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Nyanza EC, Kapiga SH, Nsanya MK, Willkens M, Cichowitz C, Peck RN. Exposure to toxic chemical elements among people living with HIV/AIDS in Northern Tanzania. ENVIRONMENTAL RESEARCH 2024; 260:119645. [PMID: 39032621 PMCID: PMC11371493 DOI: 10.1016/j.envres.2024.119645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Environmental exposure to toxic chemicals including cadmium (Cd), lead (Pb), and mercury (Hg), are known risk factors for cardiovascular (CVD) and kidney disease. In people living with HIV (PLWH), CVD and kidney disease are the leading cause of death. Neither traditional risk factors nor markers of HIV infection fully explain such an increased risk. It is of paramount importance to establish the epidemiology of toxic chemicals exposure in PLWH, to inform screening and prevention interventions in this vulnerable population. This cross-sectional study compares toxic chemical levels (T-Cd, T-Pb, and T-Hg) among PLWH and HIV-uninfected adults in Northwestern Tanzania. A total of 495 PLWH and 505 HIV-uninfected subjects were analyzed. Spearman's rank correlations were used to examine the relationship between toxic chemical elements by HIV status. Linear regression models were used to determine the association between exposures and outcomes of interest among study participants. In both PLWH and HIV-uninfected adults, blood T-Cd, T-Pb, and T-Hg levels were frequently found at levels above the reference value of 5, 50, and 20 μg/L, respectively. Overall, factors associated with blood toxic chemical levels included vegetable servings per week, obesity, untreated water sources, use of alcohol, and HIV. Among PLWH, weekly vegetable intake provided a protective effect against T-Cd (Coeff = -0.03, 95%CI = -0.06, -0.01) and T-Pb (Coeff = -0.05, 95%CI = -0.09, -0.01) exposure among PLWH. Alcohol intake (Coeff = 0.10, 95%CI = 0.06, 0.13), obesity (Coeff = 0.08, 95%CI = 0.02, 0.13), longer duration to indoor smoke exposure (Coeff = 0.003, 95%CI = 0.001, 0.004), and HIV infection (Coeff = 0.11, 95%CI = 0.07, 0.15) were associated with increased individuals blood T-Hg levels. Individuals in northwestern Tanzania, including PLWH, have high blood levels for T-Cd, T-Pb, and T-Hg. Factors associated with higher blood levels include water sources, obesity, use of alcohol, exposure to indoor smoke, and HIV infection.
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Affiliation(s)
- Elias C Nyanza
- Department of Environmental, Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania; Mwanza Intervention Trials Unit & National Institute for Medical Research (MITU/NIMR), Mwanza, Tanzania
| | - Saidi H Kapiga
- Mwanza Intervention Trials Unit & National Institute for Medical Research (MITU/NIMR), Mwanza, Tanzania; London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mussa K Nsanya
- Mwanza Intervention Trials Unit & National Institute for Medical Research (MITU/NIMR), Mwanza, Tanzania
| | - Megan Willkens
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, USA
| | - Cody Cichowitz
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Robert N Peck
- Mwanza Intervention Trials Unit & National Institute for Medical Research (MITU/NIMR), Mwanza, Tanzania; Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, USA.
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Cai P, He H, Song X, Qiu T, Chen D, Zhang H. Association between gestational arsenic exposure and infant physical development: a prospective cohort study. BMC Public Health 2024; 24:2292. [PMID: 39174974 PMCID: PMC11342644 DOI: 10.1186/s12889-024-19818-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Arsenic pollution is widespread worldwide. The association between gestational arsenic exposure and adverse birth outcomes has been demonstrated in previous studies; however, few investigations have examined whether gestational arsenic exposure has adverse effects on infant growth and development after birth. OBJECTIVE Our study was designed to evaluate particular associations between gestational arsenic exposure during pregnancy and newborn birth size and to investigate whether these associations continue to affect infants after birth. METHODS An ongoing prospective cohort study of 1100 pregnant women was conducted at the Wuxi Maternity and Child Health Care Hospital. The total urinary arsenic concentrations in the 2nd and 3rd trimester were determined using atomic fluorescence spectrometry. The relationships between urinary arsenic concentration and foetal growth parameters (birth weight, head circumference, length, and ponderal index), SGA (Small for gestational age), and physical growth of infants within one year after birth were analysed. RESULTS Urinary arsenic concentration in the 3rd trimester was associated with an increased incidence of SGA [adjusted model: OR = 2.860 (95% CI: 1.168, 7.020), P = 0.021)]. Arsenic exposure in late pregnancy had an adverse effect on the physical development of infants before the age of 1 year, and there was an interaction effect with the sex of infants. The weight and length of boys at 6 and 12 months negatively correlated with maternal urinary arsenic levels during late pregnancy. CONCLUSIONS In addition to affecting foetal growth, exposure to arsenic in the 3rd trimester also negatively affected the growth of offspring within the first year of life.
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Affiliation(s)
- Panyuan Cai
- Experimental Teaching Center of Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Hongning He
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Department of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Wuxi, 214002, China
| | - Xiaoyue Song
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Department of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Wuxi, 214002, China
| | - Ting Qiu
- Department of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Wuxi, 214002, China
| | - Daozhen Chen
- Department of Clinical Laboratory, Wuxi Maternity and Child Health Care Hospital, Wuxi, 214002, China
| | - Heng Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China.
- Department of Child Health Care, Wuxi Maternity and Child Health Care Hospital, Wuxi, 214002, China.
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Margiana R, Hamoud Alshahrani S, Kayumova D, Hussien Radie Alawadi A, Hjazi A, Alsalamy A, Qasim QA, Juyal A, Garousi N. Association between maternal exposure to arsenic by drinking water during pregnancy and risk of preterm birth: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2947-2956. [PMID: 37967266 DOI: 10.1080/09603123.2023.2280155] [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: 08/05/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
The relation of exposure to arsenic in drinking water during pregnancy to the risk of preterm birth (PTB) was contradictory. This meta-analysis aimed to examine the association between drinking water arsenic and PTB. A systematic search in PubMed and Scopus was performed to achieve all relevant studies. Odds ratios (OR) and 95% confidence intervals (CI) were used to pool data using the random-effect models. Overall, 11 studies with a total sample size of 3,404,189 participants were included in the meta-analysis. Arsenic exposure through drinking water during pregnancy was related to an increased risk of PTB (OR = 1.06; 95%CI = 1.01-1.10 for highest versus lowest category of arsenic), with significant heterogeneity across the studies (I2 = 84.8%, P = 0.001). This finding was supported by cohort studies (OR = 1.05; 95%CI = 1.01-1.10). This meta-analysis proposes that higher arsenic exposure in drinking water may be a risk factor for PTB.
