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Yang Z, Zhang J, Wang M, Wang X, Liu H, Zhang F, Fan H. Prenatal endocrine-disrupting chemicals exposure and impact on offspring neurodevelopment: A systematic review and meta-analysis. Neurotoxicology 2024; 103:335-357. [PMID: 39013523 DOI: 10.1016/j.neuro.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/11/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Considering that endocrine disruptors have certain effects on fetal growth, we conducted a systematic review of epidemiological literature to elucidate the correlation between exposure to endocrine-disrupting chemicals during pregnancy and the neurodevelopment of offspring. METHOD We systematically explored PubMed, Web of Science, and CINAHL databases from inception to April 4, 2023. References from pertinent studies were reviewed, and data regarding the link between maternal prenatal EDC exposure and offspring neurological development were compiled. A domain-based approach was used to evaluate studies of neurodevelopmental effects in children ≤3 years old by two reviewers, including cognition, motor, behavior, language, and non-verbal ability. RESULTS A comprehensive search yielded 45,373 articles, from which 48 articles, involving 26,005 mother-child pairs, met the criteria and were subsequently included in our analysis. The results revealed that EDC exposure during pregnancy had a significant impact on offspring neurobehavior development, especially in cognition, motor, and language. Our findings indicated adverse associations between prenatal exposure to metals and offspring cognition (before 12 months: β coefficient: -0.28; 95 % CI, -0.50 to -0.06; 1-3 years old: β coefficient: -0.55; 95 % CI: -1.08 to -0.02). Furthermore, metals (β coefficient: -0.71; 95 % CI: -1.23 to -0.19) and phthalates (β coefficient: -0.69; 95 % CI: -1.05 to -0.33) exposure exhibited detrimental effects on motor development from1-3 years old, while poly-fluoroalkyl substances were linked to the disruption of offspring language development (β coefficient: -1.01; 95 % CI: -1.90 to -0.11) within this timeframe. Additionally, exposure to EDCs during pregnancy had a negative impact on cognition development among girls from 12 to 36 months of age (β coefficient: -0.53; 95 % CI: -1.01 to -0.06). CONCLUSION Prenatal exposure to EDCs, especially metals, phthalates and, poly-fluoroalkyl substances, was associated with disrupting the development of offspring neurobehavior in the short and long term. Additionally, cognitive development showed gender differences due to prenatal endocrine-disrupting chemicals exposure.
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Affiliation(s)
- Ziyi Yang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Jie Zhang
- Medical School of Nantong University, Nantong, Jiangsu 226007, China
| | - Mingbo Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Xin Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Huahua Liu
- Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226018, China
| | - Feng Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
| | - Hong Fan
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
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Kou X, Becerra-Tomás N, Canals J, Bulló M, Arija V. Association between Prenatal Dietary Toxicants and Infant Neurodevelopment: The Role of Fish. TOXICS 2024; 12:338. [PMID: 38787117 PMCID: PMC11126097 DOI: 10.3390/toxics12050338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
More research is needed to understand how the maternal consumption of fish and fish-borne toxicants impacts infant neurodevelopment. The present analysis was conducted over 460 mother-infant pairs within the ECLIPSES study. Dietary intake of metals and persistent organic pollutants from fish (including white fish, blue fish, and seafood) was estimated in pregnant women. The infants underwent cognitive, language, and motor function assessments using the Bayley Scales of Infant Development-III at the 40-day postpartum. Associations between dietary toxicants and outcomes were assessed using multivariable linear regression models. Estimated prenatal exposure to fish-borne toxicants, such as arsenic, inorganic arsenic, methylmercury, dioxin-like polychlorinated biphenyls (DL-PCBs), and non-DL-PCBs, was associated with poorer language functions in infants, whereas no significant associations were found with motor or cognitive functions. Maternal fish consumption exceeding the Spanish recommendation of no more than 71 g per day was linked to these adverse effects on language abilities without affecting motor or cognitive development. This highlights the importance of vigilant monitoring of environmental toxicants and the provision of dietary guidance for pregnant women, with potential implications for public health and child development.
