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Weiss MC, Sun J, Jackson BP, Turyk ME, Wang L, Brown EL, Aguilar D, Hanis CL, Argos M, Sargis RM. Predictors of Toxic Metal/Metalloid Exposures Among Mexican Americans in Starr County, Texas. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02064-3. [PMID: 38969926 DOI: 10.1007/s40615-024-02064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Arsenic, cadmium, and lead are toxic elements that widely contaminate our environment. These toxicants are associated with acute and chronic health problems, and evidence suggests that minority communities, including Hispanic/Latino Americans, are disproportionately exposed. Few studies have assessed culturally specific predictors of exposure to understand the potential drivers of racial/ethnic exposure disparities. OBJECTIVE We sought to evaluate acculturation measures as predictors of metal/metalloid (hereafter "metal") concentrations among Mexican American adults to illuminate potential exposure sources that may be targeted for interventions. METHODS As part of a longitudinal cohort, 510 adults, aged 35 to 69 years, underwent baseline interview, physical examination, and urine sample collection. Self-reported acculturation was assessed across various domains using the Short Acculturation Scale for Hispanics (SASH). Multivariable linear regression was used to assess associations between acculturation and urinary concentrations of arsenic, cadmium, and lead. Ordinal logistic regression was utilized to assess associations between acculturation and a metal mixture score. Lastly, best subset selection was used to build a prediction model for each toxic metal with a combination of the acculturation predictors. RESULTS After adjustment, immigration factors were positively associated with arsenic and lead concentrations. For lead alone, English language and American media and food preferences were associated with lower levels. Immigration and parental heritage from Mexico were positively associated with the metal mixture, while preferences for English language, media, and food were negatively associated. CONCLUSION Acculturation-related predictors of exposure provide information about potential sources of toxic metals, including international travel, foods, and consumer products. The findings in this research study provide information to empower future efforts to identify and address specific acculturation-associated toxicant exposures in order to promote health equity through clinical guidance, patient education, and public policy.
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Affiliation(s)
- Margaret C Weiss
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jiehuan Sun
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Brian P Jackson
- Department of Earth Sciences, Dartmouth College, Hanover, NH, USA
| | - Mary E Turyk
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
- Chicago Center for Health and Environment, Chicago, IL, USA
| | - Luyu Wang
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Eric L Brown
- Center for Infectious Disease, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Aguilar
- Division of Cardiovascular Medicine, LSU Health School of Medicine, New Orleans, LA, USA
| | - Craig L Hanis
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maria Argos
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Robert M Sargis
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA.
- Chicago Center for Health and Environment, Chicago, IL, USA.
- Section of Endocrinology, Diabetes, and Metabolism, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA.
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois Chicago, 835 S. Wolcott, Suite E625; M/C 640, Chicago, IL, 60612, USA.
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Fong KC, Heo S, Lim CC, Kim H, Chan A, Lee W, Stewart R, Choi HM, Son JY, Bell ML. The Intersection of Immigrant and Environmental Health: A Scoping Review of Observational Population Exposure and Epidemiologic Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:96001. [PMID: 36053724 PMCID: PMC9438924 DOI: 10.1289/ehp9855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Transnational immigration has increased since the 1950s. In countries such as the United States, immigrants now account for > 15 % of the population. Although differences in health between immigrants and nonimmigrants are well documented, it is unclear how environmental exposures contribute to these disparities. OBJECTIVES We summarized current knowledge comparing immigrants' and nonimmigrants' exposure to and health effects of environmental exposures. METHODS We conducted a title and abstract review on articles identified through PubMed and selected those that assessed environmental exposures or health effects separately for immigrants and nonimmigrants. After a full text review, we extracted the main findings from eligible studies and categorized each article as exposure-focused, health-focused, or both. We also noted each study's exposure of interest, study location, exposure and statistical methods, immigrant and comparison groups, and the intersecting socioeconomic characteristics controlled for. RESULTS We conducted a title and abstract review on 3,705 articles, a full text review on 84, and extracted findings from 50 studies. There were 43 studies that investigated exposure (e.g., metals, organic compounds, fine particulate matter, hazardous air pollutants) disparities, but only 12 studies that assessed health disparities (e.g., mortality, select morbidities). Multiple studies reported higher exposures in immigrants compared with nonimmigrants. Among immigrants, studies sometimes observed exposure disparities by country of origin and time since immigration. Of the 50 studies, 43 were conducted in North America. DISCUSSION The environmental health of immigrants remains an understudied area, especially outside of North America. Although most identified studies explored potential exposure disparities, few investigated subsequent differences in health effects. Future research should investigate environmental health disparities of immigrants, especially outside North America. Additional research gaps include the role of immigrants' country of origin and time since immigration, as well as the combined effects of immigrant status with intersecting socioeconomic characteristics, such as race/ethnicity, income, and education attainment. https://doi.org/10.1289/EHP9855.