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Affiliation(s)
- Ria Margiana
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Dilrabo Kayumova
- Department of Obstetrics and Gynecology, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Ahmed Hussien Radie Alawadi
- College of technical engineering, the Islamic University, Najaf, Iraq
- College of technical engineering, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
| | - Ahmed Hjazi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ali Alsalamy
- College of technical engineering, Imam Ja'afar Al-Sadiq University, Al-Muthanna, Iraq
| | | | - Ashima Juyal
- Electronics & Communication engineering, Uttaranchal Institute of Technology, Uttaranchal University, Dehradun, India
| | - Nazila Garousi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Wang Y, Wu W, Zhang P, Chen X, Feng Y, Yang H, Jin L, Huang H, Shi X, Wang S, Zhang Y. Vitamin C Alleviates the Risk of Gestational Diabetes Mellitus Associated With Exposure to Metals. J Diabetes Res 2024; 2024:1298122. [PMID: 39035682 PMCID: PMC11260216 DOI: 10.1155/2024/1298122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/22/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Background: Exposure to heavy metals has been suggested to increase the risk of gestational diabetes mellitus (GDM) through the oxidative stress pathway. The study is aimed at examining whether vitamin C could modify the association between exposure to heavy metals and risk of GDM. Methods: We conducted a case-control study in Taiyuan, China, with 776 GDM cases and 776 controls. Data on vitamin C intake from diet and supplements were collected through questionnaires. Concentrations of metals in participants' blood were measured using inductively coupled plasma-mass spectrometry (ICP-MS). Unconditional logistic regression models were applied to estimate effect modification of vitamin C on the association between heavy metals and GDM. Results: Women with higher blood levels of mercury (Hg) (odds ratio (OR) = 2.36, 95% confidence interval (CI): 1.43, 3.92 and 2.04, 95% CI: 1.20, 3.46 for the second and third vs. the first tertile) and arsenic (As) (OR = 2.46, 95% CI: 1.37, 4.43 and 2.16, 95% CI: 1.12, 4.17 for the second and third vs. the first tertile) exposure were associated with increased risk of GDM among women without vitamin C supplement use and having dietary vitamin C intake < 85 mg/day. We found no significant association with metals among women who took vitamin C supplements and/or dietary vitamin C ≥ 85 mg/day. Significant interactions were observed between vitamin C and exposures to metals (i.e., Hg and As) on the risk of GDM (P interaction = 0.048 and 0.045, respectively). Conclusions: Our study, for the first time, suggests that vitamin C supplement use or higher dietary vitamin C intake during preconception and early pregnancy could alleviate the risk of GDM associated with exposure to As and Hg. The results warrant further investigation.
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Affiliation(s)
- Ying Wang
- Department of EpidemiologyShanxi Medical University School of Public Health, Taiyuan, China
- Center of Clinical Epidemiology and Evidence Based MedicineShanxi Medical University, Taiyuan, China
| | - Weiwei Wu
- Department of EpidemiologyShanxi Medical University School of Public Health, Taiyuan, China
- Center of Clinical Epidemiology and Evidence Based MedicineShanxi Medical University, Taiyuan, China
| | - Ping Zhang
- Department of EpidemiologyShanxi Medical University School of Public Health, Taiyuan, China
| | - Xi Chen
- National Institute of Environmental HealthChinese Center for Disease Control and Prevention, Beijing, China
| | - Yongliang Feng
- Department of EpidemiologyShanxi Medical University School of Public Health, Taiyuan, China
- Center of Clinical Epidemiology and Evidence Based MedicineShanxi Medical University, Taiyuan, China
| | - Hailan Yang
- Department of ObstetricsThe First Affiliated HospitalShanxi Medical University, Taiyuan, China
| | - Lan Jin
- Department of SurgeryYale School of Medicine, New Haven, Connecticut, USA
| | - Huang Huang
- Department of Cancer Prevention and ControlNational Cancer Center/National Clinical Research Center for Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoming Shi
- National Institute of Environmental HealthChinese Center for Disease Control and Prevention, Beijing, China
| | - Suping Wang
- Department of EpidemiologyShanxi Medical University School of Public Health, Taiyuan, China
- Center of Clinical Epidemiology and Evidence Based MedicineShanxi Medical University, Taiyuan, China
| | - Yawei Zhang
- Department of Cancer Prevention and ControlNational Cancer Center/National Clinical Research Center for Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kastury F, Besedin J, Betts AR, Asamoah R, Herde C, Netherway P, Tully J, Scheckel KG, Juhasz AL. Arsenic, cadmium, lead, antimony bioaccessibility and relative bioavailability in legacy gold mining waste. JOURNAL OF HAZARDOUS MATERIALS 2024; 469:133948. [PMID: 38493633 PMCID: PMC11097331 DOI: 10.1016/j.jhazmat.2024.133948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
Bioaccessibility and relative bioavailability of As, Cd, Pb and Sb was investigated in 30 legacy gold mining wastes (calcine sands, grey battery sands, tailings) from Victorian goldfields (Australia). Pseudo-total As concentration in 29 samples was 1.45-148-fold higher than the residential soil guidance value (100 mg/kg) while Cd and Pb concentrations in calcine sands were up to 2.4-fold and 30.1-fold higher than the corresponding guidance value (Cd: 20 mg/kg and Pb: 300 mg/kg). Five calcine sands exhibited elevated Sb (31.9-5983 mg/kg), although an Australian soil guidance value is currently unavailable. Arsenic bioaccessibility (n = 30) and relative bioavailability (RBA; n = 8) ranged from 6.10-77.6% and 10.3-52.9% respectively. Samples containing > 50% arsenopyrite/scorodite showed low As bioaccessibility (<20.0%) and RBA (<15.0%). Co-contaminant RBA was assessed in 4 calcine sands; Pb RBA ranged from 73.7-119% with high Pb RBA associated with organic and mineral sorbed Pb and, lower Pb RBA observed in samples containing plumbojarosite. In contrast, Cd RBA ranged from 55.0-67.0%, while Sb RBA was < 5%. This study highlights the importance of using multiple lines of evidence during exposure assessment and provides valuable baseline data for co-contaminants associated with legacy gold mining activities.
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Affiliation(s)
- Farzana Kastury
- Future Industries Institute, STEM, University of South Australia, SA, Australia.
| | - Julie Besedin
- Future Industries Institute, STEM, University of South Australia, SA, Australia; School of Science, STEM, RMIT University, Victoria, Australia
| | - Aaron R Betts
- United States Environmental Protection Agency, Center for Environmental Solutions and Emergency Response, Land Remediation and Technology Division, Cincinnati, OH, USA
| | - Richmond Asamoah
- Future Industries Institute, STEM, University of South Australia, SA, Australia
| | - Carina Herde
- South Australian Health and Medical Research Institute, Adelaide 5086, Australia
| | - Pacian Netherway
- EPA Science, Environment Protection Authority Victoria, Centre for Applied Sciences, Ernest Jones Drive, Macleod, Melbourne, Victoria 3085, Australia
| | - Jennifer Tully
- United States Environmental Protection Agency, Center for Environmental Solutions and Emergency Response, Water Infrastructure Division, Cincinnati, OH, USA
| | - Kirk G Scheckel
- United States Environmental Protection Agency, Center for Environmental Solutions and Emergency Response, Land Remediation and Technology Division, Cincinnati, OH, USA
| | - Albert L Juhasz
- Future Industries Institute, STEM, University of South Australia, SA, Australia
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Chaulo W, Nyanza EC, Asori M, Thomas DSK, Mashuda F. A retrospective study of congenital anomalies and associated risk factors among children admitted at a tertiary hospital in northwestern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003177. [PMID: 38691565 PMCID: PMC11062536 DOI: 10.1371/journal.pgph.0003177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/14/2024] [Indexed: 05/03/2024]
Abstract
Congenital anomalies in Sub-Sahara Africa (SSA) are understudied despite the significant pediatric health burden. This retrospective longitudinal hospital-based study evaluated the records of 326 inpatient children under the age of two years with congenital anomalies at Bugando Medical Centre, a tertiary referral hospital in northwestern Tanzania. Classical logistic regression was used in the analysis of congenital malformation of muscles, gastrointestinal malformation, oral facial clefts, neural tube defects, and skeletal malformations. A modified poisson regression was used to model risk factors for Central Nervous System (CNS) hydrocephalus and congenital heart disease (CHD). A majority (78.8%) of children included in the study were less than six months of age. Nearly half (48.8%) were diagnosed with CHD followed by CNS hydrocephalus (10.4%) and congenital malformation of muscles (8.9%). Babies whose mothers missed periconceptual folic acid supplementation had 83% higher risk of hydrocephalus (aPR = 1.83, 95% CI = 1.11-1.96) and 78% higher for CHD (aPR = 1.78, 95% CI = 1.31-1.94). Male children had 1.67 higher odds of muscular congenital malformations (aOR = 1.67, 95% CI = 1.23-1.89). Less than 37 gestational age had a 1.86 higher odds of muscular congenital malformations (aOR = 1.86, 95% CI = 1.53-3.66). Our study highlights the critical need for folic acid supplementation and establishes a need for a registry and the potential for mapping.
