Effect of maternal manganese blood levels on erythrocyte calcium-pump activity in newborns

Appraisal of groundwater arsenic on opposite banks of River Ganges, West Bengal, India, and quantification of cancer risk using Monte Carlo simulations

This study was conducted to inspect the spatial distribution, source identification, and risk assessment of groundwater arsenic (As) in different blocks that lie on the opposite banks of river Bhagirathi (a distributary of river Ganges), Murshidabad, West Bengal, India. It has been observed that the blocks that lie towards the eastern bank of river Bhagirathi have elevated arsenic and comparatively more reducing groundwater (lower oxidation-reduction potential and high iron). About 66% of groundwater samples across the district have arsenic concentration higher than the World Health Organization (WHO) permissible limit. Speciation of groundwater arsenic reveals that about 90% of arsenic species were present as arsenic (III). Further, principal component analysis (PCA) was employed to identify the controlling factors that favor the release of arsenic. PC1 comprises EC, TDS, As, Fe, TOC, and HCO₃^- with moderate loadings, which suggests microbially mediated degradation of organic matter (OM), helps in reductive dissolution of arsenic-bearing Fe-Mn oxyhydroxides. Results pointed out severe groundwater arsenic poisoning; hence, a health risk assessment was performed for the exposure of arsenic in groundwater, using incremental lifetime cancer risk (ILCR) models coupled with Monte Carlo simulations. On the eastern bank of river Bhagirathi, incremental lifetime cancer risk (ILCR) due to oral exposure (5th to 95th percentile values) ranged from 1.30538E - 04 to 9.31398E - 03 with a mean of 2.84194E - 03 for adults, which is 2841 times higher than the USEPA high safety risk guidelines of one in 1 million. The outcomes of the results will be useful for the policymakers and regulatory boards in defining the actual impact and deciding the pre-remediation goals.

Status of Oxidative Stress during Low-Risk Labour: Preliminary Data

Pregnancy and childbirth are associated with the forming of reactive oxygen species that generate oxidative stress. Oxidative stress is a factor that may adversely affect the development of the fetus and the course of labour. Monitoring the parameters of oxidative stress can be used to assess the risk of health issues in the course of pregnancy and the condition of the newborn. Therefore, the analysis of oxidative stress in the physiological course of labour is the basis for understanding the role of oxidative stress in the pathogenesis of miscarriages and neonatal health circumstances. The study aimed to assess oxidative stress of mother-child pairs in the venous blood and umbilical cord blood at the time of physiological labour. One hundred and sixty-eight mother-child pairs were recruited to donate the mother’s venous blood in the first stage of labour and the venous umbilical cord blood after the newborn’s birth. Total antioxidant status (TAS), the activity of superoxide dismutase (SOD) with cofactors (Zn, Cu, Mn) and the activity of glutathione peroxidase (GPx) were analysed in venous blood plasma and umbilical cord blood. TAS value (p = 0.034), GPx activity (p < 0.001) and Zn concentration (p = 0.007) were significantly lower in maternal blood plasma as compared to neonatal umbilical cord blood. However, the activity of SOD (p = 0.013) and the concentration of Cu (p < 0.001) were significantly higher in the blood of mothers than of new-borns. The concentration of Mn in the plasma of the mother’s blood and the umbilical cord blood of the newborns was similar. Our research indicates higher levels of antioxidant enzyme (GPx) and total antioxidant potential (TAS) in umbilical cord blood compared to maternal blood, which may suggest depletion of redox reserves in women’s blood during labour.

Environmental Exposures in the Etiology of Abortion: Placental Toxic and Trace Element Levels

PURPOSE

Intensive research has been conducted on the effects of toxic and trace elements on pregnancy. Previous studies indicated a possible relationship between placental levels of these elements and first-trimester abortion; however, their effects on the further gestational weeks are not clear. This study aimed to investigate the effect of changes in the levels of placental trace and toxic elements on second-trimester abortion.

METHODS

The patient group consisted of 30 women with missed abortion. The control group comprised 60 healthy term and singleton pregnant women who gave birth. Placental samples were obtained from the patients and the healthy controls, and the concentrations of placental elements were measured using inductively coupled plasma mass spectrometry.