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Affiliation(s)
- Kelvin C. Fong
- School of the Environment, Yale University, New Haven, Connecticut, USA
- Department of Earth and Environmental Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Seulkee Heo
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Chris C. Lim
- Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Honghyok Kim
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Alisha Chan
- School of the Environment, Yale University, New Haven, Connecticut, USA
- School of Engineering & Applied Science, Yale University, New Haven, Connecticut, USA
| | - Whanhee Lee
- School of the Environment, Yale University, New Haven, Connecticut, USA
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Rory Stewart
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | | | - Ji-Young Son
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Michelle L. Bell
- School of the Environment, Yale University, New Haven, Connecticut, USA
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McElroy KG, Iobst SE, DeVance-Wilson C, Ludeman E, Barr E. Systematic Review and Meta-Analysis of the Effect of Nutrients on Blood Lead Levels in Pregnancy. J Obstet Gynecol Neonatal Nurs 2020; 49:243-253. [PMID: 32259512 DOI: 10.1016/j.jogn.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To synthesize experimental and nonexperimental research on the relationship between nutrients and blood lead levels in pregnant women. We also performed a meta-analysis on a subgroup of studies on calcium and blood lead levels. DATA SOURCES PubMed, Embase, and CINAHL databases were searched in July 2019. STUDY SELECTION We included articles published in English in any year that reported the results of experimental or observational studies on the effect of nutrients on blood lead levels in pregnancy. DATA EXTRACTION Three nurse reviewers extracted data and appraised the studies using tools from the Joanna Briggs Institute. DATA SYNTHESIS AND META-ANALYSIS We included 28 studies from 16 countries. Study authors examined 14 distinct nutrients, with calcium being the most frequent. The metaregression included nine analyses of the effect of calcium on blood lead levels and showed a small but significant inverse relationship. The quality of evidence for the effect of calcium on lead levels was high. Eleven analyses were related to the effect of iron on blood lead levels. The quality of evidence was high, and we found mostly negative associations between iron intake and blood lead levels. The quality of evidence for the remaining nutrients was moderate, with few significant findings. CONCLUSION Targeted nutritional interventions may be beneficial for pregnant women with current lead exposure or a history of elevated lead levels, particularly those with calcium- or iron-deficient diets. More rigorously designed studies are needed in this area.
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Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite 2017; 120:163-170. [PMID: 28864256 DOI: 10.1016/j.appet.2017.08.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/17/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Anecdotal evidence suggests that pica occurs among Hispanic women in the United States, especially during pregnancy. However, the prevalence and socio-demographic and biological factors associated with pica in this population have not been adequately identified. METHODS Trained, bilingual study personnel conducted structured interviews at public health clinics in Salinas Valley, California with 187 pregnant Hispanic women in their 2nd or 3rd trimesters of pregnancy. Hemoglobin was measured using Hemocue; concentrations of transferrin receptor (TfR) and alpha-1 acid glycoprotein (AGP) were measured in dried blood spots. Multivariable stepwise regression analyses were conducted with pica during pregnancy as the dependent variable and individual- and family-level factors as independent variables to identify significant associations. Additionally, multivariable models were built to explore the associations between pica and iron status (iron deficiency and anemia). RESULTS Half of all participants (51.3%) had ever engaged in pica, and 37.6% had done so during the current pregnancy. Pica substances included large quantities of ice, frost, raw starches, and various earthen items. Pica during the current pregnancy was significantly associated with higher TfR concentrations [OR: 1.29; 95% CI: 1.11, 1.51] indicative of low iron stores and greater food insecurity [OR: 1.20, 95% CI: 1.03, 1.40]. Women who engaged in pica during the current pregnancy were more likely to be iron deficient [adjusted OR: 2.58; 95% CI: 1.19, 5.60], but not anemic [adjusted OR: 1.40; 0.60, 3.23]. CONCLUSIONS Among pregnant Hispanic women, pica was prevalent and strongly associated with iron deficiency and food insecurity. Clinicians should screen for pica during pregnancy in Hispanic populations, and future studies should elucidate the underlying etiology and consequences of engaging in pica during pregnancy.
