 statistically significant associations between a postnatal metric and an endpoint. Six were associated with the TW-C and eight with the TW-A. Thirteen were adverse. Only the TW-C association at 9 years with the Bender Gestalt error score showed improvement. TW-C was adversely associated at 9 years with the Continuous Performance Task risk score, at 22 years with the Boston Naming Test (BNT) total and no cues scores, and at 24 years with the Test of Variables of Attention (TOVA) auditory response time variability and visual response time mean on the logarithmic scale. TW-A was adversely associated at 17 years with the Wisconsin Card Sorting Test % total errors, the Woodcock-Johnson passage comprehension, and the CANTAB rapid visual information processing false alarms, and at 22 years with the BNT total and no cue scores, the CANTAB rapid visual information processing false alarms and the intra-extra dimensional shift total errors and trials.

CONCLUSION

These findings suggest that postnatal MeHg exposure may be adversely associated with neurodevelopmental outcomes in early adulthood. However, the associations are statistical and of unknown, if any, clinical significance. The results need confirmation in other cohorts.

Prenatal perfluoroalkyl substance exposure and neuropsychological development throughout childhood: The INMA Project

BACKGROUND

Perfluoroalkyl substances (PFASs) have been related to neurodevelopmental toxicity in animals. However, human studies are inconclusive.

OBJECTIVES

To evaluate the association between prenatal PFAS exposure and neuropsychological development during childhood.

METHODS

1240 mother-child pairs from the Spanish INMA Project were analyzed. Perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorononanoic acid (PFNA) were measured in first-trimester maternal plasma. Neuropsychological development was assessed at 14 months, 4-5 and 7 years covering four domains: general cognitive, general motor, attention, and working memory. Associations were studied by means of multivariable regression analyses.

RESULTS

PFHxS, PFOA, PFOS, and PFNA medians were: 0.6, 2.4, 6.1, and 0.7 ng/mL. Higher PFAS prenatal exposure was associated with worse motor development at 14 months, especially in the case of PFHxS (β[95%CI]: -1.49[-2.73, -0.24]) and to a lesser extent PFOS (-1.25[-2.62, 0.12]). There was also a marginal positive association between general cognitive development at 4-5 years and PFOS (1.17[-0.10, 2.43]) and PFNA (0.99[-0.13, 2.12]). No clear associations for other neuropsychological outcomes or any sex differences were found.

DISCUSSION

This study shows no clear-cut evidence of an association between prenatal PFAS exposure and adverse neuropsychological development in children up to the age of 7 years.

Pre and postnatal exposure to mercury and respiratory health in preschool children from the Spanish INMA Birth Cohort Study

Effects of mercury on maturing immune system have been reported, however the association with respiratory and allergy problems during infancy remains unclear. The aim of this study is to evaluate the association between pre and postnatal mercury exposure and respiratory and allergy problems among preschool children and to examine the role of potential modifying factors. Study subjects were children participant in Spanish Childhood and Environment Project (INMA, 2003-2008). We measured total mercury levels in cord blood (n = 1868) and hair at 4 years of age (n = 1347). Respiratory outcomes (wheezing, severe wheezing, chestiness, persistent cough, eczema and otitis) were obtained by questionnaires administered to parents. Associations were investigated by logistic regression adjusted for socio-demographic and lifestyle-related variables in each cohort and subsequent meta-analysis. We tested effect modification by factors related to individual susceptibility, diet and co-exposure with other pollutants. The geometric mean of cord blood and hair total mercury was 8.20 μg/L and 0.97 μg/g, respectively. No statistically significant association between pre or postnatal mercury exposure and respiratory and allergy outcomes was found. Notwithstanding, lower maternal intake of fruits and vegetables increased the risk of some respiratory outcomes due to the prenatal exposure to mercury (p_int < 0.05). Moreover, an inverse association between prenatal mercury exposure and some respiratory outcomes was observed among children with higher maternal exposure to organocholorine compounds or smoking (p_int < 0.05). Also, sex and postnatal smoking exposure modulated mercury postnatal effects on persistent cough (p_int < 0.05). In conclusion, no association between pre and postnatal mercury exposure and respiratory and allergy problems among the whole population at study was found. However, diet and other toxicants could modulate this relation, especially during prenatal period. More research on this topic is warranted due to the limited evidence.

