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de Melo NC, Sampaio E Souza PC, Marques RC, Bernardi JVE, Bastos WR, Cunha MPL. Environmental exposure to metal(loid)s and hypertensive disorders of pregnancy: A systematic review. ENVIRONMENTAL RESEARCH 2024; 257:119391. [PMID: 38857855 DOI: 10.1016/j.envres.2024.119391] [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: 01/03/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Environmental exposure to metal(loid)s has been associated with adverse effects on human health, but the systemic repercussion of these elements on the development of hypertensive disorders of pregnancy (HDP) is still poorly understood. OBJECTIVE To summarize evidence published about the influence of environmental exposure to aluminum, arsenic, barium, cadmium, lead, strontium and mercury on the development of HDP. METHODS We conducted a systematic literature review according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search strategy was validated by the Peer Review of Electronic Search Strategies. We searched for articles published up to February 2023 in seven databases without language restriction. Two researchers conducted the steps for selection, data extraction and evaluation of the methodological quality of the instruments for epidemiological studies of the Joanna Briggs Institute. Any disagreements were resolved by a third researcher. RESULTS We obtained 5076 records, of which 37 articles met the inclusion criteria moderate to high methodological quality. Single exposure to metal(loid)s was predominant, and the leading biological matrix analyzed to detect the concentrations from exposure was maternal blood. Lead was the metal investigated the most, and had the largest number of studies showing positive association with HDP. In relation to the other metal(loid)s, higher levels were found in women with HDP in comparison with healthy women, but the finding of a cause-effect relationship was inconsistent. CONCLUSIONS Although we found evidence of harmful effects of the metal(loid)s studied on human health, the results were inconclusive with regard to HDP. Longitudinal studies that consider prospective investigation, adjustment of confounding factors and the interference of other contaminants in the exacerbation of oxidative stress in women from the preconception phase to the puerperal period should be encouraged.
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Affiliation(s)
- Nayra Carla de Melo
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil.
| | - Priscilla Cristovam Sampaio E Souza
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil
| | - Rejane Correa Marques
- Postgraduate Program in Environmental Sciences and Conservation, Federal University of Rio de Janeiro Janeiro (UFRJ), Macaé, Rio de Janeiro, 27965-045, Brazil
| | - José Vicente Elias Bernardi
- Geostatistics and Geodesy Laboratory, UnB Planaltina College, University of Brasília, Planaltina, Federal District, 73345-010, Brazil
| | - Wanderley Rodrigues Bastos
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil
| | - Mônica Pereira Lima Cunha
- Postgraduate Program in Regional Development and Environment, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76801-059, Brazil; WCP Environmental Biogeochemistry Laboratory, Federal University of Rondônia Foundation, Porto Velho, Rondônia, 76815-800, Brazil
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Khalaf EM, Taherian M, Almalki SG, Asban P, Kareem AK, Alhachami FR, Almulla AF, Romero-Parra RM, Jawhar ZH, Kiani F, Noroozi Manesh I, Mohammadi MJ. Relationship between exposure to heavy metals on the increased health risk and carcinogenicity of urinary tract (kidney and bladder). REVIEWS ON ENVIRONMENTAL HEALTH 2023:reveh-2022-0245. [PMID: 37076952 DOI: 10.1515/reveh-2022-0245] [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] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
In today's society, with the continuous development of manufacturing industries and factories related to chemicals, the amount of heavy metals in the inhaled air of humans, water and even food consumption has increased dramatically. The aim of this study was investigation of relationship between exposure to heavy metals on the increased carcinogenicity risk of kidney and bladder. Databases used to for searched were the Springer, Google Scholar, Web of Science, Science Direct (Scopus) and PubMed. At the end after sieve we selected 20 papers. Identify all relevant studies published 2000-2021. The results of this study showed that exposure to heavy metals due to the bio accumulative properties of these metals can cause kidney and bladder abnormalities and provide the basis through various mechanisms for malignant tumors in these organs. Based on result this study, since a limited number of heavy metals including copper, iron, zinc and nickel in very small amounts as micronutrients play a very important role in the function of enzymes and the body cells biological reactions, but exposure to some of them like arsenic, lead, vanadium and mercury will cause irreversible effects on people's health and cause various diseases including cancers of the liver, pancreas, prostate, breast, kidney and bladder. The kidneys, ureter and bladder are the most important organs in the urinary tract on human. According to the result of this study, the duty of this urinary system is to remove toxins, chemicals and heavy metals from the blood, balance electrolytes, excrete excess fluid, produce urine and transfer it to the bladder. This mechanism causes the kidneys and bladder to be highly associated with these toxins and heavy metals, which can lead to various diseases in these two important organs. According to the finding the reducing exposure to heavy metals in various ways can prevent many diseases related to this system and reduce the incidence of kidney and bladder cancers.
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Affiliation(s)
- Eman M Khalaf
- Department of Pharmacy, Al Maarif University College, Ramadi, Anbar, Iraq
| | - Masoume Taherian
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sami G Almalki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Parisa Asban
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A K Kareem
- Biomedical Engineering Department, Al-Mustaqbal University College, Hillah, Iraq
| | - Firas Rahi Alhachami
- Radiology Department, College of Health and Medical Technololgy, Al-Ayen University, Thi-Qar, Iraq
| | - Abbas F Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | | | - Zanko Hassan Jawhar
- Department of Medical Laboratory Science, College of Health Sciences, Lebanese French University, Erbil, Kurdistan Region, Iraq
| | - Fatemeh Kiani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Iman Noroozi Manesh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Borghese MM, Fisher M, Ashley-Martin J, Fraser WD, Trottier H, Lanphear B, Johnson M, Helewa M, Foster W, Walker M, Arbuckle TE. Individual, Independent, and Joint Associations of Toxic Metals and Manganese on Hypertensive Disorders of Pregnancy: Results from the MIREC Canadian Pregnancy Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47014. [PMID: 37079392 PMCID: PMC10117658 DOI: 10.1289/ehp10825] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Toxic metals, such as lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg), may be associated with a higher risk of gestational hypertension and preeclampsia, whereas manganese (Mn) is an essential metal that may be protective. OBJECTIVES We estimated the individual, independent, and joint associations of Pb, Cd, As, Hg, and Mn on the risk of developing gestational hypertension and preeclampsia in a cohort of Canadian women. METHODS Metal concentrations were analyzed in first and third trimester maternal blood (n=1,560). We measured blood pressure after 20 wk gestation to diagnose gestational hypertension, whereas proteinuria and other complications defined preeclampsia. We estimated individual and independent (adjusted for coexposure) relative risks (RRs) for each doubling of metal concentrations and examined interactions between toxic metals and Mn. We used quantile g-computation to estimate the joint effect of trimester-specific exposures. RESULTS Each doubling of third trimester Pb (RR=1.54; 95% CI: 1.06, 2.22) and first trimester blood As (RR=1.25; 95% CI: 1.01, 1.58) was independently associated with a higher risk of developing preeclampsia. First trimester blood As (RR=3.40; 95% CI: 1.40, 8.28) and Mn (RR=0.63; 95% CI: 0.42, 0.94) concentrations were associated with a higher and lower risk, respectively, of developing gestational hypertension. Mn modified the association with As such that the deleterious association with As was stronger at lower concentrations of Mn. First trimester urinary dimethylarsinic acid concentrations were not associated with gestational hypertension (RR=1.31; 95% CI: 0.60, 2.85) or preeclampsia (RR=0.92; 95% CI: 0.68, 1.24). We did not observe overall joint effects for blood metals. DISCUSSION Our results confirm that even low blood Pb concentrations are a risk factor for preeclampsia. Women with higher blood As concentrations combined with lower Mn in early pregnancy were more likely to develop gestational hypertension. These pregnancy complications impact maternal and neonatal health. Understanding the contribution of toxic metals and Mn is of public health importance. https://doi.org/10.1289/EHP10825.
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Affiliation(s)
- Michael M. Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Mandy Fisher
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Jillian Ashley-Martin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - William D. Fraser
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Markey Johnson
- Water and Air Quality Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Michael Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Warren Foster
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Tye E. Arbuckle
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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Fisher M, Marro L, Arbuckle TE, Potter BK, Little J, Weiler H, Morisset AS, Lanphear B, Oulhote Y, Braun JM, Kumarathasan P, Walker M, Borghese MM, Ashley-Martin J, Shutt R, Fraser WD. Association between toxic metals, vitamin D and preterm birth in the Maternal-Infant research on environmental chemicals study. Paediatr Perinat Epidemiol 2023. [PMID: 36864001 DOI: 10.1111/ppe.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Toxic metals, like lead, are risk factors for preterm birth (PTB), but few studies have examined low levels found in most Canadians. Vitamin D, which may have antioxidant activity, protects against PTB. OBJECTIVES In this study, we investigated the impact of toxic metals (lead, mercury, cadmium and arsenic) on PTB and examined if maternal plasma vitamin D concentrations modify these associations. METHODS We investigated whether concentrations of metals in whole blood measured in early and late pregnancy were associated with PTB (<37 weeks) and spontaneous PTB in 1851 live births from the Maternal-Infant Research on Environmental Chemicals Study using discrete time survival analysis. We also investigated whether the risk of PTB was modified by first-trimester plasma 25-hydroxyvitamin D (25OHD) concentrations. RESULTS Of 1851 live births, 6.1% (n = 113) were PTBs and 4.9% (n = 89) were spontaneous PTB. A 1 μg/dL increase in blood lead concentrations during pregnancy was associated with an increased risk of PTB (relative risk [RR] 1.48, 95% confidence interval [CI] 1.00, 2.20) and spontaneous PTB (RR 1.71, 95% CI 1.13, 2.60). The risk was higher in women with insufficient vitamin D concentrations (25OHD <50 nmol/L) for both PTB (RR 2.42, 95% CI 1.01, 5.79) and spontaneous PTB (RR 3.04, 95% CI 1.15, 8.04). However, an interaction on the additive scale was not present. Arsenic was associated with a higher risk of PTB (RR 1.10, 95% CI 1.02, 1.19) and spontaneous PTB (RR 1.11, 95% CI 1.03, 1.20) per 1 μg/L. CONCLUSIONS Gestational exposure to low levels of lead and arsenic may increase the risk of PTB and spontaneous PTB; individuals with insufficient vitamin D may be more susceptible to the adverse effects of lead. Given our relatively small number of cases, we encourage testing of this hypothesis in other cohorts, especially those with vitamin D-deficient populations.