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Affiliation(s)
- Xiruo Kou
- Nutrition and Mental Health (NUTRISAM) Research Group, Universitat Rovira i Virgili, 43204 Reus, Spain; (X.K.); (N.B.-T.); (J.C.)
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain;
| | - Nerea Becerra-Tomás
- Nutrition and Mental Health (NUTRISAM) Research Group, Universitat Rovira i Virgili, 43204 Reus, Spain; (X.K.); (N.B.-T.); (J.C.)
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain;
| | - Josefa Canals
- Nutrition and Mental Health (NUTRISAM) Research Group, Universitat Rovira i Virgili, 43204 Reus, Spain; (X.K.); (N.B.-T.); (J.C.)
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain;
- Centre de Recerca en Avaluació i Mesura de la Conducta (CRAMC), Department of Psychology, Universitat Rovira i Virgili, 43007 Tarragona, Spain
- University Research Institute on Sustainablility, Climate Change and Energy Transition (IU-RESCAT), Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Monica Bulló
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain;
- CIBER Physiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Center of Environmental, Food and Toxicological Technology—TecnATox, Rovira i Virgili University, 43201 Reus, Spain
| | - Victoria Arija
- Nutrition and Mental Health (NUTRISAM) Research Group, Universitat Rovira i Virgili, 43204 Reus, Spain; (X.K.); (N.B.-T.); (J.C.)
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain;
- University Research Institute on Sustainablility, Climate Change and Energy Transition (IU-RESCAT), Universitat Rovira i Virgili, 43003 Tarragona, Spain
- Collaborative Research Group on Lifestyles, Nutrition and Smoking (CENIT), Tarragona-Reus Research Support Unit, Jordi Gol Primary Care Research Institute, 43003 Tarragona, Spain
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3
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Spiller P, van Wijngaarden E, Adams HR, Strain JJ, McSorley EM, Mulhern MS, Conway MC, Yeates AJ, Carrington C, Bolger PM, Morgan KM, Taylor CM, Ralston NVC, Crawford MA, Hibbeln JR, Brenna JT, Myers GJ. Net effects explains the benefits to children from maternal fish consumption despite methylmercury in fish. Neurotoxicology 2023; 99:195-205. [PMID: 37866693 DOI: 10.1016/j.neuro.2023.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
In 2001 the U.S. Food and Drug Administration (FDA) issued precautionary advice to pregnant women to limit fish consumption over concern that the methylmercury content might harm their children's neurodevelopment. This concern was based largely on results from an epidemiological study of mothers primarily exposed to methylmercury from consuming pilot whale. Subsequently, FDA and the World Health Organization/Food and Agriculture Organization (WHO/FAO) undertook independent assessments of fish consumption that considered net effects from both fish nutrients, primarily omega-3 fatty acids, as beneficial and methylmercury as harmful. Both assessments estimated that when mothers regularly consume fish during pregnancy, their children are likely to have improved neurodevelopment compared to children of non-fish eaters despite their exposure to methylmercury. These estimated improvements included gains of two to over five full scale IQ points from levels of maternal consumption that are achievable in most of the world. Consistent with those estimates, human research on fish consumption and child neurodevelopment from more than 200,000 mother-child pairs now collectively reports 51 beneficial associations with neurodevelopmental outcomes and three adverse associations, the latter with no discernable pattern. These associations include full scale IQ gains similar to, or somewhat higher than, those estimated by FDA and FAO/WHO. Also consistent with the FDA and FAO/WHO estimates, research has reported beneficial associations with fish consumption when pregnant women are exposed to methylmercury from fish in excess of the U.S. Environmental Protection Agency's (EPA) Reference Dose (RfD). Our analysis evaluates how the net effects approach as utilized by FDA and FAO/WHO provides a holistic explanation for these results with implications for public health policy. This concordance of net effects modeling and empirical scientific evidence supports a clarification of current public health recommendations to focus on greater fish consumption by pregnant women for their children's neurodevelopment.