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Affiliation(s)
- Wango Chaulo
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, TANZANIA
| | - Elias C. Nyanza
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, TANZANIA
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Deborah S. K. Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Florentina Mashuda
- Department of Pediatrics and Child Health, Bugando Medical Centre, Mwanza, TANZANIA
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Thomas DSK, Asori M, Nyanza EC. The role of geophagy and artisanal gold mining as risk factors for elevated blood lead levels in pregnant women in northwestern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002958. [PMID: 38394051 PMCID: PMC10889643 DOI: 10.1371/journal.pgph.0002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Neither artisanal and small-scale gold mining (ASGM) or geophagy practices have received substantial attention related to blood lead levels despite the well documented deleterious effects of lead. This cross-sectional analytical study aimed to document the risk of lead exposure from geophagy and mining-related occupational activities for pregnant women. The study recruited 1056 pregnant women (883 in an ASGM area and 173 in a non-ASGM area) between April 2015 -April 2017. Generalized Linear Model with an identity link function was used to model the association between blood lead levels (BLLs) and geophagy practices and involvement in gold mining. The prevalence of geophagy was 36.2% (95% CI: 33.6, 39.4%) and 6.3% engaged in mining as a primary occupation. Practicing geophagy increased BLLs by 22% (β = 1.22, 95% CI: 1.116, 1.309, p<0.0001). Living in a gold mining area increased BLLs by 33.4% (β = 1.334, 95% CI: 1.2, 1.483, p<0.0001). Having mining as a primary occupation increased BLLs by 1.3% β = 1.013, 95% CI: 0.872, 1.176, p = 0.869) even though the association was not statistically significant. Socioeconomic wealth quantile (β = 1.037, 95% CI: 1.021, 1.054, p<0.001) increased blood lead levels by 3.7%. Developing a comprehensive inventory capturing sources of community-level lead exposure is essential. Further, increasing public health campaigns and education are crucial to limit geophagy practices and to minimize work in gold mining activities during pregnancy.
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Affiliation(s)
- Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Elias C Nyanza
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Schrenk D, Bignami M, Bodin L, Chipman JK, del Mazo J, Grasl‐Kraupp B, Hogstrand C, Hoogenboom L(R, Leblanc J, Nebbia CS, Nielsen E, Ntzani E, Petersen A, Sand S, Vleminckx C, Wallace H, Barregård L, Benford D, Broberg K, Dogliotti E, Fletcher T, Rylander L, Abrahantes JC, Gómez Ruiz JÁ, Steinkellner H, Tauriainen T, Schwerdtle T. Update of the risk assessment of inorganic arsenic in food. EFSA J 2024; 22:e8488. [PMID: 38239496 PMCID: PMC10794945 DOI: 10.2903/j.efsa.2024.8488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.
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Jovine J, Nyanza EC, Asori M, Thomas DS. Prenatal arsenic and mercury levels among women practicing geophagy in areas with artisanal and small-scale gold mining activities, Northwestern Tanzania. BMC Pregnancy Childbirth 2023; 23:854. [PMID: 38087268 PMCID: PMC10714484 DOI: 10.1186/s12884-023-06174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Artisanal and small-scale gold mining (ASGM) areas potentially pose increased exposure to arsenic and mercury through community contamination, occupations at gold mines, and/or geophagy when soil is locally sourced. This study examined the effects of geophagy, a deliberate soil eating practice, along with community and occupational exposures in ASGM areas on urinary arsenic and blood mercury levels among pregnant women in the Mining and Health Longitudinal Cohort in northwestern Tanzania. METHODS Data on maternal arsenic and mercury levels were captured for 1056 pregnant women using an unprovoked morning urine samples and dried blood spots respectively. We used a step-wise generalized linear regression model to retain the most relevant covariates for the model. A generalized linear regression model with identity link function was used to predict the effect of geophagy practices on arsenic and mercury levels separately. The model was adjusted using sociodemographic correlates, including maternal age, education level, whether respondents lived in mining or non-mining area, years of residence, marital status, maternal occupation, individual partner's education, and occupational, and socioeconomic status. RESULTS In the adjusted regression model, eating soil during pregnancy increased arsenic concentration by almost 23% (β = 1.229, 95% CI: 1.094, 1.38, p < 0.001) and living in mining areas had a 21.2% (β = 1.212; 95% CI: 1.039,1.414, p = 0.014) increased risk. Geophagy significantly increased mercury levels by 13.3% (β = 1.133, 95% CI: 1.022, 1.257, p = 0.018). Living in areas with ASGM activities was associated with a 142% (β = 2.422, 95% CI: 2.111, 2.776, p < 0.0001) increase in blood mercury. CONCLUSION Geophagy practices increased urinary arsenic and blood mercury levels in pregnant women, which was especially true for arsenic when living in areas with ASGM activities. Working in mining = increased risk for blood mercury levels. Community-based environmental health policies should address reductions in occupational and community exposures, along with strategic geophagy reduction interventions.
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Affiliation(s)
- Jovina Jovine
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, Wurzburg Road, P.O.BOX 1464, Mwanza, Tanzania
| | - Elias C Nyanza
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, Wurzburg Road, P.O.BOX 1464, Mwanza, Tanzania.
| | - Moses Asori
- Department of Geography & Earth Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - Deborah Sk Thomas
- Department of Geography & Earth Sciences, University of North Carolina at Charlotte, Charlotte, USA
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Zhang T, Wang X, Luo ZC, Liu J, Chen Y, Fan P, Ma R, Ma J, Luo K, Yan CH, Zhang J, Ouyang F. Maternal blood concentrations of toxic metal(loid)s and trace elements from preconception to pregnancy and transplacental passage to fetuses. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 264:115394. [PMID: 37625333 DOI: 10.1016/j.ecoenv.2023.115394] [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: 02/15/2023] [Revised: 04/27/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023]
Abstract
Intrauterine exposure to heavy metals may adversely affect the developing fetus and health later in life, while certain trace elements may be protective. There is limited data on their dynamic fluctuation in circulating concentration of women from preconception to pregnancy and the degree of transplacental passage to fetus. Such information is critically needed for an optimal design of research studies and intervention strategies. In the present study, we profiled the longitudinal patterns and trajectories of metal(loid)s and trace elements from preconception to late pregnancy and in newborns. We measured whole blood metal(loid)s in women at preconception, 16, 24 and 32 weeks of gestation and in cord blood in 100 mother-newborn pairs. Our data showed that the mean concentrations of mercury (Hg), lead (Pb), rubidium (Rb), manganese (Mn), and iron (Fe) were lower during early-, mid-, and late-pregnancy than at preconception. Copper (Cu), and calcium (Ca) concentrations increased after pregnancy (Cu 798 versus 1353, 1488, and 1464 μg/L). Concentrations at preconception were correlated with those during pregnancy for all examined metal(loid)s. Maternal Hg, Pb, and Se concentrations at late-pregnancy were correlated with those in newborn cord blood in various degrees (correlation coefficients: Hg 0.66, Pb 0.29, Se 0.39). The estimated placental transfer ratio for toxic metal(loid)s ranging from 1.68 (Hg) to 0.18 (Cd). Two trajectory groups were identified for Hg, Pb, Cd, Se concentrations. Hg concentrations may be correlated with maternal education levels. The study is the first to present longitudinal circulating concentration trajectories of toxic metal(loid)s and trace elements from preconception to pregnancy stages. A high degree of transplacental passage was observed in toxic metals Pb and Hg which may pose hazards to the developing fetus.