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Affiliation(s)
- Mandy Fisher
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.,University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Leonora Marro
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Tye E Arbuckle
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Beth K Potter
- University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Julian Little
- University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Hope Weiler
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | | | - Bruce Lanphear
- Simon Fraser University. Vancouver, British Columbia Canada, Vancouver, British Columbia, Canada
| | - Youssef Oulhote
- Department of Epidemiology and Biostatistics, School of Public Health and Health Sciences, University of Massachusetts Amherst, Boston, Massachusetts, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | | | - Mark Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael M Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Jillian Ashley-Martin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Robin Shutt
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - William D Fraser
- Centre de Recherche du CHUS, and Department of Obstetrics and gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
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Zhong Z, Yang Q, Li C, Chen X, Zhou F. A global perspective of correlation between maternal blood lead levels and risks of preeclampsia: An updated systematic review and meta-analysis. Front Public Health 2022; 10:1072052. [PMID: 36620238 PMCID: PMC9816335 DOI: 10.3389/fpubh.2022.1072052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Preeclampsia (PE) is a specific hypertensive disorder in pregnancy. Lead (Pb) is a heavy metal that affects women's reproductive health. However, it is unclear whether lead exposure during can predispose maternal risk of developing preeclampsia. This systematic review and meta-analysis study aimed to explore the association. Methods We searched studies from three databases (PubMed, Web of Science, Embase). Only case-control, cross-sectional, and cohort studies reporting maternal blood lead levels (BLL) and PE were included from database inception to 31st July 2022. Pregnant women with blood lead levels measured were eligible. Those healthy pregnant women who did not develop preeclampsia were assessed as comparators. Letters, comments, case reports, and reviews were excluded. Newcastle-Ottawa Scale (NOS) and its adaptive form were applied for assessment. The random-effects method (REM) was applied to calculate the standardized mean difference (SMD) with a 95% confidence interval (CI). Stata 16.0 and RevMan 5.3 were the software used for data extraction and analysis. Results 25 studies out of 1,808 articles made the finalist for systematic reviews, of which 21 underwent further quantity analysis. A total of 1,533 preeclamptic women and 10,998 healthy pregnant controls were included in the meta-analysis. The overall result revealed that maternal lead exposure was significantly higher in women with preeclampsia (SMD: 1.06, 95% CI 0.69, 1.43); (I 2 = 96.40%; P = 0.000). Conclusion This study demonstrates that maternal lead exposure is associated with preeclampsia during pregnancy. The association is present even in low blood lead levels. The conclusion should be taken seriously and women should avoid unexpected exposure to a lead-containing environment as much as possible. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347220, identifier: CRD42022347220.
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Affiliation(s)
- Zixing Zhong
- Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qingmei Yang
- Graduate School, Bengbu Medical University, Bengbu, Anhui, China,Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Chu Li
- The Second Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohong Chen
- Department of Pediatrics, Central Hospital of Haining, Haining, Zhejiang, China,*Correspondence: Xiaohong Chen ✉
| | - Feifei Zhou
- Center for Reproductive Medicine, Department of Traditional Chinese Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China,Feifei Zhou ✉
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6
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Wang J, Yang Y, Zhang J, Liu N, Xi H, Liang H. Trends of Blood Lead Levels in US Pregnant Women: The National Health and Nutrition Examination Survey (2001–2018). Front Public Health 2022; 10:922563. [PMID: 35844875 PMCID: PMC9283785 DOI: 10.3389/fpubh.2022.922563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives This study investigates the trends of blood lead levels in US pregnant women based on the National Health and Nutrition Examination Survey from 2001 to 2018. Methods A total of 1,230 pregnant women were included in this study. The weighted logistic regression was applied to analyze the association between sociodemographic characteristics with high blood levels. We computed the blood lead levels for each survey period from 2001–2002 to 2017–2018. Moreover, we used the adjusted linear regression model to investigate the time-related change in blood lead level. The odds ratio (OR) with a 95% confidence interval (CI) was calculated accordingly. Results The mean blood lead was 0.73 ± 0.03 ug/dL, and high blood lead was observed in 2.53% of individuals. The Mexican Americans were more associated with high blood lead than the non-Hispanic white (OR, 1.072; 95% CI, 1.032-1.112). The mean blood lead level has decreased from 0.97 ug/dL in 2001–2002 to 0.46 ug/dL in 2013–2014. Afterward, a slight increase was observed with the mean blood lead of 0.55 ug/dL in 2015–2016 and 0.53 ug/dL in 2017-2018. In the adjusted linear regression model, each year's increase would lead to a 0.029 ug/dL decrease in blood lead (P < 0.001). However, no significant change was observed in the 2017–2018 cycle compared with 2009–2010 (P = 0.218). Conclusion This study summarized the trend of blood lead levels in US pregnant women over 2001–2018. Continued effort is still required to control lead sources better and protect this population from lead exposure.
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Affiliation(s)
- Jing Wang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yujie Yang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Juan Zhang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Na Liu
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
- Na Liu
| | - Huifang Xi
- The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Huifang Xi
| | - Hong Liang
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Hong Liang
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Goto Y, Mandai M, Nakayama T, Yamazaki S, Nakayama SF, Isobe T, Sato T, Nitta H. Association of prenatal maternal blood lead levels with birth outcomes in the Japan Environment and Children's Study (JECS): a nationwide birth cohort study. Int J Epidemiol 2021; 50:156-164. [PMID: 33141187 DOI: 10.1093/ije/dyaa162] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite dramatic declines in prenatal maternal blood lead levels (BLLs) in most developed countries, little is known about the effects of extremely low-level (<1.0 µg/dL) lead exposure on fetal growth. METHODS We measured maternal BLL during the second or third trimester of pregnancy and assessed birth outcomes, including birthweight, preterm birth (<37 gestational weeks) risk, small for gestational age births (SGA; birthweight <10th percentile) and low birthweight (LBW; <2500 g). The association between birthweight and maternal BLL was estimated using linear and quadratic spline models. Multivariable logistic models were used to examine the risk of binary responses. RESULTS From 103 099 pregnant women, 20 000 blood samples were randomly selected for analysis. The maternal BLL range was 0.16-7.4 µg/dL, and the median was 0.63 µg/dL. After adjusting for covariates, the linear model showed that each 0.1 μg/dL increase in maternal BLL was associated with a 5.4 g decrease in mean birthweight [95% confidence interval (CI), 3.4 to 7.5 g]. The risk of SGA [adjusted odds ratio (aOR), 1.03; 95% CI, 1.02 to 1.05) and LBW (aOR, 1.03; 95% CI, 1.02 to 1.05) increased, whereas the risk of preterm delivery did not (aOR, 0.99; 95% CI, 0.97 to 1.02). CONCLUSIONS Even at a maternal BLL below 1.0 µg/dL, prenatal lead exposure was associated with decreased birthweight and increased risk of SGA and LBW, but not preterm delivery. The adverse effect estimates of prenatal lead exposure on birth outcomes were quantitatively small and clinically limited at this low level.
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Affiliation(s)
| | - Marie Mandai
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shin Yamazaki
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tomohiko Isobe
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroshi Nitta
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
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Stone J, Sutrave P, Gascoigne E, Givens MB, Fry RC, Manuck TA. Exposure to toxic metals and per- and polyfluoroalkyl substances and the risk of preeclampsia and preterm birth in the United States: a review. Am J Obstet Gynecol MFM 2021; 3:100308. [PMID: 33444805 PMCID: PMC8144061 DOI: 10.1016/j.ajogmf.2021.100308] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 01/09/2023]
Abstract
Preeclampsia and preterm birth are among the most common pregnancy complications and are the leading causes of maternal and fetal morbidity and mortality in the United States. Adverse pregnancy outcomes are multifactorial in nature and increasing evidence suggests that the pathophysiology behind preterm birth and preeclampsia may be similar-specifically, both of these disorders may involve abnormalities in placental vasculature. A growing body of literature supports that exposure to environmental contaminants in the air, water, soil, and consumer and household products serves as a key factor influencing the development of adverse pregnancy outcomes. In pregnant women, toxic metals have been detected in urine, peripheral blood, nail clippings, and amniotic fluid. The placenta serves as a "gatekeeper" between maternal and fetal exposures, because it can reduce or enhance fetal exposure to various toxicants. Proposed mechanisms underlying toxicant-mediated damage include disrupted placental vasculogenesis, an up-regulated proinflammatory state, oxidative stressors contributing to prostaglandin production and consequent cervical ripening, uterine contractions, and ruptured membranes and epigenetic changes that contribute to disrupted regulation of endocrine and immune system signaling. The objective of this review is to provide an overview of studies examining the relationships between environmental contaminants in the US setting, specifically inorganic (eg, cadmium, arsenic, lead, and mercury) and organic (eg, per- and polyfluoroalkyl substances) toxicants, and the development of preeclampsia and preterm birth among women in the United States.
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Affiliation(s)
- Juliana Stone
- Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pragna Sutrave
- Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily Gascoigne
- Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew B Givens
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Institute for Environmental Health Solutions, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Institute for Environmental Health Solutions, Chapel Hill, NC.
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9
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Wu SZ, Xu HY, Chen Y, Chen Y, Zhu QL, Tan MH, Zhang MM. Association of blood lead levels with preeclampsia: A cohort study in China. ENVIRONMENTAL RESEARCH 2021; 195:110822. [PMID: 33539829 DOI: 10.1016/j.envres.2021.110822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Preeclampsia is the main cause of maternal and perinatal death, especially in developing countries. Multiple studies suggest that blood lead levels in pregnancy are a risk factor for preeclampsia, even with low levels of blood lead. But less knows the dose-effect relationship of preeclampsia in low blood lead levels. OBJECTIVES This study aims to assess the association between blood lead levels and preeclampsia and to explore its dose-effect relationship between low blood lead levels and preeclampsia. METHODS The retrospective cohort study was consecutively conducted in a comprehensive tertiary hospital in Foshan city of Guangdong Province, China, from August 1, 2019, to November 30, 2019. Blood lead levels were measured in maternal whole blood in 12-27 (+6) weeks of pregnancy, using atomic absorption spectrometer. Preeclampsia diagnosis was ascertained from the electronic medical records system. The risk of preeclampsia was estimated by multivariable logical regression analysis, and a two-stage linear regression model was established to find out the dose-effect. RESULTS A total of 2174 people were included in this study, and 59 (2.7%) women developed preeclampsia. The dose-effect analysis revealed a non-linear association between blood lead levels and the risk of preeclampsia, with a cut-off point at 4.2 μg/dl. When blood lead levels were over 4.2 μg/dl, the risk of preeclampsia increased significantly with an increase in blood lead levels (OR = 2.05, 95%CI: 1.50, 2.81). In the multivariate regression models, per 1 μg/dl increment in blood lead levels was associated with 43% higher risk of developing preeclampsia (OR = 1.43,95%CI:1.17,1.74). Moreover, the association between blood lead levels and preeclampsia was stable in different subgroups. CONCLUSIONS Low levels of lead exposure had a dose-effect relationship of preeclampsia, with a cut-off point at 4.2 μg/dl. Blood lead levels had a non-linear association with preeclampsia. When the blood lead levels were higher than 4.2 μg/dl, the risk of preeclampsia increases by 105% for every 1 μg/dl increase in blood lead levels.
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Affiliation(s)
- Su Zhen Wu
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China.
| | - Huan Ying Xu
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China.
| | - Ying Chen
- Candidate of Master's Degree, Foshan Clinical Medical School of Guangzhou University of Chinese Medicine, Chancheng District, Foshan, Guangdong province, China
| | - Yu Chen
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China
| | - Qiao Ling Zhu
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China
| | - Min Hua Tan
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China
| | - Miao Miao Zhang
- TCM Gynecology Department, Foshan Chancheng Central Hospital, Chancheng District, Foshan, Guangdong province, China
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Yadav G, Chambial S, Agrawal N, Gothwal M, Kathuria P, Singh P, Sharma P, Sharma PP. Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes. J Family Med Prim Care 2020; 9:3106-3111. [PMID: 32984181 PMCID: PMC7491757 DOI: 10.4103/jfmpc.jfmpc_78_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes. MATERIALS AND METHODS This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels. RESULTS We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl-16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels. CONCLUSIONS We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.