RESULTS

In the abortion group, placental arsenic, cadmium, mercury, lead, antimony, tin, cobalt, manganese, and selenium levels were significantly higher than those of the control group (p<0.05). Antimony was determined as an independent predictor with an odds ratio of 6.1 in toxic elements (p=0.025), and selenium was determined as an independent predictor with an odds ratio of 2.3 in trace elements (p=0.015).

CONCLUSION

The changes in trace element and toxic element levels, especially an increase in antimony and selenium, in placental tissue due to environmental exposure may play an important role in second-trimester abortion.

Association between blood manganese level during pregnancy and birth size: The Japan environment and children's study (JECS)

BACKGROUND

Manganese (Mn) is both an essential element and a potential toxicant. Although a few studies have suggested a nonlinear relationship between the maternal whole blood Mn level at delivery and infant birth weight, little is known about the effects of Mn levels during pregnancy on fetal growth, particularly with regard to sex-specific differences.

METHODS

In this nationwide birth cohort study, we examined the association of maternal blood Mn level during pregnancy with infant birth weight, length, and head circumference in 16,473 mother-infant pairs. Pregnant women living in 15 regions across Japan were recruited between January 2011 and March 2014. The analysis of birth size (8,484 males and 7,989 females) was conducted using a nonlinear spline, followed by the use of quadratic regression or linear regression models. The analysis of small-for-gestational-age (SGA) (6,962 males and 6,528 females born vaginally) was conducted using multivariate logistic regression. Additionally, subgroup analysis was conducted according to the timing of blood sampling.

RESULTS

The median maternal blood Mn level during pregnancy (i.e., 2nd and 3rd trimesters) was 16.2 µg/L (range, 4.3-44.5 µg/L). A positive linear association between the log blood Mn level and head circumference was observed in both male and female infants. However, a nonlinear relationship between the log blood Mn level and birth weight was observed only in male infants, such that the birth weight increased up to a blood Mn level of 18.6 µg/L. In the subgroup analysis stratified by the timing of maternal blood sampling, this nonlinear relationship was obvious only when sampling was performed in the 3rd trimester. Male infants in the lowest blood Mn level quartile (≤ 13.2 µg/L) faced an increased risk of SGA (odds ratio [95% confidence interval] = 1.35 [1.04-1.74]), as did those in the highest blood Mn level quartile (≥ 21.0 µg/L) when sampling was performed during the 3rd trimester (odds ratio [95% confidence interval] = 1.62 [1.10 to 2.39]), compared to those in the third blood Mn level quartile (the category including 18.6 µg/L). No association of blood Mn level with birth weight was observed among female infants, and blood Mn level was not associated with birth length in either male or female infants.

CONCLUSION

A low blood Mn level during pregnancy or a high blood Mn level during the 3rd trimester was associated with a lower birth weight and increased risk of SGA in male infants, but not in female infants. A low blood Mn level was found to correlate slightly with a small head circumference among infants of both sexes.

Manganese Toxicity Upon Overexposure: a Decade in Review

Exposure to manganese (Mn) causes clinical signs and symptoms resembling, but not identical to, Parkinson's disease. Since our last review on this subject in 2004, the past decade has been a thriving period in the history of Mn research. This report provides a comprehensive review on new knowledge gained in the Mn research field. Emerging data suggest that beyond traditionally recognized occupational manganism, Mn exposures and the ensuing toxicities occur in a variety of environmental settings, nutritional sources, contaminated foods, infant formulas, and water, soil, and air with natural or man-made contaminations. Upon fast absorption into the body via oral and inhalation exposures, Mn has a relatively short half-life in blood, yet fairly long half-lives in tissues. Recent data suggest Mn accumulates substantially in bone, with a half-life of about 8-9 years expected in human bones. Mn toxicity has been associated with dopaminergic dysfunction by recent neurochemical analyses and synchrotron X-ray fluorescent imaging studies. Evidence from humans indicates that individual factors such as age, gender, ethnicity, genetics, and pre-existing medical conditions can have profound impacts on Mn toxicities. In addition to body fluid-based biomarkers, new approaches in searching biomarkers of Mn exposure include Mn levels in toenails, non-invasive measurement of Mn in bone, and functional alteration assessments. Comments and recommendations are also provided with regard to the diagnosis of Mn intoxication and clinical intervention. Finally, several hot and promising research areas in the next decade are discussed.