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Affiliation(s)
- Philip Spiller
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration (retired), College Park, MD 20740, USA.
| | - Edwin van Wijngaarden
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14623, USA
| | - Heather R Adams
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14623, USA
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Emeir M McSorley
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Marie C Conway
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Allison J Yeates
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Clark Carrington
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration (retired), College Park, MD 20740, USA
| | - P Michael Bolger
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration (retired), College Park, MD 20740, USA
| | - Kara M Morgan
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration (retired), College Park, MD 20740, USA
| | - Caroline M Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol BS8 2PS, UK
| | - Nicholas V C Ralston
- Earth System Science and Policy, University of North Dakota, Grand Forks, ND 58202, USA
| | - Michael A Crawford
- Department of Metabolism, Digestion and Reproduction. Imperial College, London, Chelsea and Westminster Hospital Campus, Room H 3, 34, 369 Fulham Road, London SW10 9NH, UK
| | - Joseph R Hibbeln
- Section on Nutritional Neurosciences, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (retired), Rockville, MD, USA
| | - J Thomas Brenna
- Dell Pediatric Research Institute, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX 78723, USA
| | - Gary J Myers
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14623, USA
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4
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Wu W, Chen Y, Guo W, Zhang K, Chen W, Fu M, Pan Z, Yang Y, Zhang N, Zhang W. The Relationship Between Iodine Excess and Thyroid Function During Pregnancy and Infantile Neurodevelopment at 18-24 Months. J Nutr 2023; 153:2320-2327. [PMID: 37182695 DOI: 10.1016/j.tjnut.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/15/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Thyroid disease is a prevalent condition during pregnancy, and excessive iodine intake can lead to changes in thyroid function. However, research on the relationship between maternal iodine excess, thyroid hormones during pregnancy, and infantile neurodevelopment is limited. OBJECTIVES This study aimed to explore the relationship between maternal iodine excess and thyroid hormones during pregnancy and infantile neurodevelopment. The objective was to provide evidence to support and enhance the prevention of neurodevelopmental retardation in infants. METHODS From 2016 to 2018, a prospective study was conducted from pregnancy to 18-24 mo postpartum. Maternal urinary iodine concentration (UIC), thyroid-stimulating hormone (TSH), total serum iodine (TSI), and nonprotein-bound serum iodine during pregnancy were determined. The Gesell Development Scale was used to assess neurodevelopment of infants aged 18-24 mo. The iodine status of pregnant females was divided into following 4 groups on the basis of the distribution of maternal UIC: <100 μg/L (moderate deficiency), 100-149 μg/L (mild deficiency), 150-249 μg/L (sufficiency), and >250 μg/L (above requirement). RESULTS Our study included 469 mother-infant pairs. Compared with the maternal UIC of 150-249 μg/L during pregnancy, risk of adaptive developmental delay was increased in infants with maternal UIC ≥250 μg/L (OR: 2.38; 95% CI: 1.06, 5.35). Pregnant females with TSI >90th quantiles were more likely to have offspring with language developmental delay than those with lower TSI in 10th-90th quantiles (OR: 3.06; 95% CI: 1.09, 8.58). Risk of fine motor developmental delay was increased in infants with maternal TSH ≥2.5 mIU/L during pregnancy (OR: 4.32; 95% CI: 1.43, 13.0). CONCLUSIONS Maternal iodine nutritional status above requirement (UIC ≥250 μg/L or TSI >90th quantiles) during pregnancy negatively affects infantile neurodevelopment. Maternal TSH ≥2.5 mIU/L during pregnancy was an independent risk factor for infantile neurodevelopment. This trial was registered at clinicaltrials.gov as NCT03710148.