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Affiliation(s)
- Garima Yadav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shailja Chambial
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neha Agrawal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Gothwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyanka Kathuria
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prem Prakash Sharma
- Department of Biostatistics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Blood Lead Levels in Females of Childbearing Age in Flint, Michigan, and the Water Crisis. Obstet Gynecol 2020; 134:628-635. [PMID: 31403597 DOI: 10.1097/aog.0000000000003416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare blood lead levels in females of childbearing age, 12-50 years, living within and adjacent to Flint, Michigan, before, during, and after the Flint River water exposure and compare the levels to those that have been shown to cause fetal loss and preterm birth. METHODS The switch in the community water source to the Flint River occurred on April 25, 2014, and was reverted to the original source on October 15, 2015. Using a retrospective cross-sectional study design using geocoded blood lead levels obtained from all females of childbearing age available from a single hospital database, we compared blood lead levels for the following 18-month time periods: April 25, 2012-October 15, 2013 (PRE), April 25, 2014-October 15, 2015 (DURING), and April 25, 2016-October 15, 2017 (POST). RESULTS Results are reported as geometric mean (95% CI). Within Flint, PRE blood lead levels in females of childbearing age were 0.69 micrograms/dL (95% CI 0.63-0.75), DURING blood lead levels were 0.65 micrograms/dL (95% CI 0.60-0.71), and POST blood lead levels were 0.55 micrograms/dL (95% CI 0.54-0.56). DURING Flint River water exposure blood lead levels were not significantly different than the PRE Flint River water time period. POST Flint River water exposure blood lead levels were significantly lower than both PRE and DURING levels. Overall, lower blood lead levels were found outside the Flint boundary in all cohorts. CONCLUSION Blood lead levels in Flint females of childbearing age did not increase during the Flint River water exposure and subsequent 18-month time period. Mean blood lead levels during the Flint River water exposure are not consistent with the markedly higher blood lead levels reported in the literature to be associated with fetal loss, low birth weight, or preterm birth.
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Environmental Exposures and Adverse Pregnancy-Related Outcomes. HEALTH IMPACTS OF DEVELOPMENTAL EXPOSURE TO ENVIRONMENTAL CHEMICALS 2020. [DOI: 10.1007/978-981-15-0520-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cantor AG, Hendrickson R, Blazina I, Griffin J, Grusing S, McDonagh MS. Screening for Elevated Blood Lead Levels in Childhood and Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321:1510-1526. [PMID: 30990555 DOI: 10.1001/jama.2019.1004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Elevated blood lead level is associated with serious, often irreversible, health consequences. OBJECTIVE To synthesize evidence on the effects of screening, testing, and treatment for elevated blood lead level in pregnant women and children aged 5 years and younger in the primary care setting to inform the US Preventive Services Task Force. DATA SOURCES Cochrane CENTRAL and Cochrane Database of Systematic Reviews (through June 2018) and Ovid MEDLINE (1946 to June 2018); surveillance through December 5, 2018. STUDY SELECTION English-language trials and observational studies of screening for and treating elevated lead levels in asymptomatic children and pregnant women. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers using predefined criteria. MAIN OUTCOMES AND MEASURES Elevated blood lead level, morbidity, mortality, clinical prediction tools, test accuracy, adverse events. RESULTS A total of 24 studies (N = 11 433) were included in this review. No studies evaluated the benefits or harms of screening vs no screening in children. More than 1 positive answer on the 5-item 1991 Centers for Disease Control and Prevention (CDC) screening questionnaire was associated with a pooled sensitivity of 48% (95% CI, 31.4% to 65.6%) and specificity of 58% (95% CI, 39.9% to 74.0%) for identifying children with a venous blood lead level greater than 10 μg/dL (5 studies [n = 2265]). Adapted versions of the CDC questionnaire did not demonstrate improved accuracy. Capillary blood lead testing demonstrated sensitivity of 87% to 91% and specificity greater than 90%, compared with venous measurement (4 studies [n = 1431]). Counseling and nutritional interventions or residential lead hazard control techniques did not reduce blood lead concentrations in asymptomatic children, but studies were few and had methodological limitations (7 studies [n = 1419]). One trial (n = 780) of dimercaptosuccinic acid (DMSA) chelation therapy found reduced blood lead levels in children at 1 week to 1 year but not at 4.5 to 6 years, while another trial (n = 39) found no effect at 1 and 6 months. Seven-year follow-up assessments showed no effect on neuropsychological development, a small deficit in linear growth (height difference, 1.17 cm [95% CI, 0.41 to 1.93]), and poorer cognitive outcomes reported as the Attention and Executive Functions subscore of the Developmental Neuropsychological Assessment (unadjusted difference, -1.8 [95% CI, -4.5 to 1.0]; adjusted P = .045) in children treated with DMSA chelation. Evidence was too limited to determine the accuracy of screening questionnaires or benefits and harms of treatment in pregnant women. CONCLUSIONS AND RELEVANCE Screening questionnaires were not accurate for identifying children with elevated blood lead levels. Chelating agents in children were not significantly associated with sustained effects on blood level levels but were associated with harms.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Departments of Medical Informatics and Clinical Epidemiology, Family Medicine, and Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rob Hendrickson
- Department of Emergency Medicine, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
| | - Jessica Griffin
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
| | - Sara Grusing
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
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Bede-Ojimadu O, Amadi CN, Orisakwe OE. Blood Lead Levels in Women of Child-Bearing Age in Sub-Saharan Africa: A Systematic Review. Front Public Health 2018; 6:367. [PMID: 30619808 PMCID: PMC6305709 DOI: 10.3389/fpubh.2018.00367] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/30/2018] [Indexed: 11/13/2022] Open
Abstract
This paper reported available studies on blood lead level of childbearing age in Sub-Saharan African women. PubMed and Google scholar databases were searched for original articles reporting blood lead levels of women of childbearing age in Sub-Saharan Africa. Searches were not limited to year of study but limited to studies published in English Language. Data were extracted and synthesized by estimating the weighted mean of the reported blood lead levels. Fifteen papers fulfilled the inclusion criteria. Mean blood lead levels of women in the studies ranged from 0.83 to 99 μg/dl. The overall weighted mean of blood lead levels was 24.73 μg/dl. The weighted mean from analyses of data on blood lead levels of pregnant women alone was 26.24 μg/dl. Identified sources of lead exposure included lead mine, informal lead-acid battery recycling, leaded gasoline and piped water. Elevated BLLs were associated with incidence of preeclampsia, hypertension, and malaria. Important contributing factors for elevated blood lead levels (BLL) in these women include poverty, high environmental lead burden, low awareness on lead exposure hazards and lack of regulation for lead in consumer products. BLLs of women of childbearing age in SSA are unacceptably high. There is need therefore, for aggressive programs to address lead exposure in this population.
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Affiliation(s)
- Onyinyechi Bede-Ojimadu
- Department of Chemical pathology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Cecilia Nwadiuto Amadi
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, Port-Harcourt, Nigeria
| | - Orish Ebere Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, Port-Harcourt, Nigeria
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Anyanwu BO, Ezejiofor AN, Igweze ZN, Orisakwe OE. Heavy Metal Mixture Exposure and Effects in Developing Nations: An Update. TOXICS 2018; 6:E65. [PMID: 30400192 PMCID: PMC6316100 DOI: 10.3390/toxics6040065] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023]
Abstract
The drive for development and modernization has come at great cost. Various human activities in developed and developing countries, particularly in sub-Saharan Africa (SSA) have given rise to environmental safety concerns. Increased artisanal mining activities, illegal refining, use of leaded petrol, airborne dust, arbitrary discarding and burning of toxic waste, absorption of production industries in inhabited areas, inadequate environmental legislation, and weak implementation of policies, have given rise to the incomparable contamination and pollution associated with heavy metals in recent decades. This review evaluates the public health effects of heavy metals and their mixtures in SSA. This shows the extent and size of the problem posed by exposure to heavy metal mixtures in regard to public health.
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Affiliation(s)
- Brilliance Onyinyechi Anyanwu
- World Bank Africa Centre of Excellence in Oilfield Chemicals Research, University of Port Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
| | - Anthonet Ndidiamaka Ezejiofor
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
| | - Zelinjo Nkeiruka Igweze
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, Madonna University Elele, PMB, 5001 Elele, Rivers State, Nigeria.
| | - Orish Ebere Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
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Singh L, Anand M, Singh S, Taneja A. Environmental toxic metals in placenta and their effects on preterm delivery-current opinion. Drug Chem Toxicol 2018; 43:531-538. [PMID: 30257569 DOI: 10.1080/01480545.2018.1515216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Preterm birth is a significant public reproductive health concern globally; Furthermore, preterm birth has long-lasting medical and pecuniary burdens on the society. Moreover, preterm birth is well-established as the underlying cause of low birth weight in infants as well as neonatal mortality. A growing body of literature suggests that the etiology of preterm delivery in women is elusive; however, countless environmental factors are considered responsible for preterm birth. Environmental contaminants that are toxic metals such as lead, cadmium, arsenic, and mercury are familiar confounding factors for preterm birth globally. Recent studies have indicated that these toxic heavy metals induce oxidative stress in the trophoblastic placental tissue by producing reactive oxygen species that alter the mechanism of antioxidants possibly leading to preterm birth. Moreover, no obvious mechanism underlying metal-induced oxidative stress in the placenta has been identified until date. Consequently, this review offers an outline of the currently existing scientific information on the association of toxic metals and redox status of the placental tissue with preterm birth. Furthermore, this study critically recognizes the gaps related to the deleterious effect of metals on the gestation period in scientific literature.
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Affiliation(s)
- Laxmi Singh
- Department of Chemistry, Dr. B. R. Ambedkar University, Khandari Campus, Agra, India
| | - Madhu Anand
- Department of Chemistry, Dr. B. R. Ambedkar University, Khandari Campus, Agra, India
| | - Saroj Singh
- Department of Obstetrician and Gynecology, S.N. Medical College, Agra, India
| | - Ajay Taneja
- Department of Chemistry, Dr. B. R. Ambedkar University, Khandari Campus, Agra, India
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17
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Poropat AE, Laidlaw MAS, Lanphear B, Ball A, Mielke HW. Blood lead and preeclampsia: A meta-analysis and review of implications. ENVIRONMENTAL RESEARCH 2018; 160:12-19. [PMID: 28938191 DOI: 10.1016/j.envres.2017.09.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/18/2017] [Accepted: 09/08/2017] [Indexed: 05/02/2023]
Abstract
BACKGROUND Multiple cross-sectional studies suggest that there is an association between blood lead and preeclampsia. OBJECTIVES We performed a systematic review and meta-analysis to summarize information on the association between preeclampsia and lead poisoning. METHODS Searches of Medline, Web of Science, Scopus, Pubmed, Science Direct and ProQuest (dissertations and theses) identified 2089 reports, 46 of which were downloaded after reviewing the abstracts, and 11 studies were evaluated as meeting the selection criteria. Evaluation using the ROBINS-I template (Sterne, et al., 2016), indicated moderate risk of bias in all studies. RESULTS We found that blood lead concentrations were significantly and substantially associated with preeclampsia (k = 12; N = 6069; Cohen's d = 1.26; odds ratio = 9.81; odds ratio LCL = 8.01; odds ratio UCL = 12.02; p = 0.005). Eliminating one study produced a homogeneous meta-analysis and stronger estimates, despite the remaining studies coming from eight separate countries and having countervailing risks of bias. CONCLUSIONS Blood lead concentrations in pregnant women are a major risk factor for preeclampsia, with an increase of 1μg/dL associated with a 1.6% increase in likelihood of preeclampsia, which appears to be the strongest risk factor for preeclampsia yet reported. Pregnant women with historical lead exposure should routinely have blood lead concentrations tested, especially after mid-term. Women with concentrations higher than 5μg/dL should be actively monitored for preeclampsia and be advised to take prophylactic calcium supplementation. All pregnant women should be advised to actively avoid lead exposure.