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Affiliation(s)
- Ting Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto M5G 1×5, Canada
| | - Junxia Liu
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanzhi Chen
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pianpian Fan
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Ma
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinqian Ma
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Luo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | - Chong-Huai Yan
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Zhao S, Yang X, Xu Q, Li H, Su Y, Xu Q, X Li Q, Xia Y, Shen R. Association of maternal metals exposure, metabolites and birth outcomes in newborns: A prospective cohort study. ENVIRONMENT INTERNATIONAL 2023; 179:108183. [PMID: 37690219 DOI: 10.1016/j.envint.2023.108183] [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: 06/28/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Maternal exposure to metals may pose a risk to the health of newborns, however, the underlying mechanisms remain ambiguous. Herein, we aimed to investigate the influence of metals exposure on birth outcomes and reveal the importance of metabolites in the exposure-outcomes association by using metabolomics methods. METHODS In our study, 292 mother-pairs were included who were recruited from the affiliated hospitals of Nanjing Medical University between 2006 and 2011. We measured fifteen metals (mercury, lead, vanadium, arsenic, zinc, cadmium, rubidium, copper, cobalt, iron, molybdenum, strontium, thallium, magnesium and calcium) and metabolites in maternal second trimester serums by using inductively coupled plasma mass spectrometry and ultra-high performance liquid chromatography high resolution accurate mass spectrometry, respectively. A multi-step statistical analysis strategy including exposome-wide association study (ExWAS) model, variable selection models and multiple-exposure models were performed to systematically appraise the associations of individual and mixed metals exposure with birth outcomes. Furthermore, differential metabolites that associated with metals exposure and birth outcomes were identified using linear regression models. RESULTS Metal's levels in maternal serums ranged from 0.05 μg/L to 1864.76 μg/L. In the ExWAS model, maternal exposure to arsenic was negatively associated with birth weight (β = 188.83; 95% CI: -368.27, -9.39), while maternal mercury exposure showed a positive association (β = 533.65; 95%CI: 179.40, 887.90) with birth weight. Moreover, each unit increase in mercury (1 ng/mL-log transformed) was associated with a 1.82 week-increase (95%CI: 0.85, 2.79) in gestational age. These findings were subsequently validated by variable selection models and multiple exposure models. Metabolomic analysis further revealed the significant role of 3-methyladenine in the relationship between arsenic exposure and birth weight. CONCLUSION This study provides new epidemiological evidence indicating the associations of metals exposure and neonatal birth outcomes, and emphasizes the potential role of metabolite biomarkers and their importance in monitoring adverse birth outcomes.
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Affiliation(s)
- Shuangshuang Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China; State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xu Yang
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qing Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Hang Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yan Su
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Qiaoqiao Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qing X Li
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, 1955 East-West Road, Honolulu, HI 96822, USA
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Rong Shen
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
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12
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González-Rubio JM, Domínguez-Morueco N, Pedraza-Díaz S, Cañas Portilla A, Lucena MÁ, Rodriguez A, Castaño A, Esteban-López M. A simple method for direct mercury analysis in dried blood spots (DBS) samples for human biomonitoring studies. ENVIRONMENT INTERNATIONAL 2023; 177:107958. [PMID: 37285712 DOI: 10.1016/j.envint.2023.107958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/22/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023]
Abstract
Human exposure to mercury can have serious health effects, especially in vulnerable groups such as children and fetuses. The use of dried blood spot (DBS) samples to collect capillary blood greatly facilitates sample collection and fieldwork, being a less invasive alternative to blood collection by venipuncture, needing a small volume of sample, and does not require specialized medical staff. Moreover, DBS sampling reduces logistical and financial barriers related to transport and storage of blood samples. We propose here a novel method to analyze total mercury in DBS samples in a Direct Mercury Analyzer (DMA) that allow the control of the volume of the DBS samples. This method has shown good results in terms of precision (<6% error), accuracy (<10% coefficient of variation) and recovery (75-106%). The applicability of the method in human biomonitoring (HBM) was demonstrated in a pilot study involving 41 adults aged 18-65. Mercury concentrations of DBS samples from capillary blood collected by finger prick (real DBS samples) were determined in the DMA and compared with those determined in whole blood (venous blood) by ICP-MS, the method usually used in HBM. The sampling procedure was also validated by comparison of real DBS samples and DBS generated artificially in the laboratory by depositing venous samples in cellulose cards (laboratory DBS). There were no statistically significant differences in the results obtained using both methodologies (DMA: Geometric Mean (confidence interval 95%) = 3.87 (3.12-4.79) µg/L; ICP-MS: Geometric Mean (confidence interval 95%) = 3.46 (2.80-4.27) µg/L). The proposed method is an excellent alternative to be applied in clinical settings as screening methodology for assessing mercury exposure in vulnerable groups, such us pregnant woman, babies and children.
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Affiliation(s)
| | | | - Susana Pedraza-Díaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Cañas Portilla
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ángel Lucena
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Rodriguez
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Argelia Castaño
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban-López
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
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13
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Kumar S, Sharma A, Sedha S. Occupational and environmental mercury exposure and human reproductive health - a review. J Turk Ger Gynecol Assoc 2022; 23:199-210. [PMID: 36065987 PMCID: PMC9450922 DOI: 10.4274/jtgga.galenos.2022.2022-2-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Mercury is a toxic heavy metal. Humans are exposed to mercury through several sources including environmental, occupational, contaminated food and water and from mercury-containing dental amalgam. Mercury exposure is known to harm the nervous system profoundly, and have a negative impact on digestive and immune systems, and other organs. To review and discuss the effect of mercury exposure through environmental or occupational routes on human reproduction, pregnancy, and its outcome. Published information about the potential toxic effects of mercury on human reproduction were collected and summarized. Literature was identified by systematic search using relevant keywords. Literature review revealed a number of negative impacts of mercury on human reproduction. These included effects on semen quality, including reduced sperm count, motility, and changes in morphology that may reduce fertility potential. There may also be an effect in changing reproductive hormone levels. Mercury exposure might also affect pregnancy but the data concerning mercury effects on female reproduction are limited except for some data about mercury exposure and poor pregnancy outcomes. Available data indicate that mercury exposure may have a toxicity effect on reproductive potential, especially in males. Prenatal mercury exposure may affect pregnancy or its outcome and this appears to be dependent upon dose, duration, and timing of exposure. Nutritional status of exposed individual might also influence the impact of mercury.
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Affiliation(s)
- Sunil Kumar
- National Institute of Occupational Health, Gujarat, India
| | - Anupama Sharma
- National Institute of Occupational Health, Gujarat, India
| | - Sapna Sedha
- Department of Biotechnology, Dr. Hari Singh Gour University, Madhya Pradesh, India
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14
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Dutta S, Gorain B, Choudhury H, Roychoudhury S, Sengupta P. Environmental and occupational exposure of metals and female reproductive health. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:62067-62092. [PMID: 34558053 DOI: 10.1007/s11356-021-16581-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Untainted environment promotes health, but the last few decades experienced steep upsurge in environmental contaminants posing detrimental physiological impact. The responsible factors mainly include the exponential growth of human population, havoc rise in industrialization, poorly planned urbanization, and slapdash environment management. Environmental degradation can increase the likelihood of human exposure to heavy metals, resulting in health consequences such as reproductive problems. As a result, research into metal-induced causes of reproductive impairment at the genetic, epigenetic, and biochemical levels must be strengthened further. These metals impact upon the female reproduction at all strata of its regulation and functions, be it development, maturation, or endocrine functions, and are linked to an increase in the causes of infertility in women. Chronic exposures to the heavy metals may lead to breast cancer, endometriosis, endometrial cancer, menstrual disorders, and spontaneous abortions, as well as pre-term deliveries, stillbirths. For example, endometriosis, endometrial cancer, and spontaneous abortions are all caused by the metalloestrogen cadmium (Cd); lead (Pb) levels over a certain threshold can cause spontaneous abortion and have a teratogenic impact; toxic amounts of mercury (Hg) have an influence on the menstrual cycle, which can lead to infertility. Impact of environmental exposure to heavy metals on female fertility is therefore a well-known fact. Thus, the underlying mechanisms must be explained and periodically updated, given the growing evidence on the influence of increasing environmental heavy metal load on female fertility. The purpose of this review is to give a concise overview of how heavy metal affects female reproductive health.