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Affiliation(s)
- Wen Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanting Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Guangdong, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Kexin Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Min Fu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ziyun Pan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ying Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Naifan Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, School of Public Health, Tianjin Medical University, Tianjin, China; Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
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5
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Yang K, Chen C, Yan Q, Shen X, Jiang L, Ma R, Lu L, Zhu J, Tian Y, Cai W, D'Alton ME, Zhang J, Kahe K. Combined association of early exposure to long-chain n-3 polyunsaturated fatty acids, mercury and selenium with cognitive performance in 1-year-old infants. ENVIRONMENTAL RESEARCH 2022; 207:112186. [PMID: 34627802 DOI: 10.1016/j.envres.2021.112186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Previous studies on long-chain n-3 polyunsaturated fatty acids (LCn3PUFAs) and infant neurodevelopment did not consider effect modifications of mercury (Hg) and selenium (Se). OBJECTIVES To examine the joint association of prenatal LCn3PUFAs, Hg and Se with infant cognitive performance, and to explore whether DNA methylation may explain this potential association. METHODS A total of 484 newborns were enrolled from the Shanghai Birth Cohort with available data on cord blood LCn3PUFA, nail Hg and Se during 2015-2016. Cord blood LCn3PUFA concentrations were assessed by gas chromatography, and nail Hg and Se concentrations were measured using clippings collected within 6 months of birth by inductively coupled plasma mass spectrometry. Five aspects of infant neurodevelopment (communication, gross motor, fine motor, problem-solving, and personal-social skills) were assessed using the Age and Stage Questionnaire (ASQ) at ages 6 and 12 months. Multivariable-adjusted generalized estimating equations models were performed to examine the associations between cord blood LCn3PUFA concentrations and ASQ test scores, and these associations were stratified by nail Hg and Se levels. Epigenome-wide DNA methylation in cord blood was compared in a random subgroup consisting of 19 infants from the highest and 21 from the lowest decile of LCn3PUFA concentrations. RESULTS LCn3PUFAs were not significantly associated with any ASQ test scores. However, in the subgroup with lower Hg (<median 0.13 ppm) and higher Se (≥median 0.87 ppm) levels, infants with higher LCn3PUFA concentrations had higher ASQ scores indicating better performance in gross motor skills [quartile 4 vs. 1: mean difference = 7.78; 95% confidence interval=(3.47, 12.09); Ptrend<0.01; Pinteraction = 0.03]. Additionally, twenty CpG sites were differentially methylated when comparing high to low LCn3PUFA groups. CONCLUSION The association of prenatal LCn3PUFA concentrations with infant neurodevelopment, particularly gross motor skills, may be observed among infants with high Se and low Hg levels.