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Affiliation(s)
- Arthur E Poropat
- Griffith University - School of Applied Psychology, Brisbane, Australia
| | - Mark A S Laidlaw
- RMIT University - Centre for Environmental Sustainability and Remediation (EnSuRe), School of Science, Bundoora, Victoria, Australia.
| | - Bruce Lanphear
- Simon Fraser University - Faculty of Health Sciences, Vancouver, British Columbia, Canada
| | - Andrew Ball
- RMIT University - Centre for Environmental Sustainability and Remediation (EnSuRe), School of Science, Bundoora, Victoria, Australia
| | - Howard W Mielke
- Tulane University - Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
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18
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La-Llave-León O, Méndez-Hernández EM, Castellanos-Juárez FX, Esquivel-Rodríguez E, Vázquez-Alaniz F, Sandoval-Carrillo A, García-Vargas G, Duarte-Sustaita J, Candelas-Rangel JL, Salas-Pacheco JM. Association between Blood Lead Levels and Delta-Aminolevulinic Acid Dehydratase in Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040432. [PMID: 28420209 PMCID: PMC5409633 DOI: 10.3390/ijerph14040432] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/08/2023]
Abstract
Blood lead levels (BLLs) and delta-aminolevulinic acid dehydratase (ALAD) activity are considered biomarkers of lead exposure and lead toxicity, respectively. The present study was designed to investigate the association between BLLs and ALAD activity in pregnant women from Durango, Mexico. A total of 633 pregnant women aged 13–43 years participated in this study. Blood lead was measured by a graphite furnace atomic absorption spectrometer. ALAD activity was measured spectrophotometrically. Mean blood lead was 2.09 ± 2.34 µg/dL; and 26 women (4.1%) crossed the Centers for Disease Control (CDC) recommended level of 5 µg/dL. ALAD activity was significantly lower in women with levels of lead ≥5 µg/dL compared to those with BLLs < 5 µg/dL (p = 0.002). To reduce the influence of extreme values on the statistical analysis, BLLs were analyzed by quartiles. A significant negative correlation between blood lead and ALAD activity was observed in the fourth quartile of BLLs (r = −0.113; p < 0.01). Among women with blood lead concentrations ≥2.2 µg/dL ALAD activity was negatively correlated with BLLs (r = −0.413; p < 0.01). Multiple linear regression demonstrated that inhibition of ALAD in pregnant women may occur at levels of lead in blood above 2.2 µg/dL.
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Affiliation(s)
- Osmel La-Llave-León
- Institute of Scientific Research, Juarez University of the State of Durango, AV. Universidad y Fanny Anitua s/n. Col. Centro, C. P. 34000 Durango, Mexico.
| | - Edna M Méndez-Hernández
- Institute of Scientific Research, Juarez University of the State of Durango, AV. Universidad y Fanny Anitua s/n. Col. Centro, C. P. 34000 Durango, Mexico.
| | - Francisco X Castellanos-Juárez
- Institute of Scientific Research, Juarez University of the State of Durango, AV. Universidad y Fanny Anitua s/n. Col. Centro, C. P. 34000 Durango, Mexico.
| | - Eloísa Esquivel-Rodríguez
- Faculty of Nursing and Midwifery, Juarez University of the State of Durango, Cuauhtemoc, 223 North, Col. Centro, C. P. 34000 Durango, Mexico.
| | | | - Ada Sandoval-Carrillo
- Institute of Scientific Research, Juarez University of the State of Durango, AV. Universidad y Fanny Anitua s/n. Col. Centro, C. P. 34000 Durango, Mexico.
| | - Gonzalo García-Vargas
- Faculty of Health Sciences, Juarez University of the State of Durango, Gomez Palacio la Salle 1 y Sixto Ugalde, s/n, Col. Revolucion, C. P. 35050 Gomez Palacio, Durango, Mexico.
| | - Jaime Duarte-Sustaita
- Faculty of Health Sciences, Juarez University of the State of Durango, Gomez Palacio la Salle 1 y Sixto Ugalde, s/n, Col. Revolucion, C. P. 35050 Gomez Palacio, Durango, Mexico.
| | - Jorge L Candelas-Rangel
- Faculty of Health Sciences, Juarez University of the State of Durango, Gomez Palacio la Salle 1 y Sixto Ugalde, s/n, Col. Revolucion, C. P. 35050 Gomez Palacio, Durango, Mexico.
| | - José M Salas-Pacheco
- Institute of Scientific Research, Juarez University of the State of Durango, AV. Universidad y Fanny Anitua s/n. Col. Centro, C. P. 34000 Durango, Mexico.
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Ferguson KK, Chin HB. Environmental chemicals and preterm birth: Biological mechanisms and the state of the science. CURR EPIDEMIOL REP 2017; 4:56-71. [PMID: 28944158 PMCID: PMC5608103 DOI: 10.1007/s40471-017-0099-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Preterm birth is a significant worldwide health problem of uncertain origins. The extant body of literature examining environmental contaminant exposures in relation to preterm birth is extensive but results remain ambiguous for most organic pollutants, metals and metalloids, and air pollutants. In the present review we examine recent epidemiologic studies investigating these associations, and identify recent advances and the state of the science. Additionally, we highlight biological mechanisms of action in the pathway between chemical exposures and preterm birth, including inflammation, oxidative stress, and endocrine disruption, that deserve more attention in this context. RECENT FINDINGS Important advances have been made in the study of the environment and preterm birth, particularly in regard to exposure assessment methods, exploration of effect modification by co-morbidities and exposures, and in identification of windows of vulnerability during gestation. There is strong evidence for an association between maternal exposure to some persistent pesticides, lead, and fine particulate matter, but data on other contaminants is sparse and only suggestive trends can be noted with the current data. SUMMARY Beyond replicating current findings, further work must be done to improve understanding of mechanisms underlying the associations observed between environmental chemical exposures and preterm birth. By examining windows of vulnerability, disaggregating preterm birth by phenotypes, and measuring biomarkers of mechanistic pathways in these epidemiologic studies we can improve our ability to detect associations with exposure, provide additional evidence for causality in an observational setting, and identify opportunities for intervention.
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Affiliation(s)
- Kelly K. Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Helen B. Chin
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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20
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La-Llave-León O, Salas Pacheco JM, Estrada Martínez S, Esquivel Rodríguez E, Castellanos Juárez FX, Sandoval Carrillo A, Lechuga Quiñones AM, Vázquez Alanís F, García Vargas G, Méndez Hernández EM, Duarte Sustaita J. The relationship between blood lead levels and occupational exposure in a pregnant population. BMC Public Health 2016; 16:1231. [PMID: 27927239 PMCID: PMC5142354 DOI: 10.1186/s12889-016-3902-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pregnant women exposed to lead are at risk of suffering reproductive damages, such as miscarriage, preeclampsia, premature delivery and low birth weight. Despite that the workplace offers the greatest potential for lead exposure, there is relatively little information about occupational exposure to lead during pregnancy. This study aims to assess the association between blood lead levels and occupational exposure in pregnant women from Durango, Mexico. Methods A cross-sectional study was carried out in a population of 299 pregnant women. Blood lead was measured in 31 women who worked in jobs where lead is used (exposed group) and 268 who did not work in those places (control group). Chi-square test was applied to compare exposed and control groups with regard to blood lead levels. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Multivariable regression analysis was applied to determine significant predictors of blood lead concentrations in the exposed group. Results Exposed women had higher blood lead levels than those in the control group (4.00 ± 4.08 μg/dL vs 2.65 ± 1.75 μg/dL, p = 0.002). Furthermore, women in the exposed group had 3.82 times higher probability of having blood lead levels ≥ 5 μg/dL than those in the control group. Wearing of special workwear, changing clothes after work, living near a painting store, printing office, junkyard or rubbish dump, and washing the workwear together with other clothes resulted as significant predictors of elevated blood lead levels in the exposed group. Conclusions Pregnant working women may be at risk of lead poisoning because of occupational and environmental exposure. The risk increases if they do not improve the use of protective equipment and their personal hygiene. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3902-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Osmel La-Llave-León
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico.
| | - José Manuel Salas Pacheco
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | - Sergio Estrada Martínez
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | - Eloísa Esquivel Rodríguez
- Facultad de Enfermería y Obstetricia, Universidad Juárez del Estado de Durango, Ave. Cuauhtémoc, 223 norte, CP 34 000, Durango, Mexico
| | - Francisco X Castellanos Juárez
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | - Ada Sandoval Carrillo
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | - Angélica María Lechuga Quiñones
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | | | - Gonzalo García Vargas
- Facultad de Medicina de Gómez Palacio, Universidad Juárez del Estado de Durango, La Salle 1 y Sixto Ugalde, S/N. Col. Revolución, CP. 35050, Gómez Palacio, Durango, Mexico
| | - Edna Madai Méndez Hernández
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Avenida Universidad esq. con Volantín, Zona Centro, C.P. 34000, Durango, DGO, Mexico
| | - Jaime Duarte Sustaita
- Facultad de Medicina de Gómez Palacio, Universidad Juárez del Estado de Durango, La Salle 1 y Sixto Ugalde, S/N. Col. Revolución, CP. 35050, Gómez Palacio, Durango, Mexico
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Arbuckle TE, Liang CL, Morisset AS, Fisher M, Weiler H, Cirtiu CM, Legrand M, Davis K, Ettinger AS, Fraser WD. Maternal and fetal exposure to cadmium, lead, manganese and mercury: The MIREC study. CHEMOSPHERE 2016; 163:270-282. [PMID: 27540762 DOI: 10.1016/j.chemosphere.2016.08.023] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/25/2016] [Accepted: 08/03/2016] [Indexed: 05/21/2023]
Abstract
Given the susceptibility of the fetus to toxicants, it is important to estimate their exposure. Approximately 2000 pregnant women were recruited in 2008-2011 from 10 cities across Canada. Cd, Pb, Mn and total Hg were measured in maternal blood from the 1st and 3rd trimesters, umbilical cord blood, and infant meconium. Nutrient intakes of vitamin D, iron, and calcium (Ca) were assessed using a food frequency questionnaire and a dietary supplement questionnaire. Median concentrations in 1st trimester maternal blood (n = 1938) were 0.20, 8.79 and 0.70 μg/L for Cd, Mn and Hg, respectively, and 0.60 μg/dL for Pb. While the median difference between the paired 1st and 3rd trimester concentrations of Cd was 0, there was a significant decrease in Pb (0.04 μg/dL) and Hg (0.12 μg/L) and an increase in Mn (3.30 μg/L) concentrations over the course of the pregnancy. While Cd was rarely detected in cord blood (19%) or meconium (3%), median Pb (0.77 μg/dL), Mn (31.87 μg/L) and Hg (0.80 μg/L) concentrations in cord blood were significantly higher than in maternal blood. Significant negative associations were observed between estimated Ca intake and maternal Cd, Pb, Mn and Hg, as well as cord blood Pb. Vitamin D intake was associated with lower maternal Cd, Pb, and Mn as well as Pb in cord blood. Even at current metal exposure levels, increasing dietary Ca and vitamin D intake during pregnancy may be associated with lower maternal blood Pb and Cd concentrations and lower Pb in cord blood.