Monthly variations in mercury exposure of school children and adults in an industrial area of southwestern China

Recent studies have shown that rice consumption can be the major pathway for human methylmercury (MeHg) exposure in inland China. However, few studies have considered the susceptible population of school children's exposure through rice ingestion. In this study, monthly variations in total Hg (THg)/MeHg concentrations in rice, fish, hair, and urine samples were studied to evaluate the Hg (both THg and MeHg) exposure in Guiyang, a typical industrial area with high anthropogenic emission of Hg. A total of 17 primary school (school A) students, 29 middle school (school B) students, and 46 guardians participated in this study for one year. Hair THg, hair MeHg, and urine THg concentrations ranged from 355-413 ng g^-1, 213-236 ng g^-1, and 469-518 ng g^-1 Creatinine (ng·g^-1 Cr), respectively, and no significant differences were observed between different genders and age groups. Hair and urine Hg concentrations showed slightly higher values in the cold season (October to February) than the hot season (March to September), but without significant difference. High monthly variability of individual hair and urine Hg concentrations suggested that long-term study could effectively decrease the uncertainty. The school students showed significantly higher urine THg concentrations than adults due to children's unique physiological structure and behaviors. Probable daily intake (PDI) of MeHg via rice and fish ingestion averaged at 0.0091, 0.0090, and 0.0079 μg kg^-1 d^-1 for school A students, school B students, and their guardians, respectively, which means that 86%, 84%, and 87% of the PDI were originated from rice ingestion, respectively. Therefore, more attention should be paid to children as a susceptible population. The results indicated low risk of Hg exposure via rice and fish consumption for urban residents in a Chinese industrial city.

Effects of low-level mercury exposure on brain-derived neurotrophic factor in preschool children

OBJECTIVES

Mercury (Hg), a ubiquitous heavy metal, could affect the neurodevelopment of the children, however, these associations are still equivocal. Brain derived neurotrophic factor (BDNF) plays an essential role in the central nervous system development in children. This study aimed to investigate the effects of low-level mercury exposure on serum BDNF levels and the influence of sex and dietary intake on these relationships in children.

METHODS

In this cross-sectional study, a total of 541 pre-school children were recruited, the blood mercury concentrations and serum BDNF levels were measured. The background information on demographic characteristics and dietary habits of the children was collected through questionnaires. Multivariable linear models after adjustment for potential confounders were used to evaluate the associations between mercury exposure and levels of BDNF in children.

RESULTS

The GMs of blood mercury concentrations and serum BDNF levels were 1.06 μg/L, 20.4 ng/mL, respectively. A significant positive association between blood mercury concentrations and serum BDNF levels was found. After stratification by sex, the blood mercury concentrations in children were positive associated with serum BDNF levels in girls but not in boys. However, these associations were attenuated when we further adjusted the children's dietary intake variables.

CONCLUSIONS

Our findings suggest that low-levels of mercury exposure may have sex-specific effects on BDNF levels in young children and that dietary intake may be potential confounders in these relationships. However, further studies are warranted to investigate the role of BDNF in the effects of mercury on neurodevelopment.

Exposure to mercury among 9-year-old children and neurobehavioural function

Mercury (Hg) is an environmental neurotoxicant whose main route of exposure in humans is the consumption of seafood. The aim of this study was to explore the relationship between Hg exposure at 9 years old and behaviour assessed at 9 and 11 years old. Study subjects were mother-child pairs participating in the INMA (Environment and Childhood) Project in Valencia (Spain). Total Hg (THg) was measured in hair samples from the children at 9 years old. Behaviour and emotions were assessed at 9 (n = 472) years and 11 (n = 385) years of age using the Child Behaviour Checklist test (CBCL) and the Conners Parents Rating Scale-Revised: Short Form (CPRS-R:S). Furthermore, the attention function was assessed by the Attention Network Test at 11 years old. Socio-demographic, lifestyle and dietary information was collected through questionnaires during pregnancy and childhood. Polymorphism in BDNF, APOE and GSTP1 were genotyped in cord blood DNA. Multivariable negative binomial regression models were built in order to study the association between THg concentrations and the scores obtained by the children at 9 and 11 years old. Effect modification by sex and genetic polymorphisms was assessed. The association between Hg levels and CBCL scores was positive (worse neurobehavioural development) for the CBCL internalizing and total problem scales (Incidence Rate Ratio [95% confidence interval] = 1.07 [1.01, 1.13] and 1.05 [0.99, 1.11], respectively). The association between Hg and the externalizing and total problems CBCL scales and the Attention Deficit Hyperactivity Disorder (ADHD) index of the CPRS-R:S was different according to sex, with boys obtaining worse scores with increasing Hg, compared to girls. Statistically significant interactions were also observed for genetic polymorphisms affecting the association between early exposure to Hg and both CBCL and CPRS-R:S scores. In conclusion, postnatal Hg exposure is associated with poorer neurobehavioural development in 9- and 11-year-old children. Sex and the presence of certain genetic polymorphisms modified this association.