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Affiliation(s)
- Kefeng Yang
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Qi Yan
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Xiuhua Shen
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Linlei Jiang
- Instrumental Analysis Platform, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Ma
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Lu
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jie Zhu
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Ying Tian
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Cai
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
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6
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Yao Q, Vinturache A, Lei X, Wang Z, Pan C, Shi R, Yuan T, Gao Y, Tian Y. Prenatal exposure to per- and polyfluoroalkyl substances, fetal thyroid hormones, and infant neurodevelopment. ENVIRONMENTAL RESEARCH 2022; 206:112561. [PMID: 34954147 DOI: 10.1016/j.envres.2021.112561] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are believed to impair early neurodevelopment and disrupt thyroid hormone (TH) levels. However, there are limited epidemiological data on the neurodevelopmental effects in infancy of prenatal PFAS exposure and the potential mediating effects of TH. OBJECTIVES To evaluate potential associations between prenatal PFAS exposure and early neurodevelopmental deficiencies, and assess mediator effects of TH. METHODS From 2010 to 2013, 274 mother-infant pairs were recruited to the Laizhou Wan Birth Cohort in China. Ten PFAS and five TH were measured in cord serum. Developmental quotient (DQ) from 5 domains (adaptive, social, language, gross and fine motor) was assessed using Gesell Developmental Schedules for each child at 1 year of age. The associations between PFAS and DQs were evaluated using multivariable linear regressions. TH-mediated effects of PFAS on DQs were calculated by mediation analyses. RESULTS Among our study population, PFAS exposures were common and associated with DQ decrement in infants. For each 10-fold increase in PFBS concentrations, gross motor and adaptive DQ decreased by 8.56 (95%CI: -15.15, -1.97) and 5.87 (95%CI: -8.07, -3.67) points, respectively. TSH mediated 12.90% of the association of PFBS with gross motor DQ and FT4 explained 19.63% of the association of PFBS with adaptive DQ. The negative association was also found between PFHxS exposure and gross motor DQ (β = 8.14, 95%CI: -15.39, -0.98). CONCLUSIONS PFBS and PFHxS were negatively associated with early neurodevelopment, especially consistent in gross motor domain. The associations were partly explained by TSH and FT4.
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Affiliation(s)
- Qian Yao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Xiaoning Lei
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zixia Wang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengyu Pan
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Shi
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Yuan
- State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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7
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Heng YY, Asad I, Coleman B, Menard L, Benki-Nugent S, Hussein Were F, Karr CJ, McHenry MS. Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review. PLoS One 2022; 17:e0265536. [PMID: 35358213 PMCID: PMC8970501 DOI: 10.1371/journal.pone.0265536] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases worldwide and detrimentally affects child neurodevelopment. Few resources succinctly summarize the existing literature on this topic. Our objective is to systematically review and characterize the evidence regarding the relationship between heavy metals and neurodevelopment of children in LMICs. METHODS We conducted a medical librarian-curated search on multiple online databases to identify articles that included individuals <18 years living in a LMIC, quantitatively measured exposure to a heavy metal (either prenatal or postnatal), and used a standardized measurement of neurodevelopment (i.e. cognitive, language, motor, and behavior). Reviews, editorials, or case studies were excluded. Results were analyzed qualitatively, and quality was assessed. RESULTS Of the 18,043 screened articles, 298 full-text articles were reviewed, and 100 articles met inclusion criteria. The included studies represented data from 19 LMICs, only one of which was classified as a low-income country. Ninety-four percent of postnatal lead and all postnatal manganese studies showed a negative association with metal exposure and neurodevelopment, which were the strongest relationships among the metals studied. Postnatal exposure of mercury was associated with poor neurodevelopment in only half of studies. Limited data on postnatal arsenic and cadmium suggests an association with worse neurodevelopment. Findings were mixed for prenatal arsenic and lead, although some evidence supports that the neurotoxicity of lead was amplified in the presence of manganese. CONCLUSIONS AND POTENTIAL IMPACT We found that lead and manganese appear to consistently have a detrimental effect on the neurodevelopment of children, and more evidence is needed for mercury, arsenic, and cadmium. Better characterization of these effects can motivate and inform prioritization of much needed international policies and programs to reduce heavy metal exposures for young children within LMICs.