Urgent need to reevaluate the latest World Health Organization guidelines for toxic inorganic substances in drinking water

The World Health Organization (WHO) has established guidelines for drinking-water quality that cover biological and chemical hazards from both natural and anthropogenic sources. In the most recent edition of Guidelines for Drinking-water Quality (2011), the WHO withdrew, suspended, did not establish, or raised guidelines for the inorganic toxic substances manganese, molybdenum, nitrite, aluminum, boron, nickel, uranium, mercury, and selenium. In this paper, we review these changes to the WHO drinking-water guidelines, examining in detail the material presented in the WHO background documents for each of these toxic substances. In some cases, these WHO background documents use literature reviews that do not take into account scientific research published within the last 10 or more years. In addition, there are instances in which standard WHO practices for deriving guidelines are not used; for example, rounding and other mathematical errors are made. According to published meeting reports from the WHO Chemical Aspects Working Group, the WHO has a timetable for revising some of its guidelines for drinking-water quality, but for many of these toxic substances the planned changes are minimal or will be delayed for as long as 5 years. Given the limited nature of the planned WHO revisions to the inorganic toxic substances and the extended timetable for these revisions, we suggest that governments, researchers, and other stakeholders might establish independent recommendations for inorganic toxic substances and possibly other chemicals to proactively protect public health, or at the very least, revert to previous editions of the Guidelines for Drinking-water Quality, which were more protective of public health.

Biomarkers of manganese exposure in pregnant women and children living in an agricultural community in California

Manganese (Mn) is an essential nutrient but at high exposure levels is a neurotoxicant. There is no well-validated biomarker to assess perinatal Mn exposure. A total of 75 mother-child pairs provided blood, urine, and/or deciduous tooth samples. We analyzed Mn in dentin and enamel of shed teeth; maternal, cord, and child blood; and maternal and child urine and examined the interrelationships of Mn levels in all matrices. We observed higher Mn levels in prenatal than postnatal dentin (geometric mean (GM) = 0.51 vs 0.16 Mn:Ca, p < 0.001), maternal blood at delivery than 26 weeks gestation (GM = 20.7 vs. 14.6 μg/L, p = 0.001), and cord blood than child blood at 24 months of age (39.9 vs 25.0 μg/L, p = 0.005). There were no significant correlations between Mn in dentin and Mn concentrations in maternal blood or maternal or child urine. Levels of Mn in prenatal dentin, prenatal maternal blood, and 24 month urine were higher (p < 0.05) among mothers and children living with a farm worker. Prenatal Mn levels in dentin were correlated with Mn loadings and concentrations in prenatal house dust. Levels of Mn measured in tooth dentin constitute a promising biomarker of perinatal exposure.

Elevated arsenic and manganese in groundwaters of Murshidabad, West Bengal, India

High levels of geogenic arsenic (As) and manganese (Mn) in drinking water has led to widespread health problems for the population of West Bengal, India. Here we delineate the extent of occurrences of As and Mn in Murshidabad, where the contaminated aquifers occur at shallow depths between 35 and 40 m and where access to safe drinking water is a critical issue for the local population. A total of 78 well-water samples were taken in 4 blocks on either side of the river Bhagirathi: Nabagram and Kandi (west, Pleistocene sediments), Hariharpara and Beldanga (east, Holocene sediments). High As, total iron (FeT) and low Mn concentrations were found in waters from the Holocene gray sediment aquifers east of the river Bhagirathi, while the opposite was found in the Pleistocene reddish-brown aquifer west of the river Bhagirathi in Murshidabad. Speciation of As in water samples from Holocene sediments revealed the dominant species to be As(III), with ratios of As(III):AsT ranging from 0.55 to 0.98 (average 0.74). There were indications from saturation index estimations that Mn solubility is limited by the precipitation of MnCO3. Tubewells from high As areas in proximity to anthropogenic waste influx sources showing high molar Cl/Br ratios, low SO4(2-) and low NO3(-) demonstrate relatively lower As concentrations, thereby reducing As pollution in those wells. Analyses of core samples (2 in each of the blocks) drilled to a depth of 45 m indicate that there is no significant variation in bulk As (5-20mg/kg) between the Holocene and Pleistocene sediments, indicating that favorable subsurface redox conditions conducive to mobilization are responsible for the release of As. The same applies to Mn, but concentrations vary more widely (20-2000 mg/kg). Sequential extraction of Holocene sediments showed As to be associated with 'specifically sorbed-phosphate-extractable' phases (10-15%) and with 'amorphous and well crystalline Fe-oxyhydroxide' phases (around 37%) at As-contaminated well depths, suggesting that the main As release mechanisms could be either competitive ion exchange with PO4(3-), or the dissolution of Fe oxyhydroxides. In the Pleistocene sediments Mn is predominantly found in the easily exchangeable fraction.