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Affiliation(s)
- Tye E Arbuckle
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada.
| | - Chun Lei Liang
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Anne-Sophie Morisset
- Centre de recherche du centre hospitalier universitaire de sherbrooke, Sherbrooke, QC, Canada; Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Mandy Fisher
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Hope Weiler
- School of Dietetics and Human Nutrition, McGill University, Montreal, QC, Canada
| | - Ciprian Mihai Cirtiu
- Centre de toxicologie du Québec, Institut national de santé publique Québec, Quebec, QC, Canada
| | - Melissa Legrand
- Chemicals Surveillance Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Karelyn Davis
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Adrienne S Ettinger
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - William D Fraser
- Centre de recherche du centre hospitalier universitaire de sherbrooke, Sherbrooke, QC, Canada; Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
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22
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Rahman A, Kumarathasan P, Gomes J. Infant and mother related outcomes from exposure to metals with endocrine disrupting properties during pregnancy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 569-570:1022-1031. [PMID: 27378155 DOI: 10.1016/j.scitotenv.2016.06.134] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Endocrine-related adverse health effects from exposure to heavy metals such as lead, arsenic, cadmium, and mercury are yet to be adequately described. The purpose of this review was to gain insight into maternal exposure to heavy metals, and to identify potential endocrine-related adverse health effects in the mother and the infant. METHODS Relevant databases were searched for original research reports and a total of 46 articles were retained for scrutiny. Required data was extracted from these studies and their methodology was assessed. RESULTS Impaired fetal growth was observed from exposure to all endocrine disrupting metals, while exposure to lead and arsenic were associated with spontaneous abortion, stillbirth and neonatal deaths. Maternal exposure to arsenic was associated with impaired glucose tolerance in these mothers. CONCLUSION Impaired fetal growth, fetal loss, and neonatal deaths were significantly associated with heavy metals exposure during pregnancy; however, hypertension and gestational diabetes require further investigation.
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Affiliation(s)
- A Rahman
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - P Kumarathasan
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - J Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada; McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada.
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23
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Gulson B, Taylor A, Eisman J. Bone remodeling during pregnancy and post-partum assessed by metal lead levels and isotopic concentrations. Bone 2016; 89:40-51. [PMID: 27233973 DOI: 10.1016/j.bone.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
Abstract
Bone remodeling is normally evaluated using bone turnover markers/indices as indicators of bone resorption and formation. However, during pregnancy and post-partum, there have been inconsistent results between and within biomarkers for bone formation and resorption. These differences may relate to pregnancy-related changes in metabolism and/or hemodilution altering measured marker levels. An alternative approach to evaluating bone remodeling is to use the metal lead (Pb) concentrations and Pb isotopic compositions in blood. These measurements can also provide information on the amount of Pb that is mobilized from the maternal skeleton. Despite some similarities with accepted bone turnover markers, the Pb data demonstrate increased bone resorption throughout pregnancy that further continues post-partum independent of length of breast-feeding, dietary intake and resumption of menses. Furthermore the isotopic measurements are not affected by hemodilution. These data confirm calcium balance studies that indicate increased bone resorption throughout pregnancy and lactation. They also indicate potentially major public health implications of the transfer of maternal Pb burden to the fetus and new born.
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Affiliation(s)
- Brian Gulson
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO), Energy Flagship, Sydney, Australia.
| | - Alan Taylor
- Department of Psychology, Macquarie University, Australia.
| | - John Eisman
- Garvan Institute of Medical Research, St Vincent's Hospital, School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia; University of New South Wales, Garvan Institute of Medical Research, St Vincent's Hospital, School of Medicine Sydney, Sydney, NSW, Australia.
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24
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Zheng T, Zhang J, Sommer K, Bassig BA, Zhang X, Braun J, Xu S, Boyle P, Zhang B, Shi K, Buka S, Liu S, Li Y, Qian Z, Dai M, Romano M, Zou A, Kelsey K. Effects of Environmental Exposures on Fetal and Childhood Growth Trajectories. Ann Glob Health 2016; 82:41-99. [PMID: 27325067 PMCID: PMC5967632 DOI: 10.1016/j.aogh.2016.01.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Delayed fetal growth and adverse birth outcomes are some of the greatest public health threats to this generation of children worldwide because these conditions are major determinants of mortality, morbidity, and disability in infancy and childhood and are also associated with diseases in adult life. A number of studies have investigated the impacts of a range of environmental conditions during pregnancy (including air pollution, endocrine disruptors, persistent organic pollutants, heavy metals) on fetal and child development. The results, while provocative, have been largely inconsistent. This review summarizes up to date epidemiologic studies linking major environmental pollutants to fetal and child development and suggested future directions for further investigation.
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Affiliation(s)
- Tongzhang Zheng
- Department of Epidemiology, Brown School of Public Health, Providence, RI.
| | - Jie Zhang
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | | | - Bryan A Bassig
- National Cancer Institute, Division of Cancer Epidemiology & Genetics, Occupational and Environmental Epidemiology Branch, Bethesda, MD
| | - Xichi Zhang
- George Washington University, Washington, DC
| | - Jospeh Braun
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Shuangqing Xu
- Tongji School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Peter Boyle
- International Prevention Research Institute, Lyon, France
| | - Bin Zhang
- Wuhan Medical & Health Center for Women and Children, Wuhan, Hubei, P.R. China
| | - Kunchong Shi
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Stephen Buka
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Siming Liu
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Yuanyuan Li
- Department of Epidemiology, Brown School of Public Health, Providence, RI; Tongji School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Zengmin Qian
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO
| | - Min Dai
- China National Cancer Center, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Megan Romano
- Department of Epidemiology, Brown School of Public Health, Providence, RI
| | - Aifen Zou
- Wuhan Medical & Health Center for Women and Children, Wuhan, Hubei, P.R. China
| | - Karl Kelsey
- Department of Epidemiology, Brown School of Public Health, Providence, RI
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25
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Thomas S, Arbuckle TE, Fisher M, Fraser WD, Ettinger A, King W. Metals exposure and risk of small-for-gestational age birth in a Canadian birth cohort: The MIREC study. ENVIRONMENTAL RESEARCH 2015; 140:430-9. [PMID: 25967284 DOI: 10.1016/j.envres.2015.04.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Lead, mercury, cadmium and arsenic are some of the most common toxic metals to which Canadians are exposed. The effect of exposure to current low levels of toxic metals on fetal growth restriction is unknown. OBJECTIVE The aim of this study was to examine relationships between exposure to lead, mercury, cadmium and arsenic during pregnancy, and risk of small for gestational age (SGA) birth. METHODS Lead, mercury, cadmium and arsenic levels were measured in blood samples from the first and third trimesters in 1835 pregnant women from across Canada. Arsenic species in first trimester urine were also assessed. Relative risks and 95% confidence intervals were estimated using log binomial multivariate regression. Important covariates including maternal age, parity, pre-pregnancy BMI, and smoking, were considered in the analysis. An exploratory analysis was performed to examine potential effect modification of these relationships by single nucleotide polymorphisms (SNPs) in GSTP1 and GSTO1 genes. RESULTS No association was found between blood lead, cadmium or arsenic and risk for SGA. We observed an increased risk for SGA for the highest compared to the lowest tertile of exposure for mercury (>1.6 µg/L, RR=1.56.; 95% CI=1.04-2.58) and arsenobetaine (>2.25 µg/L, RR=1.65; 95% CI=1.10-2.47) after adjustment for the effects of parity and smoking. A statistically significant interaction was observed in the relationship between dimethylarsinic acid (DMA) levels in urinary arsenic and SGA between strata of GSTO1 A104A (p for interaction=0.02). A marginally significant interaction was observed in the relationship between blood lead and SGA between strata of GSTP1 A114V (p for interaction=0.06). CONCLUSIONS These results suggest a small increase in risk for SGA in infants born to women exposed to mercury and arsenic. Given the conflicting evidence in the literature this warrants further investigation in other pregnant populations.
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Affiliation(s)
- Shari Thomas
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tye E Arbuckle
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada.
| | - Mandy Fisher
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | - William D Fraser
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, Canada
| | - Adrienne Ettinger
- Center for Perinatal, Pediatric & Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Will King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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26
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Zhang B, Xia W, Li Y, Bassig BA, Zhou A, Wang Y, Li Z, Yao Y, Hu J, Du X, Zhou Y, Liu J, Xue W, Ma Y, Pan X, Peng Y, Zheng T, Xu S. Prenatal exposure to lead in relation to risk of preterm low birth weight: A matched case-control study in China. Reprod Toxicol 2015; 57:190-195. [PMID: 26122562 DOI: 10.1016/j.reprotox.2015.06.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 05/11/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022]
Abstract
We investigated the association between prenatal exposure to lead (Pb) and the risk of preterm low birth weight (PLBW). Pb concentrations in maternal urine collected at birth from 408 subjects (102 cases and 306 matched controls) were analyzed and adjusted by creatinine. The median Pb concentration in the PLBW cases (10.60μgPb/g creatinine) was higher than that of the controls (7.28μgPb/g creatinine). An adjusted odds ratio (OR) of 2.96 (95% CI=1.49-5.87) for PLBW was observed when the highest tertile was compared to the lowest tertile of Pb levels. The association was more pronounced among female infants (adjusted OR=3.67 for the highest tertile; 95% CI=1.35-9.93) than male infants (adjusted OR=1.91 for the highest tertile; 95% CI=0.74-4.95). Our study suggests that prenatal exposure to levels of Pb encountered today in China is associated with an elevated risk of PLBW.
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Affiliation(s)
- Bin Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bryan A Bassig
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT USA
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Youjie Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhengkuan Li
- Macheng Maternity and Child Health Care Hospital, Macheng, Hubei, People's Republic of China
| | - Yuanxiang Yao
- Ezhou Maternity and Child Health Hospital, Ezhou, Hubei, People's Republic of China
| | - Jie Hu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiaofu Du
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yanqiu Zhou
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Juan Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Weiyan Xue
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yue Ma
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xinyun Pan
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yang Peng
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Tongzhang Zheng
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT USA
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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27
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Revisiting mobilisation of skeletal lead during pregnancy based on monthly sampling and cord/maternal blood lead relationships confirm placental transfer of lead. Arch Toxicol 2015; 90:805-16. [DOI: 10.1007/s00204-015-1515-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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28
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Shen W, Zhang B, Liu S, Wu H, Gu X, Qin L, Tian P, Zeng Y, Ye L, Ni Z, Wang Q. Association of blood lead levels with methylenetetrahydrofolate reductase polymorphisms among Chinese pregnant women in Wuhan city. PLoS One 2015; 10:e0117366. [PMID: 25723397 PMCID: PMC4344240 DOI: 10.1371/journal.pone.0117366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pregnancy is an important stimulus of bone lead release. Elevated blood lead levels (BLLs) may cause adverse pregnancy outcomes for mothers and harmful lead effects on fetuses. However, the reports about maternal BLL changes during pregnancy are conflicting to some extent. This article is to explore the variations in BLLs among pregnant women. The relationships of BLLs with methylenetetrahydrofolate reductase (MTHFR) gene C677T, A1298C, and G1793A polymorphisms, which are associated with bone resorption, were also studied. A total of 973 women, including 234, 249, and 248 women in their first, second, and third trimesters, respectively, and 242 non-pregnant women, were recruited at the Wuhan Women and Children Medical Health Center. METHODS BLLs were determined using a graphite furnace atomic absorption spectrometer. Single-nucleotide polymorphisms of MTHFR were identified with the TaqMan probe method. RESULTS The geometric mean (geometric standard deviation) of BLLs was 16.2 (1.78) μg/L for all participants. All the studied MTHFR alleles were in Hardy-Weinberg equilibrium. Multiple-linear regression analysis revealed the following results. Among the pregnant women, those that carried MTHFR 677CC (i.e. wild-genotype homozygote) and 1298CC (i.e. mutant-genotype homozygote) exhibited higher BLLs than those that carried 677CT/TT (standardized β = 0.074, P = 0.042) and 1298AC/AA (standardized β = 0.077, P = 0.035) when other covariates (e.g., age, no. of children, education and income, etc.) were adjusted. The BLLs of pregnant women consistently decreased during the pregnancy and these levels positively correlated with BMI (standard β = 0.086-0.096, P<0.05). CONCLUSIONS The 1298CC mutant-type homozygote in the MTHFR gene is a risk factor for high BLLs among low-level environmental lead-exposed Chinese pregnant women, whose BLLs consistently decreased during gestation.