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Affiliation(s)
- Yi Yan Heng
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Iqra Asad
- School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Bailey Coleman
- School of Health and Human Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Laura Menard
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sarah Benki-Nugent
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Faridah Hussein Were
- Department of Chemistry, College of Biological and Physical Sciences of the University of Nairobi, Nairobi, Kenya
| | - Catherine J. Karr
- Department of Environmental and Occupational Health Sciences, Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Megan S McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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8
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Dack K, Fell M, Taylor CM, Havdahl A, Lewis SJ. Prenatal Mercury Exposure and Neurodevelopment up to the Age of 5 Years: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041976. [PMID: 35206164 PMCID: PMC8871549 DOI: 10.3390/ijerph19041976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Neurodevelopmental delays can interfere with children’s engagement with the world and further development, and may have negative consequences into adulthood. Mercury is highly toxic and may negatively influence neurodevelopment because it can freely cross the placenta and accumulate in the fetal brain. We searched four publication databases (Embase, PsycINFO, PubMed/MEDLINE, Scopus) for studies examining the relationship between early life mercury exposure and scores on neurodevelopmental performance measures in children aged 0 to 5 years old. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Thirty-two prospective studies were included in the review. Neurodevelopmental performance was measured using 23 different scales, most commonly the Bayley Scales of Infant and Toddler Development (BSID). In most cases, the evidence for an association between mercury and neurodevelopment was weak. There did not appear to be exceptions for particular childhood ages, outcome scales, or mercury levels. The small number of results to the contrary were more likely to be studies which did not meet our high-quality criteria, and could be a consequence of multiple testing, selection bias, or incomplete confounder adjustment. Based on current evidence, dietary mercury exposure during pregnancy is unlikely to be a risk factor for low neurodevelopmental functioning in early childhood.
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Affiliation(s)
- Kyle Dack
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1TH, UK
- Correspondence:
| | - Matthew Fell
- Cleft Collective, University of Bristol, Bristol BS8 1TH, UK;
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK;
| | - Alexandra Havdahl
- Department of Mental Disorders, Norwegian Institute of Public Health, 0213 Oslo, Norway;
- Nic Waals Institute, Lovisenberg Diaconal Hospital, 0853 Oslo, Norway
| | - Sarah J. Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK;
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9
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Zhou CC, Fu H, Zhang GY, Ma JW, Ni M, Li DJ, Shen FM, Huang F. Effects of low-level mercury exposure on brain-derived neurotrophic factor in preschool children. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 208:111642. [PMID: 33396162 DOI: 10.1016/j.ecoenv.2020.111642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Can-Can Zhou
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Fu
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guo-Yan Zhang
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia-Wei Ma
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Ni
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong-Jie Li
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fu-Ming Shen
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Fang Huang
- Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Hibbeln JR, Spiller P, Brenna JT, Golding J, Holub BJ, Harris WS, Kris-Etherton P, Lands B, Connor SL, Myers G, Strain JJ, Crawford MA, Carlson SE. Relationships between seafood consumption during pregnancy and childhood and neurocognitive development: Two systematic reviews. Prostaglandins Leukot Essent Fatty Acids 2019; 151:14-36. [PMID: 31739098 PMCID: PMC6924512 DOI: 10.1016/j.plefa.2019.10.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
Abundant data are now available to evaluate relationships between seafood consumption in pregnancy and childhood and neurocognitive development. We conducted two systematic reviews utilizing methodologies detailed by the Dietary Guidelines for Americans Scientific Advisory Committee 2020-2025. After reviewing 44 publications on 106,237 mother-offspring pairs and 25,960 children, our technical expert committee developed two conclusion statements that included the following: "Moderate and consistent evidence indicates that consumption of a wide range of amounts and types of commercially available seafood during pregnancy is associated with improved neurocognitive development of offspring as compared to eating no seafood. Overall, benefits to neurocognitive development began at the lowest amounts of seafood consumed (∼4 oz/wk) and continued through the highest amounts, above 12 oz/wk, some range up to >100 oz/wk.", "This evidence does not meet the criteria for "strong evidence" only due to a paucity of randomized controlled trials that may not be ethical or feasible to conduct for pregnancy" and "Moderate and consistent evidence indicates that consumption of >4 oz/wk and likely >12 oz/wk of seafood during childhood has beneficial associations with neurocognitive outcomes." No net adverse neurocognitive outcomes were reported among offspring at the highest ranges of seafood intakes despite associated increases in mercury exposures. Data are insufficient for conclusive statements regarding lactation, optimal amounts, categories or specific species characterized by mercury content and neurocognitive development; although there is some evidence that dark/oily seafood may be more beneficial. Research was conducted in healthy women and children and is generalizable to US populations. Assessment of seafood as a whole food integrates inherently integrates any adverse effects from neurotoxicants, if any, and benefits to neurocognition from omega-3 fats, as well as other nutrients critical to optimal neurological development. Understanding of the effects of seafood consumption on neurocognition can have significant public health implications.