Manganese concentrations in maternal-infant blood and birth weight

Manganese (Mn) is an essential mineral nutrient in mammals. The physiological role of Mn in animal models is well documented, but little is known about the adverse effects of Mn deficiency or overexposure in humans, including pregnancy outcomes such as birth weight. We examined the relationship of the maternal and cord blood Mn levels with birth weight in a cohort of 172 mother-infant pairs born in Shanghai, China. Non-linear spline and quadratic regression models were used to test the hypothesis of an inverted U-shaped association between the Mn levels and birth weight. The median (range) levels of Mn in the maternal and cord blood were 5.38 (2.34-30.37) μg/dL and 7.66 (2.57-34.23) μg/dL, respectively. An inverted U-shaped relationship was observed between maternal Mn and birth weight after adjusting for potential confounders. The birth weight increased with Mn levels up to 4.18 μg/dL, and a slight reduction in weight was observed at higher levels. The cord blood Mn levels were not found to be associated with birth weight. Both lower and higher Mn exposures are associated with lower birth weight, which may influence important developmental parameters; the association of higher Mn levels with lower weight was weak and imprecise.

Relationships of chemical concentrations in maternal and cord blood: a review of available data

The developing fetus is likely to be exposed to the same environmental chemicals as the mother during critical periods of growth and development. The degree of maternal-fetal transfer of chemical compounds will be affected by chemical and physical properties such as lipophilicity, protein binding, and active transport mechanisms that influence absorption and distribution in maternal tissues. However, these transfer processes are not fully understood for most environmental chemicals. This review summarizes reported data from more than 100 studies on the ratios of cord:maternal blood concentrations for a range of chemicals including brominated flame-retardant compounds, polychlorinated biphenyls (PCB), polychlorinated dibenzodioxins and dibenzofurans, organochlorine pesticides, perfluorinated compounds, polyaromatic hydrocarbons, metals, and tobacco smoke components. The studies for the chemical classes represented suggest that chemicals frequently detected in maternal blood will also be detectable in cord blood. For most chemical classes, cord blood concentrations were found to be similar to or lower than those in maternal blood, with reported cord:maternal ratios generally between 0.1 and 1. Exceptions were observed for selected brominated flame-retardant compounds, polyaromatic hydrocarbons, and some metals, for which reported ratios were consistently greater than 1. Careful interpretation of the data in a risk assessment context is required because measured concentrations of environmental chemicals in cord blood (and thus the fetus) do not necessarily imply adverse effects or risk. Guidelines and recommendations for future cord:maternal blood biomonitoring studies are discussed.

Human health risk assessment of dissolved metals in groundwater and surface waters in the Melen watershed, Turkey

Determination of metal risk levels in potable water and their effects on human health are vital in assessment of water resources. Risk assessment of metals to human health in a watershed, which has not been studied before, is the main objective of the present study. Surface and groundwater sampling was carried out between September 2010 and August 2011 in the Melen Watershed, Turkey, an important drinking water resource for millions of people. Metals were analyzed in the laboratory using inductively coupled plasma. Of the 26 different metals monitored, Al, B, Ba, Cr, Cu, Fe, Mn, Mo and V were found in surface water and As, B, Ba, Cr, Cu, Mn, Mo, V and Zn in groundwater. In groundwater, unitless hazard quotient (HQ) values were 6 for As, 2.7 for Mn and 1 for Zn, while in surface water all metals were below the risk level (HQ < 1). The ingestion risk was found to be higher than the dermal uptake risk. Arsenic mean concentration was observed to be 0.044 mg/L in groundwater. The As carcinogenic risk (CR) value was higher than the internationally accepted risk level (10(-4)) and with maximum ingestion of groundwater the carcinogenic risk was found to be higher in adults than children. These results show that even unpolluted watersheds can pose a risk to human health and that potential carcinogenic impacts should receive more attention.