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Affiliation(s)
- Wei Shen
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bin Zhang
- Wuhan Women and Children Medical Care Center, Wuhan 430016, China
| | - Shuyun Liu
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongling Wu
- Wuhan Women and Children Medical Care Center, Wuhan 430016, China
| | - Xue Gu
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lingzhi Qin
- Wuhan Women and Children Medical Care Center, Wuhan 430016, China
| | - Ping Tian
- Wuhan Women and Children Medical Care Center, Wuhan 430016, China
| | - Yun Zeng
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Linxiang Ye
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zemin Ni
- Women and Children Medical Center of Jiang-an District, Wuhan 430017, China
| | - Qi Wang
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Taylor CM, Golding J, Emond AM. Adverse effects of maternal lead levels on birth outcomes in the ALSPAC study: a prospective birth cohort study. BJOG 2015; 122:322-8. [PMID: 24824048 PMCID: PMC4322474 DOI: 10.1111/1471-0528.12756] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study the associations of prenatal blood lead levels (B-Pb) with pregnancy outcomes in a large cohort of mother-child pairs in the UK. DESIGN Prospective birth cohort study. SETTING Avon area of Bristol, UK. POPULATION Pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). METHODS Whole blood samples were collected and analysed by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4285). Data collected on the infants included anthropometric variables and gestational age at delivery. Linear regression models for continuous outcomes and logistic regression models for categorical outcomes were adjusted for covariates including maternal height, smoking, parity, sex of the baby and gestational age. MAIN OUTCOME MEASURES Birthweight, head circumference and crown-heel length, preterm delivery and low birthweight. RESULTS The mean blood lead level (B-Pb) was 3.67 ± 1.47 μg/dl. B-Pb ≥ 5 μg/dl significantly increased the risk of preterm delivery (adjusted odds ratio [OR] 2.00 95% confidence interval [95% CI] 1.35-3.00) but not of having a low birthweight baby (adjusted OR 1.37, 95% CI 0.86-2.18) in multivariable binary logistic models. Increasing B-Pb was significantly associated with reductions in birth weight (β -13.23, 95% CI -23.75 to -2.70), head circumference (β -0.04, 95% CI -0.07 to -0.06) and crown-heel length (β -0.05, 95% CI -0.10 to -0.00) in multivariable linear regression models. CONCLUSIONS There was evidence for adverse effects of maternal B-Pb on the incidence of preterm delivery, birthweight, head circumference and crown-heel length, but not on the incidence of low birthweight, in this group of women.
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Affiliation(s)
- CM Taylor
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of BristolBristol, UK
| | - J Golding
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of BristolBristol, UK
| | - AM Emond
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of BristolBristol, UK
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30
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Perkins M, Wright RO, Amarasiriwardena CJ, Jayawardene I, Rifas-Shiman SL, Oken E. Very low maternal lead level in pregnancy and birth outcomes in an eastern Massachusetts population. Ann Epidemiol 2014; 24:915-9. [PMID: 25444892 PMCID: PMC4254591 DOI: 10.1016/j.annepidem.2014.09.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Maternal lead exposure is associated with poor birth outcomes in populations with moderate to high blood levels. However, no studies have looked at exposure levels commonly experienced by US women. METHODS We evaluated the relationship between maternal red blood cell (RBC) lead levels in midpregnancy and birth outcomes in 949 mother-child pairs in a prebirth cohort. We used multiple linear regression and logistic regression, adjusted for potential confounders including maternal age, race, prepregnancy body mass index, and smoking to relate maternal lead to infant birth size and risk for preterm birth (<37 weeks). RESULTS Mean RBC lead level was 1.2 μg/dL (range, 0.0-5.0). Mean (standard deviation) birthweight was 3505 (520) g, birthweight for gestational age z-score 0.22 (0.93), and length of gestation 39.5 (1.7) weeks. Mothers in the highest versus lowest lead quartile did not have higher odds (OR, 1.85; 95% confidence interval [CI], 0.79-4.34) of preterm delivery; after stratifying by child sex, there was an association among males (OR, 5.51; 95% CI, 1.21-25.15) but not females (OR, 0.82; 95% CI, 0.24-2.85). Maternal RBC lead was not associated with any continuous outcomes in combined or sex-stratified analyses. CONCLUSIONS Maternal lead exposure, even at very low levels, may adversely affect some childbirth outcomes, particularly preterm birth among males.
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Affiliation(s)
- Meghan Perkins
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert O Wright
- Departments of Preventive Medicine and Pediatrics, Icahn School of Medicine at Mt. Sinai, New York, NY
| | | | - Innocent Jayawardene
- Channing Laboratory, Brigham and Women׳s Hospital and Harvard Medical School, Boston, MA
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
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Zahran S, Magzamen S, Breunig IM, Mielke HW. Maternal exposure to neighborhood soil Pb and eclampsia risk in New Orleans, Louisiana (USA): evidence from a natural experiment in flooding. ENVIRONMENTAL RESEARCH 2014; 133:274-81. [PMID: 24981826 DOI: 10.1016/j.envres.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/30/2014] [Accepted: 06/02/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Previous studies link maternal blood lead (Pb) levels and pregnancy-related hypertensive disorders. OBJECTIVE Assess the relationship between neighborhood soil Pb and maternal eclampsia risk. METHODS Zip code summarized high density soil survey data of New Orleans collected before and after Hurricanes Katrina and Rita (HKR) were merged with pregnancy outcome data on 75,501 mothers from the Louisiana office of public health. Cross-sectional logistic regression analyses are performed testing the association between pre-HKR accumulation of Pb in soils in thirty-two neighborhoods and eclampsia risk. Then we examine whether measured declines in soil Pb following the flooding of the city resulted in corresponding reductions of eclampsia risk. RESULTS Cross-sectional analyses show that a one standard deviation increase in soil Pb increases the odds of eclampsia by a factor of 1.48 (95% CI: 1.31, 1.66). Mothers in zip code areas with soil Pb>333 mg/kg were 4.00 (95% CI: 3.00, 5.35) times more likely to experience eclampsia than mothers residing in neighborhoods with soil Pb<50mg/kg. Difference-in-differences analyses capturing the exogenous reduction in soil Pb following the 2005 flooding of New Orleans indicate that mothers residing in zip codes experiencing decrease in soil Pb (-387.9 to -33.6 mg/kg) experienced a significant decline in eclampsia risk (OR=0.619; 95% CI: 0.397, 0.963). CONCLUSIONS Mothers residing in neighborhoods with high accumulation of Pb in soils are at heightened risk of experiencing eclampsia.
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Affiliation(s)
- Sammy Zahran
- Department of Economics, C-312A Clark Building, Colorado State University, Fort Collins, CO, 80523-1771 USA; Robert Wood Johnson Health and Society Scholar, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Sheryl Magzamen
- Department of Environmental and Radiological and Health Sciences, 147 Environmental Health Building, Colorado State University, Fort Collins, CO, 80523-1681 USA.
| | - Ian M Breunig
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th floor, Room 01-209, Baltimore, MD 21201, USA.
| | - Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue SL-83, New Orleans, LA, 70112-2699, USA.
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Evidence that birth weight is decreased by maternal lead levels below 5μg/dl in male newborns. Reprod Toxicol 2014; 47:21-6. [DOI: 10.1016/j.reprotox.2014.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 11/23/2022]
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Johnson CK, Kelly TR, Rideout BA. Lead in ammunition: a persistent threat to health and conservation. ECOHEALTH 2013; 10:455-64. [PMID: 24419669 DOI: 10.1007/s10393-013-0896-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 12/11/2013] [Indexed: 05/11/2023]
Abstract
Many scavenging bird populations have experienced abrupt declines across the globe, and intensive recovery activities have been necessary to sustain several species, including the critically endangered California condor (Gymnogyps californianus). Exposure to lead from lead-based ammunition is widespread in condors and lead toxicosis presents an immediate threat to condor recovery, accounting for the highest proportion of adult mortality. Lead contamination of carcasses across the landscape remains a serious threat to the health and sustainability of scavenging birds, and here we summarize recent evidence for exposure to lead-based ammunition and health implications across many species. California condors and other scavenging species are sensitive indicators of the occurrence of lead contaminated carcasses in the environment. Transdisciplinary science-based approaches have been critical to managing lead exposure in California condors and paving the way for use of non-lead ammunition in California. Similar transdisciplinary approaches are now needed to translate the science informing on this issue and establish education and outreach efforts that focus on concerns brought forth by key stakeholders.
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Affiliation(s)
- C K Johnson
- Wildlife Health Center, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA,
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Taylor CM, Golding J, Hibbeln J, Emond AM. Environmental factors predicting blood lead levels in pregnant women in the UK: the ALSPAC study. PLoS One 2013; 8:e72371. [PMID: 24039753 PMCID: PMC3764234 DOI: 10.1371/journal.pone.0072371] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/08/2013] [Indexed: 11/24/2022] Open
Abstract
Background Lead is a widespread environmental toxin. The behaviour and academic performance of children can be adversely affected even at low blood lead levels (BLL) of 5–10 µg/dl. An important contribution to the infant's lead load is provided by maternal transfer during pregnancy. Objectives Our aim was to determine BLL in a large cohort of pregnant women in the UK and to identify the factors that contribute to BLL in pregnant women. Methods Pregnant women resident in the Avon area of the UK were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) in 1991–1992. Whole blood samples were collected at median gestational age of 11 weeks and analysed by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4285). Self-completion postal questionnaires were used to collect data during pregnancy on lifestyle, diet and other environmental exposures. Statistical analysis was carried out with SPSS v19. Results The mean±SD BLL was 3.67±1.47 (median 3.41, range 0.41–19.14) µg/dl. Higher educational qualification was found to be one of the strongest independent predictor of BLL in an adjusted backwards stepwise logistic regression to predict maternal BLL <5 or ≥5 µg/dl (odds ratio 1.26, 95% confidence interval 1.12–1.42; p<0.001). Other predictive factors included cigarette smoking, alcohol and coffee drinking, and heating the home with a coal fire, with some evidence for iron and calcium intake having protective effects. Conclusion The mean BLL in this group of pregnant women is higher than has been found in similar populations in developed countries. The finding that high education attainment was independently associated with higher BLL was unexpected and currently unexplained. Reduction in maternal lead levels can best be undertaken by reducing intake of the social drugs cigarettes, alcohol and caffeine, although further investigation of the effect of calcium on lead levels is needed.