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Affiliation(s)
| | | | - J Thomas Brenna
- Dell Pediatric Research Institute, Depts of Pediatrics, of Chemistry, and of Nutrition, University of Texas at Austin, TX, USA
| | - Jean Golding
- Pediatric and Perinatal Epidemiology, Population Health Sciences, University of Bristol, Bristol, UK
| | - Bruce J Holub
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - William S Harris
- Department of Internal Medicine, University of South Dakota School of Medicine and OmegaQuant Analytics, LLC, Sioux Falls, SD, USA
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Penn State University, University Park, PA, USA
| | - Bill Lands
- American Society for Nutrition, College Park, MD, USA
| | - Sonja L Connor
- Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, OR, USA
| | - Gary Myers
- Neurology, Pediatrics, and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - J J Strain
- Nutrition Innovation Centre for Food & Health, (NICHE), Ulster University, Coleraine, Northern Ireland, UK
| | - Michael A Crawford
- Division of Obstetrics and Gynaecology, Department of Surgery and Cancer, Imperial College London, UK
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
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11
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Health Impacts and Biomarkers of Prenatal Exposure to Methylmercury: Lessons from Minamata, Japan. TOXICS 2018; 6:toxics6030045. [PMID: 30081479 PMCID: PMC6161157 DOI: 10.3390/toxics6030045] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022]
Abstract
The main chemical forms of mercury are elemental mercury, inorganic divalent mercury, and methylmercury, which are metabolized in different ways and have differing toxic effects in humans. Among the various chemical forms of mercury, methylmercury is known to be particularly neurotoxic, and was identified as the cause of Minamata disease. It bioaccumulates in fish and shellfish via aquatic food webs, and fish and sea mammals at high trophic levels exhibit high mercury concentrations. Most human methylmercury exposure occurs through seafood consumption. Methylmercury easily penetrates the blood-brain barrier and so can affect the nervous system. Fetuses are known to be at particularly high risk of methylmercury exposure. In this review, we summarize the health effects and exposure assessment of methylmercury as follows: (1) methylmercury toxicity, (2) history and background of Minamata disease, (3) methylmercury pollution in the Minamata area according to analyses of preserved umbilical cords, (4) changes in the sex ratio in Minamata area, (5) neuropathology in fetuses, (6) kinetics of methylmercury in fetuses, (7) exposure assessment in fetuses.