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Affiliation(s)
- Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom, Malaysia
| | - Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Hira Choudhury
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | | | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia.
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15
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Landrigan P, Bose-O'Reilly S, Elbel J, Nordberg G, Lucchini R, Bartrem C, Grandjean P, Mergler D, Moyo D, Nemery B, von Braun M, Nowak D. Reducing disease and death from Artisanal and Small-Scale Mining (ASM) - the urgent need for responsible mining in the context of growing global demand for minerals and metals for climate change mitigation. Environ Health 2022; 21:78. [PMID: 36028832 PMCID: PMC9412790 DOI: 10.1186/s12940-022-00877-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Artisanal and small-scale mining (ASM) takes place under extreme conditions with a lack of occupational health and safety. As the demand for metals is increasing due in part to their extensive use in 'green technologies' for climate change mitigation, the negative environmental and occupational consequences of mining practices are disproportionately felt in low- and middle-income countries. The Collegium Ramazzini statement on ASM presents updated information on its neglected health hazards that include multiple toxic hazards, most notably mercury, lead, cyanide, arsenic, cadmium, and cobalt, as well as physical hazards, most notably airborne dust and noise, and the high risk of infectious diseases. These hazards affect both miners and mining communities as working and living spaces are rarely separated. The impact on children and women is often severe, including hazardous exposures during the child-bearing age and pregnancies, and the risk of child labor. We suggest strategies for the mitigation of these hazards and classify those according to primordial, primary, secondary, and tertiary prevention. Further, we identify knowledge gaps and issue recommendations for international, national, and local governments, metal purchasers, and employers are given. With this statement, the Collegium Ramazzini calls for the extension of efforts to minimize all hazards that confront ASM miners and their families.
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Affiliation(s)
- Philip Landrigan
- Program for Global Public Health and the Common Good, Global Observatory on Planetary Health, Boston College, Boston, USA.
- Centre Scientifique de Monaco, Monaco City, Monaco.
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Johanna Elbel
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Gunnar Nordberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Roberto Lucchini
- Institute of Occupational Health, University of Brescia, Brescia, Italy
| | - Casey Bartrem
- TerraGraphics International Foundation, Moscow, ID 83843, USA
| | - Philippe Grandjean
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - Donna Mergler
- Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Center for Interdisciplinary Research in Health, Wellbeing, Society and Environment, Université du Québec à Montréal, Montreal, QC, Canada
| | - Dingani Moyo
- School of Public Health, Faculty of Health Sciences, Occupational Health Division, University of the Witwatersrand, Johannesburg, Republic of South Africa
- Department of Community Medicine, Faculty of Medicine and Health, National University of Science and Technology, Bulawayo, Zimbabwe
- Department of Community Medicine, Faculty of Medicine and Health, Midlands State University, Gweru, Zimbabwe
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Margrit von Braun
- TerraGraphics International Foundation, Moscow, ID 83843, USA
- Environmental Science Program, University of Idaho, Moscow, ID 83843, USA
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
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16
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Jacobson TA, Kler JS, Bae Y, Chen J, Ladror DT, Iyer R, Nunes DA, Montgomery ND, Pleil JD, Funk WE. A state-of-the-science review and guide for measuring environmental exposure biomarkers in dried blood spots. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022:10.1038/s41370-022-00460-7. [PMID: 35963945 PMCID: PMC9375076 DOI: 10.1038/s41370-022-00460-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Dried blood spot (DBS) sampling is a simple, cost-effective, and minimally invasive alternative to venipuncture for measuring exposure biomarkers in public health and epidemiological research. DBS sampling provides advantages in field-based studies conducted in low-resource settings and in studies involving infants and children. In addition, DBS samples are routinely collected from newborns after birth (i.e., newborn dried blood spots, NDBS), with many states in the United States permitting access to archived NDBS samples for research purposes. OBJECTIVES We review the state of the science for analyzing exposure biomarkers in DBS samples, both archived and newly collected, and provide guidance on sample collection, storage, and blood volume requirements associated with individual DBS assays. We discuss recent progress regarding analytical methods, analytical sensitivity, and specificity, sample volume requirements, contamination considerations, estimating extracted blood volumes, assessing stability and analyte recovery, and hematocrit effects. METHODS A systematic search of PubMed (MEDLINE), Embase (Elsevier), and CINAHL (EBSCO) was conducted in March 2022. DBS method development and application studies were divided into three main chemical classes: environmental tobacco smoke, trace elements (including lead, mercury, cadmium, and arsenic), and industrial chemicals (including endocrine-disrupting chemicals and persistent organic pollutants). DBS method development and validation studies were scored on key quality-control and performance parameters by two members of the review team. RESULTS Our search identified 47 published reports related to measuring environmental exposure biomarkers in human DBS samples. A total of 28 reports (37 total studies) were on methods development and validation and 19 reports were primarily the application of previously developed DBS assays. High-performing DBS methods have been developed, validated, and applied for detecting environmental exposures to tobacco smoke, trace elements, and several important endocrine-disrupting chemicals and persistent organic pollutants. Additional work is needed for measuring cadmium, arsenic, inorganic mercury, and bisphenol A in DBS and NDBS samples. SIGNIFICANCE We present an inventory and critical review of available assays for measuring environmental exposure biomarkers in DBS and NDBS samples to help facilitate this sampling medium as an emerging tool for public health (e.g., screening programs, temporal biomonitoring) and environmental epidemiology (e.g., field-based studies).
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Affiliation(s)
- Tyler A Jacobson
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jasdeep S Kler
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yeunook Bae
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiexi Chen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel T Ladror
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramsunder Iyer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise A Nunes
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan D Montgomery
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joachim D Pleil
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - William E Funk
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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17
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Kim C, Ashrap P, Watkins DJ, Mukherjee B, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD. Maternal Metals/Metalloid Blood Levels Are Associated With Lipidomic Profiles Among Pregnant Women in Puerto Rico. Front Public Health 2022; 9:754706. [PMID: 35096734 PMCID: PMC8790322 DOI: 10.3389/fpubh.2021.754706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aim: The association between heavy metal exposure and adverse birth outcomes is well-established. However, there is a paucity of research identifying biomarker profiles that may improve the early detection of heavy metal-induced adverse birth outcomes. Because lipids are abundant in our body and associated with important signaling pathways, we assessed associations between maternal metals/metalloid blood levels with lipidomic profiles among 83 pregnant women in the Puerto Rico PROTECT birth cohort. Methods: We measured 10 metals/metalloid blood levels during 24–28 weeks of pregnancy. Prenatal plasma lipidomic profiles were identified by liquid chromatography–mass spectrometry-based shotgun lipidomics. We derived sums for each lipid class and sums for each lipid sub-class (saturated, monounsaturated, polyunsaturated), which were then regressed on metals/metalloid. False discovery rate (FDR) adjusted p-values (q-values) were used to account for multiple comparisons. Results: A total of 587 unique lipids from 19 lipid classes were profiled. When controlling for multiple comparisons, we observed that maternal exposure to manganese and zinc were negatively associated with plasmenyl-phosphatidylethanolamine (PLPE), particularly those containing polyunsaturated fatty acid (PUFA) chains. In contrast to manganese and zinc, arsenic and mercury were positively associated with PLPE and plasmenyl-phosphatidylcholine (PLPC). Conclusion: Certain metals were significantly associated with lipids that are responsible for the biophysical properties of the cell membrane and antioxidant defense in lipid peroxidation. This study highlighted lipid-metal associations and we anticipate that this study will open up new avenues for developing diagnostic tools.