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Ivoke N, Ikpor N, Ivoke O, Ekeh F, Ezenwaji N, Odo G, Iyaji F, Onoja U, Eyo J. Geophagy as risk behaviour for gastrointestinal nematode infections among pregnant women attending antenatal clinics in a humid tropical zone of Nigeria. Afr Health Sci 2017; 17:24-31. [PMID: 29026374 DOI: 10.4314/ahs.v17i1.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Geophagy is wide spread among pregnant women in Ebonyi State, Nigeria. OBJECTIVE The aim of this study was to assess intestinal nematode infections among geophagous pregnant women in Southern Ebonyi State, Nigeria. METHODS Pregnant women were aged 17-45 years at gestational ages of ≥ 14 to 24 weeks on hospital enrolment were sampled. Data on geophagy was collected using structured questionnaire. Gastrointestinal nematode status of the participants was determined by stool analyses. Soil types ingested were examined for intestinal nematode ova / larvae. RESULTS The prevalence of geophagy (46.4%) was associated with socio-demographic characteristics. Ascaris lumbricoides and hookworm were associated with geophagy while Trichuris trichiura and Strongyloides stercoralis had no association. Prevalence of A. lumbricoides, T. trichiura and S. stercoralis differed significantly (p<0.05) between geophagous and non-geophagous women. The soil types consumed had eggs / larvae of A. lumbricoides and T. trichiura. Geophagy is a risk behaviour directly associated with A. lumbricoides, hookworm, T. trichiura, and to a lesser extent S. stercoralis infection among pregnant women. CONCLUSION Sensitization and mass education of pregnant women on the dangers of geophagy is needed. Furthermore, deworming of pregnant women should be integrated into the healthcare delivery system of the State.
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Affiliation(s)
- Njoku Ivoke
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Nnenna Ikpor
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Obinna Ivoke
- Jackson State University, Department of Epidemiology and Biostatistics, School of Public Health
| | - Felicia Ekeh
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Ngozi Ezenwaji
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Gregory Odo
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Florence Iyaji
- Kogi State University, Department of Biological Sciences
| | - Uwakwe Onoja
- University of Nigeria, Department of Home Science, Nutrition and Dietetics, Faculty of Agriculture
| | - Joseph Eyo
- University of Nigeria, Department of Zoology and Environmental Biology
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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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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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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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Bakhireva LN, Rowland AS, Young BN, Cano S, Phelan ST, Artyushkova K, Rayburn WF, Lewis J. Sources of potential lead exposure among pregnant women in New Mexico. Matern Child Health J 2013; 17:172-9. [PMID: 22362260 DOI: 10.1007/s10995-012-0963-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objectives of this study were to ascertain the prevalence and potential sources of lead exposure among pregnant women residing in a socially-disadvantaged immigrant community in Albuquerque, New Mexico. Pregnant women (n = 140) receiving prenatal care through a community clinic participated in a structured interview and screening to measure their blood lead levels (BLLs). Potential sources of lead exposure were ascertained by the CDC and New Mexico Department of Health questionnaires. Self-reported risk factors were examined as predictors of BLLs using multiple linear regression and partial least squares discriminant analysis. Most patients were Spanish-speaking (88.6%), Latina (95%), foreign-born (87.1%), lacked health insurance (86.4%), and had a high school education or lower (84.3%). While risk factors were prevalent in this population, only three women (2.1%) had BLLs ≥3 μg/dL. Results of multivariate analyses demonstrated that pica symptoms in pregnancy, history of elevated BLLs before pregnancy, use of non-commercial pottery, and living in older houses were important predictors of elevated BLLs. Although the prevalence of other risk factors relevant to immigrant communities (i.e., use of traditional/folk remedies and cosmetics, seasonings and food products from Mexico) was high, they were not predictive of elevated BLLs. Clinics providing prenatal care to immigrant Hispanic communities should carefully assess patients' pica symptoms, use of non-commercial pottery, and a history of elevated BLLs. Moreover, additional efforts need to focus on the development of screening questionnaires which better reflect exposures of concern in this population.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, USA.