Elevated manganese concentrations in drinking water may be beneficial for fetal survival

BACKGROUND

Elevated exposure to the essential element manganese (Mn) can be toxic. Manganese concentrations in ground water vary considerably, and reported associations between Mn and early-life mortality and impaired development have raised concern. We assessed the effects of drinking water Mn exposure during pregnancy upon fetal and infant survival.

METHODS

In this population-based cohort study, we identified the outcomes of pregnancies registered between February 2002 and April 2003 in Matlab, Bangladesh. Using inductively coupled plasma mass spectrometry, we measured the concentrations of Mn and other elements in the pregnant women's drinking water.

RESULTS

A total of 1,875 women were included in the analysis of spontaneous abortions (n=158) and 1,887 women in the perinatal mortality analysis (n=70). Water Mn ranged from 3.0-6,550 µg/L (median=217 µg/L). The adjusted odds ratio (OR) for spontaneous abortion was 0.65 (95% CI 0.43-0.99) in the highest water Mn tertile (median=1,292 µg/L) as compared to the lowest tertile (median=56 µg/L). The corresponding OR for perinatal mortality was 0.69 (95% CI 0.28-1.71), which increased to 0.78 (95% CI 0.29-2.08) after adjustment for BMI and place of delivery (home/health facility; n=1,648).

CONCLUSIONS

Elevated water Mn concentrations during pregnancy appear protective for the fetus, particularly in undernourished women. This effect may be due to the element's role in antioxidant defense.

Maternal blood manganese levels and infant birth weight

BACKGROUND

Manganese is both an essential element and a known neurotoxicant to children. High manganese exposures have been associated with negative reproductive outcomes in animals, but few epidemiologic studies have examined the effects of human fetal manganese exposure.

METHODS

We studied the association between maternal and umbilical cord blood manganese levels and birth weight in a cohort of 470 mother-infant pairs born at term (>or=37 weeks gestation) in Ottawa County, Oklahoma. Nonlinear spline and quadratic regression models were used to test the hypothesis of an inverted U-shaped relationship between manganese levels and birth weight.

RESULTS

Mean (standard deviation) concentration of manganese was 2.4 (0.95) microg/dL in the maternal blood and 4.2 (1.6) microg/dL in the cord blood. Umbilical cord manganese was not associated with birth weight. A nonlinear relationship was observed between maternal manganese and birth weight after adjusting for potential confounders. Birth weight increased with manganese levels up to 3.1 microg/L, and then a slight reduction in weight was observed at higher levels. Compared with the 3.1-microg/L point of inflection, birth weight estimates at the 5th (1.3 microg/L) and 95th (4.0 microg/L) percentiles of exposure were -160 g (95% confidence interval = -286 to -33) and -46 g (-38 to 131), respectively.

CONCLUSIONS

Maternal blood manganese levels during pregnancy are associated with birth weight in a nonlinear pattern in full-term infants. These findings suggest that manganese may affect fetal growth. Possible detrimental effects of elevated manganese levels on the fetus should be further examined in more highly exposed populations.

Maternal and early life exposure to manganese in rural Bangladesh

Manganese exposure and biomarker concentrations during early pregnancy and lactation were investigated in 408 women living in an area with elevated concentrations of both arsenic and manganese in drinking water derived from wells. About 40% of the water samples had manganese concentrations above the World Health Organization's guideline value and showed a strong inverse correlation with arsenic concentrations. Water manganese was found to correlate to urine concentrations, but not to blood or breast milk concentrations. No correlations were found among manganese concentrations in urine, blood, or breast milk. Compared to other populations, manganese concentrations in both urine and blood, but not breast milk, were elevated in the Bangladeshi women and more similar to those of occupationally exposed groups. The lack of associations with water manganese is likely due to variable exposure via water and food, and differences in bioavailability, as well as a complex and/or strict regulation of intestinal manganese absorption, in turn being influenced by nutritional as well as physiological and genetic factors. The results indicate that elevated maternal manganese exposure does not necessarily lead to exposure of breast-fed infants, stressing the importance of breast feeding in high manganese areas. However, the implications of fetal exposurefrom elevated maternal exposure need further investigation.