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Affiliation(s)
- Christine Kim
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Pahriya Ashrap
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Zaira Y Rosario-Pabón
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen M Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Akram N Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
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18
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Plante I, Winn LM, Vaillancourt C, Grigorova P, Parent L. Killing two birds with one stone: Pregnancy is a sensitive window for endocrine effects on both the mother and the fetus. ENVIRONMENTAL RESEARCH 2022; 205:112435. [PMID: 34843719 DOI: 10.1016/j.envres.2021.112435] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
Pregnancy is a complex process requiring tremendous physiological changes in the mother in order to fulfill the needs of the growing fetus, and to give birth, expel the placenta and nurse the newborn. These physiological modifications are accompanied with psychological changes, as well as with variations in habits and behaviors. As a result, this period of life is considered as a sensitive window as impaired functional and physiological changes in the mother can have short- and long-term impacts on her health. In addition, dysregulation of the placenta and of mechanisms governing placentation have been linked to chronic diseases later-on in life for the fetus, in a concept known as the Developmental Origin of Health and Diseases (DOHaD). This concept stipulates that any change in the environment during the pre-conception and perinatal (in utero life and neonatal) period to puberty, can be "imprinted" in the organism, thereby impacting the health and risk of chronic diseases later in life. Pregnancy is a succession of events that is regulated, in large part, by hormones and growth factors. Therefore, small changes in hormonal balance can have important effects on both the mother and the developing fetus. An increasing number of studies demonstrate that exposure to endocrine disrupting compounds (EDCs) affect both the mother and the fetus giving rise to growing concerns surrounding these exposures. This review will give an overview of changes that happen during pregnancy with respect to the mother, the placenta, and the fetus, and of the current literature regarding the effects of EDCs during this specific sensitive window of exposure.
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Affiliation(s)
- Isabelle Plante
- INRS-Centre Armand-Frappier Santé Biotechnologie, Laval, QC, Canada.
| | - Louise M Winn
- Queen's University, School of Environmental Studies, Department of Biomedical and Molecular Sciences, Kingston, ON, Canada
| | | | - Petya Grigorova
- Département Science et Technologie, Université TELUQ, Montreal, QC, Canada
| | - Lise Parent
- Département Science et Technologie, Université TELUQ, Montreal, QC, Canada
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19
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Allan-Blitz LT, Goldfine C, Erickson TB. Environmental and health risks posed to children by artisanal gold mining: A systematic review. SAGE Open Med 2022; 10:20503121221076934. [PMID: 35173966 PMCID: PMC8841918 DOI: 10.1177/20503121221076934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
There are an estimated 5 million children working in artisanal and small-scale gold mines worldwide; however, the hazards are poorly characterized and often underreported. We systematically reviewed the literature on reports of hazards among children as a consequence of such activities through PubMed database using pre-defined search terms. We identified 113 articles published between 1984 and 2021 from 31 countries. Toxicological hazards were reported in 91 articles, including mercury, lead, and arsenic. Infectious hazards, noted in 18 articles, included malaria, cholera, and hepatitis. Six articles reported occupational hazards, including malnutrition, heat stroke, and reactive airway disease. Three articles reported traumatic hazards, including cave-ins, burns, animal attacks, falls, and weapon-inflected wounds. Those findings likely indicate a profound underreporting of the prevalence and consequences of such hazards among children. More work is needed both to characterize the burdens of those hazards and to address the underlying drivers of child labor in those settings.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Charlotte Goldfine
- Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
| | - Timothy B Erickson
- Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
- Harvard Humanitarian Institute, Cambridge, MA, USA
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Kim HK, Jeong GH. Effect of Pro-Environmental Prenatal Education Program on Pregnant Women’s Environmental Health Awareness and Behaviors based on the Protection Motivation Theory. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211047045. [PMID: 35227127 PMCID: PMC8891827 DOI: 10.1177/00469580211047045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This study aimed to verify whether a pro-environmental prenatal education program has an effect on pregnant women’s environmental health awareness and behaviors in Korea. This quasi-experimental study employed a nonequivalent control group and nonsynchronized design based on the protection motivation theory as a theoretical framework. In total, 96 pregnant women had their data collected and analyzed in Korea (40 in the experimental group; and 56 in the control group). Data collection through self-reported questionnaire was conducted between September 2017 and August 2018. The program consisted of lectures and group activities aimed at educating participants on environmental awareness and behaviors. The data were analyzed using t-test, chi square test, and ANCOVA using SPSS 24.0 program. After the intervention, the experimental group showed significantly higher sensitivity (54.78 ± 9.47 and 49.75 ± 5.42; F = 15.13, P < .001), susceptibility (26.30 ± 5.18 and 24.28 ± 4.53; F = 53.94, P < .001), response efficacy (27.40 ± 3.40 and 25.18 ± 4.23; F = 39.42, P < .001), self-efficacy (22.43 ± 4.15 and 21.35 ± 4.25; F = 41.13, P < .001), individual environmental behavior (58.59 ± 12.25 and 51.93 ± 12.64; F = 172.75, P < .001), and communal environmental behavior (18.45 ± 9.68 and 13.13 ± 8.24; F = 126.26, P < .001) than the control group. The developed pro-environmental prenatal education program contained content on the environment and pregnancy, environmental toxin, effects of endocrine disruptors, airborne pollutants, water pollutant, soil pollutant, radio-electronic exposure, and pro-environmental health behaviors during pregnancy. Pregnant women who participated in the pro-environmental prenatal education program had positive changes in environmental health perceptions and behaviors. As environmental hazards continue to increase, pregnant women should receive effective motivational education on eco-environmental protection to increase their sensitivity to environmental risk factors and to encourage active environmental health behaviors.
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Preterm Labor, a Syndrome Attributed to the Combination of External and Internal Factors. MATERNAL-FETAL MEDICINE 2022. [DOI: 10.1097/fm9.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Wu Y, Wang J, Wei Y, Chen J, Kang L, Long C, Wu S, Shen L, Wei G. Maternal exposure to endocrine disrupting chemicals (EDCs) and preterm birth: A systematic review, meta-analysis, and meta-regression analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 292:118264. [PMID: 34606968 DOI: 10.1016/j.envpol.2021.118264] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 05/15/2023]
Abstract
Preterm birth is the second most common cause of death in children under 5 years of age. The etiology of preterm birth has not yet been elucidated. Although maternal exposure to endocrine disrupting chemicals (EDCs) may increase the risk for preterm birth, associations have not been confirmed. We performed a meta-analysis to elucidate the relationships between maternal exposure to EDCs and preterm birth. A systematic search of PubMed, Ovid-EMBASE, and the Cochrane Library (CENTRAL) for relevant published studies providing quantitative data on the association between maternal EDC exposure and preterm birth in humans was conducted in July 2021. To calculate the overall estimates, we pooled the adjusted regression coefficients with 95% confidence intervals (CIs) from each study by the inverse variance method. A total of 59 studies were included. The pooled results indicated that maternal exposure to metals (OR, 1.23; 95% CI, 1.17 to 1.29) and phthalates (OR, 1.31; 95% CI, 1.21 to 1.42) was related to an increased risk for preterm birth. Specifically, maternal exposure to lead, cadmium, chromium, copper and manganese appeared to be correlated with an elevated risk for preterm birth. Additionally, maternal exposure to monoethyl phthalate (MEP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), monobenzyl phthalate (MBzP), and di (2-ethylhexyl) phthalate (DEHP) was also associated with preterm birth. In conclusion, maternal exposure to metals and phthalates may increase the risk for preterm birth based on current evidence.
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Affiliation(s)
- Yuhao Wu
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Junke Wang
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Yuexin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Jiadong Chen
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Lian Kang
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Chunlan Long
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Lianju Shen
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.