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Thihalolipavan S, Candalla BM, Ehrlich J. Examining Pica in NYC Pregnant Women with Elevated Blood Lead Levels. Matern Child Health J 2012; 17:49-55. [DOI: 10.1007/s10995-012-0947-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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La-Llave-León O, Estrada-Martínez S, Manuel Salas-Pacheco J, Peña-Elósegui R, Duarte-Sustaita J, Candelas Rangel JL, García Vargas G. Blood lead levels and risk factors in pregnant women from Durango, Mexico. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2011; 66:107-113. [PMID: 24484368 DOI: 10.1080/19338244.2010.511311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this cross-sectional study the authors determined blood lead levels (BLLs) and some risk factors for lead exposure in pregnant women. Two hundred ninety-nine pregnant women receiving medical attention by the Secretary of Health, State of Durango, Mexico, participated in this study between 2007 and 2008. BLLs were evaluated with graphite furnace atomic absorption spectrometry. The authors used Student t test, 1-way analysis of variance (ANOVA), and linear regression as statistical treatments. BLLs ranged from 0.36 to 23.6 μg/dL (mean = 2.79 μg/dL, standard deviation = 2.14). Multivariate analysis showed that the main predictors of BLLs were working in a place where lead is used, using lead glazed pottery, and eating soil.
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Affiliation(s)
- Osmel La-Llave-León
- a Institute of Scientific Research , , University of Juárez at Durango,Gómez Palacio , México
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Young SL, Khalfan SS, Farag TH, Kavle JA, Ali SM, Hajji H, Rasmussen KM, Pelto GH, Tielsch JM, Stoltzfus RJ. Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania. Am J Trop Med Hyg 2010; 83:144-51. [PMID: 20595493 DOI: 10.4269/ajtmh.2010.09-0442] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.
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Affiliation(s)
- Sera L Young
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA 95817, USA.
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Amaya MA, Jolly KW, Pingitore NE. Blood lead in the 21st Century: The sub-microgram challenge. J Blood Med 2010; 1:71-8. [PMID: 22282686 PMCID: PMC3262323 DOI: 10.2147/jbm.s7765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Indexed: 11/23/2022] Open
Abstract
In the US the dominant sources of lead through much of the 20th Century (eg, vehicular emissions, plumbing, household paint) have been significantly diminished. The reductions in adult and pediatric average blood lead levels in the US have been extraordinary. Progress continues: the US Environmental Protection Agency recently developed a new air standard for lead. In the 21st Century, the average blood lead level in a society may be seen as a marker of the status of their public's health. However, the threat of lead exposure remains a significant public health problem among subpopulation groups in the US and in many less developed countries. This paper examines some of the specific issues involved in the reduction of blood lead in a post-industrial era. These involve the control of the remaining exogenous primary sources, both general (eg, industrial emissions) and specific (eg, at-risk occupations), exogenous secondary sources (eg, contaminated urban soils, legacy lead-based paints), an endogenous source (ie, cumulative body lead burden) and emergent sources.
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Affiliation(s)
- Maria A Amaya
- School of Nursing, The University of Texas at El Paso, El Paso, TX, USA
| | - Kevin W Jolly
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas, USA
| | - Nicholas E Pingitore
- School of Nursing, The University of Texas at El Paso, El Paso, TX, USA
- Department of Geological Sciences, The University of Texas at El Paso, El Paso, TX, USA
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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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Brown RW, Longoria T. Multiple risk factors for lead poisoning in Hispanic sub-populations: a review. J Immigr Minor Health 2009; 12:715-25. [PMID: 19330449 DOI: 10.1007/s10903-009-9245-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 03/08/2009] [Indexed: 12/19/2022]
Abstract
As a result of recent media attention to lead (Pb) in consumer products, Pb exposure and toxicity to children has been placed back on the national agenda. This review presents the current literature on sources of Pb in Hispanic sub-populations in the broader context of national lead poisoning trends, sources, and exposure pathways. Pb poisoning among Hispanics is a multi-dimensional issue that is far more complex than for the general population in terms of environmental, cultural, and social dimensions. As a result, a higher percentage of Hispanic children have elevated blood lead levels compared to the general population. Given the additional risks that Hispanics face, all Hispanic children should be defined as "at risk" for lead exposure and included in targeted screening programs. This review concludes with specific public policy recommendations that directly address the increased risk of Pb poisoning to Hispanic children so that Pb will poison fewer children in the future.
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Affiliation(s)
- Ray W Brown
- The Institute of Environmental and Human Health, Texas Tech University, Lubbock, TX 79409-1163, USA.