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12
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Vigeh M, Nishioka E, Ohtani K, Omori Y, Matsukawa T, Koda S, Yokoyama K. Prenatal mercury exposure and birth weight. Reprod Toxicol 2018; 76:78-83. [DOI: 10.1016/j.reprotox.2018.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/18/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
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13
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Gao ZY, Li MM, Wang J, Yan J, Zhou CC, Yan CH. Blood mercury concentration, fish consumption and anthropometry in Chinese children: A national study. ENVIRONMENT INTERNATIONAL 2018; 110:14-21. [PMID: 29113684 DOI: 10.1016/j.envint.2017.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/31/2017] [Accepted: 08/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study sought to obtain national cross-sectional data for blood mercury levels and risk factors for mercury exposure in Chinese children aged 0 to 6years to provide evidence to support preventive measures for reducing childhood blood mercury levels. METHODS A multi-stage, stratified, clustered random sampling survey was conducted May 2013-Mar 2015. Shanghai, Jilin, Shanxi, Guangdong, Qinghai, Yunnan and Hubei, which are located in seven different geographical regions in China, were selected as the study field. A total of 14,202 children aged 0-6years participated in the study. Whole-blood venous samples (3ml) were collected from the subjects for mercury exposure assessment. The DMA-80 was applied for mercury detection, and a health questionnaire gathering information on related confounders was completed by the subjects' parents of the subjects after they received guidance from the investigators. A general linear model was used for the primary descriptive statistical analysis. Odds ratios (ORs) and 95%CIs for the risk factors were estimated using unconditional logistic regression. RESULTS A total of 14,202 eligible samples were collected. The mean mercury level was 1.39μg/L. Other results were as follows: median 1.23μg/L, p25 0.86μg/L, p75 1.73μg/L, and GM 1.10μg/L. Of the seven geographical regions, Qinghai, in northwestern China, had a median mercury level of 0.37μg/L, which was significantly lower than the mercury level in Guangdong, in southeastern China (2.01μg/L). The median blood mercury level of children in suburban areas was 1.34μg/L, which was remarkably higher than that of children in rural areas (1.09μg/L). Dichotomous subgroups were generated using the median mercury concentration. Unconditional logistic regression analysis revealed that fish consumption may contribute to increased blood mercury levels (p<0.05). Additionally, we observed significantly positive associations between mercury concentrations and the children's anthropometric characteristics (BMI; p<0.05). CONCLUSIONS Blood mercury concentrations among Chinese children aged 0-6years were considered low, and children who consumed more marine fish, freshwater fish and shellfish tended to have higher mercury concentrations. Our study suggests that children's growth is likely affected by the positive effects of mercury, which may have implications concerning the positive effects of fish consumption.
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Affiliation(s)
- Zhen-Yan Gao
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China
| | - Min-Ming Li
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China
| | - Ju Wang
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China
| | - Jin Yan
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China
| | - Can-Can Zhou
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China
| | - Chong-Huai Yan
- Department of Child and Adolescent Healthcare, Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, PR China.
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14
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Tsai MS, Chen MH, Lin CC, Ng S, Hsieh CJ, Liu CY, Hsieh WS, Chen PC. Children's environmental health based on birth cohort studies of Asia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 609:396-409. [PMID: 28755589 DOI: 10.1016/j.scitotenv.2017.07.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/14/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
Numerous studies have explored the associations between environmental pollutants and pediatric health. Recent studies have investigated the issue in Asia, but no systematic review has been published to date. This study aims to elucidate the issue by summarizing relevant epidemiologic evidence for cohorts in Asia, using information from the Birth Cohort Consortium of Asia (BiCCA). Environmental pollutants include mercury, environmental tobacco smoke (ETS), polychlorinated biphenyls (PCB), perfluoroalkyl substances (PFAS) and phthalates. This study sought to classify the effects of such compounds on fetal growth and pregnancy outcomes, neurodevelopment and behavioral problems, allergic disease and immune function and the endocrine system and puberty. These evidences showed ETS has been associated with infant birth weight, children's neurodevelopment and allergy disease; mercury and PCB have been shown to affect children's neurodevelopment; phthalate has effects on endocrine function; PFAS alters children's neurodevelopment, the endocrine system, and the allergic response. However, more consistent and coordinated research is necessary to understand the whole picture of single environmental and/or co-exposure and children's health. Therefore, harmonization and international collaboration are also needed in Asia.
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Affiliation(s)
- Meng-Shan Tsai
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Mei-Huei Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Chun Lin
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Sharon Ng
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualian County, Taiwan
| | - Chen-Yu Liu
- Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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15
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Mortazavi SMJ, Mortazavi G, Paknahad M. Prenatal low-level mercury exposure and infant neurodevelopment at 12 months in rural northern China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:12480-12481. [PMID: 27117146 DOI: 10.1007/s11356-016-6722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Affiliation(s)
- S M J Mortazavi
- Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Physics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghazal Mortazavi
- Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Paknahad
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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