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Rakete S, Moonga G, Wahl AM, Mambrey V, Shoko D, Moyo D, Muteti-Fana S, Tobollik M, Steckling-Muschack N, Bose-O'Reilly S. Biomonitoring of arsenic, cadmium and lead in two artisanal and small-scale gold mining areas in Zimbabwe. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4762-4768. [PMID: 34409536 PMCID: PMC8741681 DOI: 10.1007/s11356-021-15940-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
People living and working in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to elemental mercury (Hg), which is used for gold extraction. However, additional exposure to other toxic metals such as arsenic (As), cadmium (Cd) and lead (Pb) may result from mining-related activities and could be ingested via dust, water or food. In these areas, only limited biomonitoring data is available for toxic metals other than Hg. In particular, data about the exposure to As, Cd and Pb is unavailable for the Zimbabwean population. Therefore, we conducted a cross-sectional study in two ASGM areas in Zimbabwe to evaluate the internal exposure to these metals. In total, urine and blood samples from 207 people that identified themselves as miners were collected and analysed for As and Cd in urine as well as Pb in blood by GF-AAS. Median levels (interquartile ranges in μg/l) of As and Pb were 9.7 μg/l (4.0, 18.5) and 19.7 μg/l (12.5, 34.5), respectively. The 25th percentile and the median for Cd were below the limit of detection (0.5 μg/l); the 75th percentile was at 0.9 μg/l. The results were compared to reference values found for the general population in the USA and Germany, and a significant number of participants exceeded these values (As, 33 %; Cd, 27 %; Pb, 32 %), indicating a relevant exposure to toxic metals. Although not representative for the Zimbabwean population, our results demonstrate that the exposure to toxic metals is relevant for the public health in Zimbabwe and requires further investigation.
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Affiliation(s)
- Stefan Rakete
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany.
| | - Given Moonga
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
- Center for International Health, LMU University Hospital Munich, Munich, Germany
- Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Anna-Maria Wahl
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Viola Mambrey
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | | | - Dingani Moyo
- School of Public Health, Faculty of Health Sciences, Occupational Health Division, University of the Witwatersrand, Johannesburg, Republic of South Africa
- Faculty of Medicine & Faculty of Social Sciences, Midlands State University, Gweru, Zimbabwe
| | - Shamiso Muteti-Fana
- Department of Community Medicine, UZ College of Health Sciences, Harare, Zimbabwe
| | - Myriam Tobollik
- Section Environmental Medicine and Health Effects Assessment German Environment Agency, Berlin, Germany
| | - Nadine Steckling-Muschack
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Hall in Tirol, Austria
- University Children's Hospital Regensburg (KUNO-Clinics), Clinic St. Hedwig, University of Regensburg, Regensburg, Germany
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An H, Wang B, Li Z, Jin Y, Ren M, Yu Y, Zhang Y, Zhang L, Yan L, Li Z, Ren A, Ye R, Li K. Distribution of mercury in serum and blood cells and risk of spontaneous preterm birth: A nested case-control study in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 217:112228. [PMID: 33892343 DOI: 10.1016/j.ecoenv.2021.112228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
The relationship between maternal mercury (Hg) intake and the risk of spontaneous preterm birth (SPB) remains unclear. We conducted a nested case-control study from a prospective cohort in Shanxi Province, China, to explore their associations. In total, 126 pregnant women with SPB (cases) and 348 controls with term delivery were included. We measured the Hg concentrations in their serum (Hgs) and blood cell (Hgc) fractions and calculated the concentration ratio of Hg in serum to Hg in blood cells (Hgs/c). We found that only the Hgs/c in the case group was slightly higher than that in control group. The OR of Hgs/c associated with SPB risk was 1.57 [95%CI: 0.99-2.46] with adjusting confounders. After stratification by sampling time, the association above was only statistically significant in the first trimester. High Hgs/c may increase the risk of SPB in the first trimester among women with relatively low Hg exposure.
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Affiliation(s)
- Hang An
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Bin Wang
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Zhiyi Li
- Institute of Geographic Sciences and Natural Resources Research, CAS, Beijing 100101, PR China
| | - Yu Jin
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Mengyuan Ren
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Yanxin Yu
- School of Environment, Beijing Normal University, Beijing 100875, PR China
| | - Yali Zhang
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Le Zhang
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Lailai Yan
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, PR China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Aiguo Ren
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Rongwei Ye
- Institute of Reproductive and Child Health, Peking University, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China.
| | - Kexin Li
- Institute of Geographic Sciences and Natural Resources Research, CAS, Beijing 100101, PR China.
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Dórea JG. Neurodevelopment and exposure to neurotoxic metal(loid)s in environments polluted by mining, metal scrapping and smelters, and e-waste recycling in low and middle-income countries. ENVIRONMENTAL RESEARCH 2021; 197:111124. [PMID: 33861977 DOI: 10.1016/j.envres.2021.111124] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
This review covers a wide body of literature to gain an understanding of the impacts of informal activities related to metal extraction (primary mining and recycling) on early life exposure to neurotoxicants and on neurodevelopment. In primary mining, gold extraction with Hg amalgamation is the main environmental cause of Hg pollution in most artisanal small-scale gold mining (ASGM) activities around the world. Nevertheless, in Sub-Saharan Africa (SSA), Pb disrupted from gold-related ores, mining, and artisanal cookware production are an important neurotoxicant that seriously contaminates the affected population, with devastating effects on children. In e-waste recycling settings, the range of neurotoxic substances that contaminate mothers and children is wider than in primary mining environments. Thus, Hg and Pb are major pre- and postnatal neurotoxicants affecting children in the informal metal extraction activities and SSA countries show the highest record of human contamination and of neurotoxic effects on children. There are additional sources of neurotoxic contamination from mining and metal processing activities (cyanide tailing in South America and SSA) and/or co-exposure to Hg-containing products such as cosmetics (soaps and Hg-based skin lightning creams in Africa) and pediatric Thimerosal-containing vaccines (TCVs, that breaks down to ethyl-mercury) in current use in middle and low income countries. However, the action of these neurotoxicants (per se or in combination) on children needs more attention and research. Studies show a negative association between biomarkers of all environmental metal(loid)s (As, Cd, Hg, Mn, and Pb) studied and neurodevelopment in young children. Sadly, in many unregulated activities, child labor is widely employed, thus presenting an additional occupational exposure. Children living in polluted environments related to metal processing are disproportionately exposed to a wide range of co-occurring neurotoxic substances. The review showed compelling evidence from highly representative parts of the world (Africa, Asia, and Latin America) that the studied neurotoxic substances negatively affected areas of the brain associated with language, memory and executive function, as well as psychosocial behavior. Protecting the environment and children from unregulated and highly polluting metal extraction and processing are inextricably intertwined and deserve urgent attention.
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Affiliation(s)
- José G Dórea
- Universidade de Brasília, Brasília, 70919-970, DF, Brazil.
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Nyanza EC, Bernier FP, Martin JW, Manyama M, Hatfield J, Dewey D. Effects of prenatal exposure and co-exposure to metallic or metalloid elements on early infant neurodevelopmental outcomes in areas with small-scale gold mining activities in Northern Tanzania. ENVIRONMENT INTERNATIONAL 2021; 149:106104. [PMID: 32948351 DOI: 10.1016/j.envint.2020.106104] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Artisanal and small-scale gold mining (ASGM) is associated with release of neurotoxic metallic or metalloid chemical elements including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As). OBJECTIVE To examine associations between prenatal exposure and co-exposure to total lead (T-Pb), total mercury (T-Hg), total cadmium (T-Cd) and total arsenic (T-As) and infant neurodevelopment at 6 to 12 months of age in areas with ASGM activities in Tanzania. METHODS Women in their second trimester of pregnancy who resided in ASGM areas were enrolled from 2015 to 2017 (n = 883). At 6 to 12 months of age, children were assessed with the Malawi Developmental Assessment Tool (MDAT) (n = 439). We measured T-Pb, T-Hg, and T-Cd in maternal dried blood spots and T-As in maternal urines. Poisson regression was used to examine associations between prenatal concentrations of these elements and neurodevelopmental outcomes. RESULTS Prenatal T-Hg concentration was associated with global neurodevelopment status (aPR 1.03, CI:1.01-1.04; p < 0.001) and language impairment (aPR 1.05, CI:1.03-1.07; p < 0.001) on the MDAT. When prenatal T-Hg and T-As values were at or above the human biomonitoring reference values (≥95%) of the German Environmental Survey for Human Biomonitoring, that is 0.80 µg/L and 15 µg/L, respectively, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p = 0.034). There was a 40% increase in the prevalence ratio of global neurodevelopmental impairment (aPR 1.4, CI:0.90-2.10, p = 0.027), when prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-Pb was at or above the reference value of 35 µg/L. When prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-As was at or above the reference value of 15 µg/L, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p < 0.034). DISCUSSION Infants born to women in areas with ASGM activities are at significant risk for neurodevelopmental impairment and this is associated with exposure to higher concentrations of Hg prenatally. Co-exposure to high concentrations of Hg and Pb, or Hg and As appeared to have negative potentiated effects on infants' neurodevelopment.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania
| | - Francois P Bernier
- Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Science, Stockholm University, 106 91 Stockholm, Sweden; Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada; Owerko Centre, #397 Child Development Centre, University of Calgary, 2500 University Dr. NW Calgary, AB T2N 1N4, Canada.