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Affiliation(s)
- Caroline M. Taylor
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Jean Golding
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Joseph Hibbeln
- NIAAA, National Institutes of Health, Rockville, Maryland, United States of America
| | - Alan M. Emond
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Ugwuja EI, Ibiam UA, Ejikeme BN, Obuna JA, Agbafor KN. Blood Pb Levels in pregnant Nigerian women in Abakaliki, South-Eastern Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2013; 185:3795-3801. [PMID: 22915221 DOI: 10.1007/s10661-012-2828-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 08/09/2012] [Indexed: 06/01/2023]
Abstract
Environmental lead (Pb) exposure and toxicity have been recognised as public health problems of global importance, affecting both the developed and developing nations. In this work, blood Pb of pregnant women that were not exposed to lead by their occupation (n = 349), with mean ± SD age of 27.0 ± 4.8 years and gestational age of 21.8 ± 3.1 weeks at recruitment were determined using atomic absorption spectrophotometer. The results showed that 309 (88.5 %) of the women had a mean ± SD blood Pb of 40.0 ± 16.5 μg/dl, which is higher than the current US Centre for Disease Prevention and Control action limit (>10 μg/dl). The observed high prevalence of elevated blood Pb levels may be related to maternal low socioeconomic status. Health education is, therefore, urgently needed to sensitise the general public and the policy makers of the level of Pb exposure in Abakaliki environment and the inherent health implications. In addition to mandatory environmental lead monitoring, blood Pb screening for would-be mother is recommended, and those whose blood Pb are found elevated should be appropriately treated.
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Affiliation(s)
- Emmanuel I Ugwuja
- Department of Chemical Pathology, Faculty of Clinical Medicine, Ebonyi State University, PMB 053, Abakaliki, Nigeria.
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Ferguson KK, O'Neill MS, Meeker JD. Environmental contaminant exposures and preterm birth: a comprehensive review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2013; 16:69-113. [PMID: 23682677 PMCID: PMC3889157 DOI: 10.1080/10937404.2013.775048] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Preterm birth is a significant public health concern, as it is associated with high risk of infant mortality, various morbidities in both the neonatal period and later in life, and a significant societal economic burden. As many cases are of unknown etiology, identification of the contribution of environmental contaminant exposures is a priority in the study of preterm birth. This is a comprehensive review of all known studies published from 1992 through August 2012 linking maternal exposure to environmental chemicals during pregnancy with preterm birth. Using PubMed searches, studies were identified that examined associations between preterm birth and exposure to five categories of environmental toxicants, including persistent organic pollutants, drinking-water contaminants, atmospheric pollutants, metals and metalloids, and other environmental contaminants. Individual studies were summarized and specific suggestions were made for future work in regard to exposure and outcome assessment methods as well as study design, with the recommendation of focusing on potential mediating toxicological mechanisms. In conclusion, no consistent evidence was found for positive associations between individual chemical exposures and preterm birth. By identifying limitations and addressing the gaps that may have impeded the ability to identify true associations thus far, this review can guide future epidemiologic studies of environmental exposures and preterm birth.
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Affiliation(s)
- Kelly K Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029, USA.
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Kennedy DA, Woodland C, Koren G. Lead exposure, gestational hypertension and pre-eclampsia: A systematic review of cause and effect. J OBSTET GYNAECOL 2012; 32:512-7. [DOI: 10.3109/01443615.2012.693987] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Flora SJS, Gautam P, Kushwaha P. Lead and ethanol co-exposure lead to blood oxidative stress and subsequent neuronal apoptosis in rats. Alcohol Alcohol 2012; 47:92-101. [PMID: 22215003 DOI: 10.1093/alcalc/agr152] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The present study was aimed at investigating chronic exposure to lead and ethanol, individually and in combination with blood oxidative stress leading to possible brain apoptosis in rats. METHODS Rats were exposed to lead (0.1% w/v in drinking water) or ethanol (1 and 10%) either individually or in combination for four months. Biochemical variables indicative of oxidative stress (blood and brain) and brain apoptosis were examined. Native polyacrylamide agarose gel electrophoresis was carried out in brain homogenates for glucose-6-phosphate dehydrogenase (G6PD) analysis, whereas western blot analysis was done for the determination of apoptotic markers like Bax, Bcl-2, caspase-3, cytochrome c and p53. RESULTS The results suggest that most pronounced increase in oxidative stress in red blood cells and brain of animals co-exposed to lead and 10% ethanol compared all the other groups. Decrease in G6PD activity followed the same trend. Upregulation of Bax, cytochrome c, caspase-3, p53 and down-regulation of Bcl-2 suggested apoptosis in the rat brain co-exposed to lead and ethanol (10%) compared with their individual exposures. Significantly high lead accumulation in blood and brain during co-exposure further support synergistic toxicity. CONCLUSION The present study thus suggests that higher consumption of ethanol during lead exposure may lead to brain apoptosis, which may be mediated through oxidative stress.
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Affiliation(s)
- Swaran J S Flora
- Division of Pharmacology and Toxicology, Defence Research and Development Establishment, Jhansi Road, Gwalior 474002, India.
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Rahman A, Al-Rashidi HAG, Khan AR. Association of Maternal Blood Lead Level During Pregnancy with Child Blood Lead Level and Pregnancy Outcome in Kuwait. Ecol Food Nutr 2012; 51:40-57. [DOI: 10.1080/03670244.2012.635571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bellinger DC. The protean toxicities of lead: new chapters in a familiar story. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2593-628. [PMID: 21845148 PMCID: PMC3155319 DOI: 10.3390/ijerph8072593] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/17/2011] [Accepted: 06/20/2011] [Indexed: 12/11/2022]
Abstract
Many times in the history of lead toxicology the view that "the problem" has been solved and is no longer a major health concern has prevailed, only to have further research demonstrate the prematurity of this judgment. In the last decade, an extraordinary amount of new research on lead has illustrated, all too clearly, that "the problem" has not disappeared, and that, in fact, it has dimensions never before considered. Recent risk assessments have concluded that research has yet to identify a threshold level below which lead can be considered "safe." Although children's intelligence has traditionally been considered to be the most sensitive endpoint, and used as the basis for risk assessment and standard setting, increased lead exposure has been associated with a wide variety of other morbidities both in children and adults, in some cases at biomarker levels comparable to those associated with IQ deficits in children. In adults, these endpoints include all-cause mortality and dysfunctions in the renal, cardiovascular, reproductive, central nervous systems. In children, IQ deficits are observed at blood lead levels well below 10 μg/dL, and the dose-effect relationship appears to be supra-linear. Other health endpoints associated with greater early-life lead exposure in children include ADHD, conduct disorder, aggression and delinquency, impaired dental health, and delayed sexual maturation. Studies employing neuroimaging modalities such as volumetric, diffusion tensor, and functional MRI are providing insights into the neural bases of the cognitive impairments associated with greater lead exposure.
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Affiliation(s)
- David C Bellinger
- Children's Hospital Boston, Farley Basement Box 127, 300 Longwood Avenue, Boston, MA 02115, USA.
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Critical windows of fetal lead exposure: adverse impacts on length of gestation and risk of premature delivery. J Occup Environ Med 2011; 52:1106-11. [PMID: 21063188 DOI: 10.1097/jom.0b013e3181f86fee] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Research on the role of environmental lead exposure in the complex etiology of premature birth has yielded inconsistent results. We assessed the trimester-specific effect of prenatal lead exposure on gestational age and risk of premature delivery. METHODS We used linear and logistic regression to identify critical windows of susceptibility to lead exposure on gestational length. RESULTS In single-trimester models, decreases in gestational length were most strongly associated with first and second trimester blood lead. In adjusted logistic regression models, a one-standard deviation increase in second trimester blood lead was associated with an odds ratio of prematurity of 1.75 (95% CI: 1.02, 3.02). CONCLUSIONS Maternal whole blood lead levels measured during first and second trimesters yielded the most prominent inverse association with length of gestation and increased the risk of prematurity.
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Wells EM, Navas-Acien A, Herbstman JB, Apelberg BJ, Silbergeld EK, Caldwell KL, Jones RL, Halden RU, Witter FR, Goldman LR. Low-level lead exposure and elevations in blood pressure during pregnancy. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:664-9. [PMID: 21292600 PMCID: PMC3094418 DOI: 10.1289/ehp.1002666] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 12/17/2010] [Indexed: 05/07/2023]
Abstract
BACKGROUND Lead exposure is associated with elevated blood pressure during pregnancy; however, the magnitude of this relationship at low exposure levels is unclear. OBJECTIVES Our goal was to determine the association between low-level lead exposure and blood pressure during late pregnancy. METHODS We collected admission and maximum (based on systolic) blood pressures during labor and delivery among 285 women in Baltimore, Maryland. We measured umbilical cord blood lead using inductively coupled plasma mass spectrometry. Multivariable models were adjusted for age, race, median household income, parity, smoking during pregnancy, prepregnancy body mass index, and anemia. These models were used to calculate benchmark dose values. RESULTS Geometric mean cord blood lead was 0.66 μg/dL (95% confidence interval, 0.61-0.70). Comparing blood pressure measurements between those in the highest and those in the lowest quartile of lead exposure, we observed a 6.87-mmHg (1.51-12.21 mmHg) increase in admission systolic blood pressure and a 4.40-mmHg (0.21-8.59 mmHg) increase in admission diastolic blood pressure after adjustment for confounders. Corresponding values for maximum blood pressure increase were 7.72 (1.83-13.60) and 8.33 (1.14-15.53) mmHg. Benchmark dose lower limit values for a 1-SD increase in blood pressure were < 2 μg/dL blood lead for all blood pressure end points. CONCLUSIONS A significant association between low-level lead exposures and elevations in maternal blood pressure during labor and delivery can be observed at umbilical blood lead levels < 2 μg/dL.