Contamination of drinking water resources in the Mekong delta floodplains: arsenic and other trace metals pose serious health risks to population

This study presents a transnational groundwater survey of the 62,000 km(2) Mekong delta floodplain (Southern Vietnam and bordering Cambodia) and assesses human health risks associated with elevated concentrations of dissolved toxic elements. The lower Mekong delta generally features saline groundwater. However, where groundwater salinity is <1 g L(-)(1) Total Dissolved Solids (TDS), the rural population started exploiting shallow groundwater as drinking water in replacement of microbially contaminated surface water. In groundwater used as drinking water, arsenic concentrations ranged from 0.1-1340 microg L(-)(1), with 37% of the studied wells exceeding the WHO guidelines of 10 microg L(-)(1) arsenic. In addition, 50% exceeded the manganese WHO guideline of 0.4 mg L(-)(1), with concentrations being particularly high in Vietnam (range 1.0-34 mg L(-)(1)). Other elements of (minor) concern are Ba, Cd, Ni, Se, Pb and U. Our measurements imply that groundwater contamination is of geogenic origin and caused by natural anoxic conditions in the aquifers. Chronic arsenic poisoning is the most serious health risk for the ~2 million people drinking this groundwater without treatment, followed by malfunction in children's development through excessive manganese uptake. Government agencies, water specialists and scientists must get aware of the serious situation. Mitigation measures are urgently needed to protect the unaware people from such health problems.

Biomarkers of manganese exposure in a population living close to a mine and mineral processing plant in Mexico

Manganese (Mn) is considered an essential metal; nevertheless, excessive Mn exposure in humans is known to affect central nervous system. Mn access to its toxic target, the brain, is a complex phenomenon subject to physiological and physiopathological processes; in which, among others, the route of exposure plays an important role. Mn airborne exposure has gained interest both in occupational and environmental studies in order to understand the effects of low-level, long-term exposure. The objective of the present study was to describe the relationship between blood Mn and prolactin as marker of effect exposure, as well as other variables from subjects dwelling in a mining district in central Mexico environmentally exposed to the metal. This study was conducted on 230 volunteers; blood samples were obtained from cubital vein and hemoglobin, prolactin, lead (Pb), and Mn levels were measured. Non-parametrical Spearman's correlation showed statistical associations between blood and Mn levels and prolactin (rho=0.197), hemoglobin (rho= -0.213), age (rho= -0.186), and blood lead (rho= -0.167). Multiple regression analysis showed that blood Mn levels as an important factor to determine serum prolactin levels (beta=0.111, p=0.029) in a model corrected by gender and age. Results suggest that assessment of Mn exposure by biomarkers on general population is complex due to the variability and characteristics of the metal; however, specific subpopulations such as iron-deficient individuals are suspected to accumulate Mn in blood and thus they may be susceptible to the neurotoxic effects of Mn.

Arsenic and manganese contamination of drinking water resources in Cambodia: coincidence of risk areas with low relief topography

Arsenic contamination of groundwater has been identified in Cambodia, where some 100,000 family-based wells are used for drinking water needs. We conducted a comprehensive groundwater survey in the Mekong River floodplain, comprising an area of 3700 km(2) (131 samples, 30 parameters). Seasonal fluctuations were also studied. Arsenic ranged from 1 to 1340 microg L(-1) (average 163 microg L(-1)), with 48% exceeding 10 microg L(-1). Elevated manganese levels (57% >0.4 mg L(-1)) are posing an additional health threat to the 1.2 million people living in this area. With 350 people km(-2) potentially exposed to chronic arsenic poisoning, the magnitude is similar to that of Bangladesh (200 km(-2)). Elevated arsenic levels are sharply restricted to the Bassac and Mekong River banks and the alluvium braided by these rivers (Kandal Province). Arsenic in this province averaged 233 microg L(-1) (median 100 microg L(-1)), while concentrations to the west and east of the rivers were <10 microg L(-1). Arsenic release from Holocene sediments between the rivers is most likely caused by reductive dissolution of metal oxides. Regions exhibiting low and elevated arsenic levels are co-incident with the present low relief topography featuring gently increasing elevation to the west and east of a shallow valley-understood as a relict of pre-Holocene topography. The full georeferenced database of groundwater analysis is provided as Supporting Information.