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Cossa H, Scheidegger R, Leuenberger A, Ammann P, Munguambe K, Utzinger J, Macete E, Winkler MS. Health Studies in the Context of Artisanal and Small-Scale Mining: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1555. [PMID: 33562086 PMCID: PMC7914471 DOI: 10.3390/ijerph18041555] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
Artisanal and small-scale mining (ASM) is an important livelihood activity in many low- and middle-income countries. It is widely acknowledged that there are a myriad of health risk and opportunities associated with ASM. However, little is known with regard to which aspects of health have been studied in ASM settings. We conducted a scoping review of peer-reviewed publications, using readily available electronic databases (i.e., PubMed, Scopus, and Web of Science) from inception to 14 July 2020. Relevant information was synthesized with an emphasis on human and environmental exposures and health effects in a context of ASM. Our search yielded 2764 records. After systematic screening, 176 health studies from 38 countries were retained for final analysis. Most of the studies (n = 155) focused on health in ASM extracting gold. While many of the studies included the collection of environmental and human samples (n = 154), only few (n = 30) investigated infectious diseases. Little attention was given to vulnerable groups, such as women of reproductive age and children. Our scoping review provides a detailed characterisation of health studies in ASM contexts. Future research in ASM settings should address health more comprehensively, including the potential spread of infectious diseases, and effects on mental health and well-being.
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Affiliation(s)
- Hermínio Cossa
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (A.L.); (P.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Manhiça Health Research Centre, C.P. 1929 Maputo, Mozambique; (K.M.); (E.M.)
| | - Rahel Scheidegger
- Swiss Federal Institute of Technology, P.O. Box, CH-8092 Zurich, Switzerland;
| | - Andrea Leuenberger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (A.L.); (P.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Priska Ammann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (A.L.); (P.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Khátia Munguambe
- Manhiça Health Research Centre, C.P. 1929 Maputo, Mozambique; (K.M.); (E.M.)
- Faculty of Medicine, University Eduardo Mondlane, C.P. 257 Maputo, Mozambique
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (A.L.); (P.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Eusébio Macete
- Manhiça Health Research Centre, C.P. 1929 Maputo, Mozambique; (K.M.); (E.M.)
- National Directorate of Public Health, Ministry of Health, C.P. 264 Maputo, Mozambique
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (A.L.); (P.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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Liang C, Han Y, Ma L, Wu X, Huang K, Yan S, Li Z, Xia X, Pan W, Sheng J, Wang Q, Tong S, Cao Y, Tao F. Low levels of arsenic exposure during pregnancy and maternal and neonatal thyroid hormone parameters: The determinants for these associations. ENVIRONMENT INTERNATIONAL 2020; 145:106114. [PMID: 33035893 DOI: 10.1016/j.envint.2020.106114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The potential maternal and neonatal thyrotoxicity associated with exposure to arsenic during pregnancy is very limited and unclear. OBJECTIVES This study aimed to examine the associations between arsenic exposure levels in maternal and cord serum and maternal and neonatal thyroid hormone parameters in a prospective birth cohort study. METHODS The study including 2089 mother-neonate pairs was based upon Ma'an Shan birth cohort study in China. The exposure variables including maternal serum arsenic levels in the first, second and third trimester and average arsenic exposure level during pregnancy and cord serum arsenic level. Maternal serum TSH and FT4 levels in the first, second and third trimester and cord serum TSH and FT4 levels were determined using the electrochemiluminescence immunoassay with Cobas Elecsys 411. Linear mixed models were used to examine associations between arsenic exposure variables during pregnancy and maternal thyroid hormone parameters, and multiple linear regression analyses were used to examine associations between arsenic exposure during pregnancy and neonatal thyroid hormone parameters. Bayesian kernal machine regression (BKMR) analyses based on a kernel function were also used to examine the effects of exposure to metal mixtures (arsenic, mercury, cadmium and selenium). RESULTS The geometric means of arsenic exposure levels across 3 trimesters were 1.74 μg/L, 1.81 μg/L and 1.99 μg/L, respectively, and 1.90 μg/L in cord serum; the geometric means of maternal FT4 levels across 3 trimesters were 16.91 pmol/L, 11.91 pmol/L and 13.16 pmol/L, respectively, and 16.10 pmol/L in cord serum; the geometric means of maternal TSH levels across 3 trimesters were 1.27 μIU/mL, 2.32 μIU/mL and 2.08 μIU/mL, respectively, and 8.47 μIU/mL in cord serum. Maternal serum arsenic levels in the first, seond, third trimester and average arsenic exposure level during pregnancy were all not associated with maternal thyroid hormone parameters after adjustment for all the covariates, the adjusted β (95% CI) were -0.002 (-0.10 to 0.09), 0.05 (-0.05 to 0.16), -0.09 (-0.17 to 0.003) and -0.05 (-0.22 to 0.11) for maternal FT4, respectively; and -0.005 (-0.04 to 0.03), -0.003 (-0.04 to 0.03), -0.004 (-0.03 to 0.02) and -0.01 (-0.06 to 0.04) for maternal lnTSH, respectively. Maternal serum arsenic levels in the first, second trimester and average arsenic exposure level during pregnancy were all inversely associated with neonatal FT4 level after adjustment for all the confounders, the adjusted β (95% CI) were -0.19 (-0.31 to -0.07), -0.14 (-0.26 to -0.01), -0.22 (-0.42 to -0.02), respectively; and cord serum arsenic level was positively related with neonatal TSH level, the adjusted β (95% CI) were 0.04 (0.001 to 0.08). The adverse joint toxic effect of the four metals in maternal serum in the first trimester and in cord serum on neonatal thyroid hormone parameters were also found. CONCLUSIONS In this study, exposure to low levels of arsenic during pregnancy could directly affect neonatal thyroid hormone parameters without being mediated by maternal effect of exposure, and maternal serum arsenic levels in the first, second trimester and average arsenic exposure level during pregnancy and cord serum arsenic level may be risk factors affecting neonatal thyroid hormones. These findings indicate that neonates are more sensitive to the thyrotoxicity of arsenic exposure even at low levels. In addition, the adverse joint toxic effect of metal mixtures is also worthy of attention.
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Affiliation(s)
- Chunmei Liang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yan Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Liya Ma
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Healthcare (MCH) Center, Ma'anshan 243011, China
| | - Zhijuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xun Xia
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Weijun Pan
- Ma'anshan Maternal and Child Healthcare (MCH) Center, Ma'anshan 243011, China
| | - Jie Sheng
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Qunan Wang
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shilu Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Yunxia Cao
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
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First report of successful management of acute promyelocytic leukemia in a pregnant female with All-Trans-Retinoic Acid and Arsenic Trioxide-based induction regimen. Blood Cells Mol Dis 2020; 85:102476. [PMID: 32688220 DOI: 10.1016/j.bcmd.2020.102476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022]
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