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Affiliation(s)
- Ellen M. Wells
- Department of Environmental Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julie B. Herbstman
- Columbia Center for Children’s Environmental Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Benjamin J. Apelberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ellen K. Silbergeld
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathleen L. Caldwell
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert L. Jones
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rolf U. Halden
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Environmental Biotechnology, Biodesign Institute, Arizona State University, Tempe, Arizona, USA
| | - Frank R. Witter
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lynn R. Goldman
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- George Washington University School of Public Health and Health Services, Washington, DC, USA
- Address correspondence to L.R. Goldman, George Washington University School of Public Health and Health Services, 2300 Eye St. NW, Suite 106, Washington, DC 20037 USA. Telephone: (202) 994-7270. Fax: (202) 994-3773. E-mail:
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Pérez RL, Handley MA, Grieshop J. SAVORING THE TASTE OF HOME: THE PERVASIVENESS OF LEAD POISONING FROM CERAMIC AND ITS IMPLICATIONS IN TRANSNATIONAL CARE PACKAGES. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1556-4797.2010.01054.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gundacker C, Fröhlich S, Graf-Rohrmeister K, Eibenberger B, Jessenig V, Gicic D, Prinz S, Wittmann KJ, Zeisler H, Vallant B, Pollak A, Husslein P. Perinatal lead and mercury exposure in Austria. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 408:5744-9. [PMID: 20825977 DOI: 10.1016/j.scitotenv.2010.07.079] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 07/20/2010] [Accepted: 07/30/2010] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The heavy metals lead (Pb) and mercury (Hg) are ubiquitous environmental pollutants with high neurotoxic potential. We aimed to compare perinatal Pb and Hg concentrations and to explore the potential association between Pb and Hg exposure and newborn anthropometry. STUDY DESIGN Pregnant women were recruited in 2005 at the General Hospital Vienna for participation in this longitudinal study. Pb and Hg concentrations were measured in maternal blood and hair, placenta, cord blood, meconium, and breast milk of 53 mother-child pairs by CV-AAS, GF-AAS, and HPLC-CV-ICPMS. We conducted bivariate analyses and categorical regression analysis (CATREG) to evaluate the determinants of Pb and Hg exposure, and of infant anthropometry. RESULTS Median Pb and total Hg contents were low, i.e., 25 μg/L (maternal blood-Pb), 13 μg/L (cord blood-Pb), 0.7 μg/L (maternal blood-Hg), and 1.1 μg/L (cord blood-Hg). Hg levels in maternal and fetal tissues were frequently correlated (r>0.3, P<0.05, respectively). Regarding Pb, only maternal blood and cord blood concentrations correlated (P=0.043). Cord blood levels indicated higher Hg exposure but lower Pb exposure relative to maternal blood contents. Adjusted CATREG models indicated the significant predictors of birth length (placenta-Pb, gestational length, meconium-Pb), birth weight (placenta-Pb, gestational length, maternal blood-Pb), and head circumference (maternal education, maternal height). Besides one significant correlation between maternal hair Hg and birth length, the mercury levels were not associated with newborn anthropometry. CONCLUSIONS Our data implicate that different modes of action may exist for placentar transfer of Pb and Hg as well as that low Pb exposure levels can result in lower birth weight. The findings related to newborn anthropometry need to be confirmed by the examination of larger study groups. Further research is needed to clarify the mechanisms of Pb and Hg transfer via the placenta, and to explore how prenatal Pb exposure is related to intrauterine growth.
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Affiliation(s)
- Claudia Gundacker
- Institute of Medical Genetics, Medical University of Vienna, Währinger Strasse 10, 1090 Vienna, Austria.
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Zhu M, Fitzgerald EF, Gelberg KH, Lin S, Druschel CM. Maternal low-level lead exposure and fetal growth. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:1471-5. [PMID: 20562053 PMCID: PMC2957931 DOI: 10.1289/ehp.0901561] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 05/18/2010] [Indexed: 05/18/2023]
Abstract
BACKGROUND Limited epidemiologic studies have examined the association between maternal low-level lead exposure [blood lead (PbB) < 10 µg/dL] and fetal growth. OBJECTIVE We examined whether maternal low-level lead exposure is associated with decreased fetal growth. METHODS We linked New York State Heavy Metals Registry records of women who had PbB measurements with birth certificates to identify 43,288 mother-infant pairs in upstate New York in a retrospective cohort study from 2003 through 2005. We used multiple linear regression with fractional polynomials and logistic regression to relate birth weight, preterm delivery, and small for gestational age to PbB levels, adjusting for potential confounders. We used a closed-test procedure to identify the best fractional polynomials for PbB among 44 combinations. RESULTS We found a statistically significant association between PbB (square root transformed) and birth weight. Relative to 0 µg/dL, PbBs of 5 and 10 µg/dL were associated with an average of 61-g and 87-g decrease in birth weight, respectively. The adjusted odds ratio for PbBs between 3.1 and 9.9 µg/dL (highest quartile) was 1.04 [95% confidence interval (CI), 0.89-1.22] for preterm delivery and 1.07 (95% CI, 0.93-1.23) for small for gestational age, relative to PbBs ≤ 1 µg/dL (lowest quartile). No clear dose-response trends were evident when all of the quartiles were assessed. CONCLUSIONS Low-level PbB was associated with a small risk of decreased birth weight with a supralinear dose-response relationship, but was not related to preterm birth or small for gestational age. The results have important implications regarding maternal PbB.
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Affiliation(s)
- Motao Zhu
- Department of Community Medicine, West Virginia University, Morgantown, West Virginia, USA
- Address correspondence to M. Zhu, West Virginia University, Department of Community Medicine, White Birch Towers, 4th Floor, 1299 Pineview Dr., Morgantown, West Virginia 26505 USA. Telephone: (304) 293-6682. Fax: (304) 293-0265. E-mail:
| | - Edward F. Fitzgerald
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Rensselaer, New York, USA
| | - Kitty H. Gelberg
- Bureau of Occupational Health, New York State Department of Health, Troy, New York, USA
| | - Shao Lin
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Troy, New York, USA
| | - Charlotte M. Druschel
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Troy, New York, USA
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Blood lead levels among pregnant women: historical versus contemporaneous exposures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1508-19. [PMID: 20617043 PMCID: PMC2872339 DOI: 10.3390/ijerph7041508] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/23/2010] [Accepted: 03/29/2010] [Indexed: 11/16/2022]
Abstract
Blood lead among pregnant women, even at modest levels, may impair offspring cognitive development. We examine whether blood lead levels (BLLs) result from current versus historic exposures, among a cohort of pregnant women. Cumulative logit models were used to characterize the relationship between maternal risk factors and higher BLLs. Maternal blood lead levels more likely result from lead remobilization from historic versus contemporaneous exposures. Even if all lead sources were abated immediately, women and their fetuses would experience lead exposure for decades. This work emphasizes the importance of addressing sources of environmental lead exposure in the United States and internationally.
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Yazbeck C, Thiebaugeorges O, Moreau T, Goua V, Debotte G, Sahuquillo J, Forhan A, Foliguet B, Magnin G, Slama R, Charles MA, Huel G. Maternal blood lead levels and the risk of pregnancy-induced hypertension: the EDEN cohort study. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1526-30. [PMID: 20019901 PMCID: PMC2790505 DOI: 10.1289/ehp.0800488] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 06/26/2009] [Indexed: 05/03/2023]
Abstract
BACKGROUND Prior studies revealed associations of environmental lead exposure with risks of hypertension and elevated blood pressure. OBJECTIVE We examined the effect of blood lead levels on blood pressure and the incidence of pregnancy-induced hypertension (PIH) in the second and third trimesters of pregnancy. METHODS One thousand seventeen pregnant women were enrolled in two French municipalities between 2003 and 2005 for the EDEN (Etude des Déterminants pré et post natals du développement et de la santé de l' Enfant) cohort study. Blood lead concentrations were measured by atomic absorption spectrometry in mothers between 24 and 28 weeks of gestation. RESULTS PIH was diagnosed in 106 subjects (10.9%). Age, parity, weight gain, alcohol, smoking habits, and calcium supplementation were comparable between hypertensive and nonhypertensive women. Lead levels were significantly higher in PIH cases (mean +/- SD, 2.2 +/- 1.4 microg/dL) than in normotensive patients (1.9 +/- 1.2 microg/dL; p = 0.02). Adjustment for potential confounder effects slightly attenuated but did not eliminate the significant association between blood lead levels and the risk of PIH (adjusted odds ratio of PIH = 3.3; 95% confidence interval, 1.1-9.7). We also observed geographic differences in lead exposure and in the incidence of PIH and found significant correlations between blood lead levels and unadjusted as well as adjusted systolic and diastolic blood pressures after 24 weeks of gestation. CONCLUSIONS These findings confirm the relationship between blood lead levels at mid-pregnancy and blood pressure and suggest that environmental lead exposure may play an etiologic role in PIH.
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Ettinger AS, Lamadrid-Figueroa H, Téllez-Rojo MM, Mercado-García A, Peterson KE, Schwartz J, Hu H, Hernández-Avila M. Effect of calcium supplementation on blood lead levels in pregnancy: a randomized placebo-controlled trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:26-31. [PMID: 19165383 PMCID: PMC2627861 DOI: 10.1289/ehp.11868] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 09/02/2008] [Indexed: 05/19/2023]
Abstract
BACKGROUND Prenatal lead exposure is associated with deficits in fetal growth and neurodevelopment. Calcium supplementation may attenuate fetal exposure by inhibiting mobilization of maternal bone lead and/or intestinal absorption of ingested lead. OBJECTIVE Our goal was to evaluate the effect of 1,200 mg dietary calcium supplementation on maternal blood lead levels during pregnancy. METHODS In a double-blind, randomized, placebo-controlled trial conducted from 2001 through 2003 in Mexico City, we randomly assigned 670 women in their first trimester of pregnancy to ingest calcium (n = 334) or placebo (n = 336). We followed subjects through pregnancy and evaluated the effect of supplementation on maternal blood lead, using an intent-to-treat analysis by a mixed-effects regression model with random intercept, in 557 participants (83%) who completed follow-up. We then conducted as-treated analyses using similar models stratified by treatment compliance. RESULTS Adjusting for baseline lead level, age, trimester of pregnancy, and dietary energy and calcium intake, calcium was associated with an average 11% reduction (0.4 microg/dL) in blood lead level relative to placebo (p = 0.004). This reduction was more evident in the second trimester (-14%, p < 0.001) than in the third (-8%, p = 0.107) and was strongest in women who were most compliant (those who consumed > or = 75% calcium pills; -24%, p < 0.001), had baseline blood lead > 5 microg/dL (-17%, p < 0.01), or reported use of lead-glazed ceramics and high bone lead (-31%, p < 0.01). CONCLUSION Calcium supplementation was associated with modest reductions in blood lead when administered during pregnancy and may constitute an important secondary prevention effort to reduce circulating maternal lead and, consequently, fetal exposure.
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Lead hazards for pregnant women and children: part 1: immigrants and the poor shoulder most of the burden of lead exposure in this country. Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do. Am J Nurs 2008; 108:40-9; quiz 50. [PMID: 18827541 DOI: 10.1097/01.naj.0000337736.76730.66] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor, urban, and immigrant populations are at far greater risk for lead exposure than are other groups in the United States. Children with even slightly elevated blood lead levels are at increased risk for significant neurobehavioral problems that can extend through adolescence. Research has shown that elevated blood lead levels in pregnant women, even those well below 10 micrograms per deciliter-the Centers for Disease Control and Prevention's "level of concern"-can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers, routine prenatal lead screening and lead education is not a standard of care. Part 1 of this two-part article presents a short case example of a pregnant mother with lead poisoning and describes the epidemiology of lead exposure in the United States, the main sources of lead exposure, and the effects of lead on the pregnant mother and the developing fetus and child. Prevention is crucial. Treatment options such as chelation must be used selectively and will not reverse damage once it's occurred. Part 2 will describe recommendations for screening, education, nutrition, reducing environmental exposures, and treatment.
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Abstract
OBJECTIVE To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy. DESIGN Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW. RESULTS Of 540 infants, 100 (18.5 %) weighed <or=2.5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1.83; 95 % CI 1.09, 3.07) and none or one prenatal visit (adjPR = 2.18; 95 % CI 1.39, 3.43) were associated with LBW. A statistically significant interaction between mothers' mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake <or=208.7 mg/d (adjPR = 10.67; 95 % CI 1.50, 76.02) and mothers with MUAC less than or equal to the median and vitamin C intake <or=208.7 mg/d (adjPR = 13.19; 95 % CI 1.85, 93.79) more likely to give birth to an LBW infant. CONCLUSIONS In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
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