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Janjua NZ, Delzell E, Larson RR, Meleth S, Kabagambe EK, Kristensen S, Sathiakumar N. Maternal nutritional status during pregnancy and surma use determine cord lead levels in Karachi, Pakistan. ENVIRONMENTAL RESEARCH 2008; 108:69-79. [PMID: 18656859 PMCID: PMC2581773 DOI: 10.1016/j.envres.2008.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/05/2008] [Accepted: 06/12/2008] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To estimate the umbilical cord blood lead levels (BLLs) of Pakistani neonates and to identify determinants for umbilical BLLs. METHODS We conducted a cross-sectional study of mothers and infants at one of the two obstetric units of two tertiary care hospitals in Karachi during January-August 2005. Information from 540 mothers selected randomly from those registered for delivery was obtained about their pregnancy, diet, and current and past lead exposures. We collected umbilical cord blood for lead levels analyzed using graphite furnace atomic absorption spectrophotometry. We computed geometric and arithmetic means. We performed multiple linear regression analysis to identify factors associated with log-transformed umbilical cord BLLs. We also performed logistic regression analysis to identify determinants of high lead cord BLLs (10 microg/dl). RESULTS The geometric mean cord BLL of the neonates was 9.6 microg/dl; arithmetic mean (S.D.) was 10.8 microg/dl (5.7) with a median of 9.7 microg/dl and a range of 1.8-48.9 microg/dl. Women who reported intake of less than 58.5mg of elemental iron supplement per day during pregnancy had cord BLL of 10.0 microg/dl; in comparison those women who had higher iron intake had lower cord BLL (8.4 microg/dl). Those who used surma (an eye cosmetic) daily had higher cord BLL (11.5 microg/dl) as compared to those who used it less frequently (9.4 microg/dl). In multivariable linear regression model, higher iron intake, owning a car, and being in 2nd quartile of mid-arm circumference were associated with low lead levels while father's occupation in lead-based industry was associated with significantly higher umbilical cord BLLs. There was interaction of daily surma use and ethnicity. Geometric mean BLLs were varied among surma users by ethnicity. CONCLUSIONS Umbilical cord BLLs are high in Karachi, Pakistan, in comparison to those in developed countries such as United States. Measures are needed to reduce fetal lead exposure to prevent adverse affect on neurocognitive development. Association of low iron (below RDA of 60 mg per day) with high umbilical cord has implications for strengthening iron supplement intake during pregnancy. Umbilical cord BLLs differed among surma users by ethnicity.
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Affiliation(s)
- Naveed Zafar Janjua
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 430, Birmingham, AL 35294, USA.
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Geophagia is not associated with Trichuris or hookworm transmission in Zanzibar, Tanzania. Trans R Soc Trop Med Hyg 2007; 101:766-72. [PMID: 17568644 DOI: 10.1016/j.trstmh.2007.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 04/25/2007] [Accepted: 04/25/2007] [Indexed: 11/20/2022] Open
Abstract
Geophagia may be harmful as a method for the transmission of geohelminths. In this study, we pose two questions in a representative sample of 970 pregnant women from Pemba Island, Zanzibar, Tanzania. Can consumed earth be a vector for geohelminth infection? And do geophagists have differential parasitic infection? The parasitological content of 59 non-food substance samples was analysed. Cross-sectional data regarding pica behaviour were collected through interviews conducted by local researchers. Ascaris, Trichuris and hookworm status was ascertained through Kato-Katz smears. The prevalence of geophagia at baseline was 5.6% and the overall prevalence of Ascaris, Trichuris and hookworm infection was 5.6%, 33.2% and 32.9%, respectively. No consumed soil samples contained infectious parasitic stages, and only one of the consumed pica substances (charcoal) contained parasites of potential risk to human health. In bivariate analyses, neither the prevalence nor the intensity of infection with Ascaris, Trichuris or hookworm differed significantly by geophagia status. Furthermore, in multivariate models, geophagia was not a significant predictor of helminth infection status. We conclude that geophagia is not a source of Trichuris or hookworm infection among pregnant women in Pemba (insufficient power to evaluate the effect of Ascaris), which is in contrast to existing findings of helminth infection and geophagia.
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18
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Abstract
The heavy metal lead is a widely deposited environmental toxicant known to impact numerous physiological systems, including the reproductive, neurological, hepatic, renal, and immune systems. Studies illustrating the capacity of lead to impair immune function and/or host resistance to disease date back to at least the 1960s. However, it has only been in recent years that lead has been recognized among a new category of immunotoxicants-those that dramatically shift immune functional capacity while producing only modest changes to immune cell populations and lymphoid organs. These relatively noncytotoxic immunomodulating chemicals and drugs represent the immunotoxic hazards most difficult to identify and problematic for risk assessment using historic approaches. As a result, such environmental factors are also among the most likely to contribute to chronic immune-related disease at relevant exposure levels. This review considers the animal and human evidence that lead exposure can produce a stark shift in immune functional capacity with a skewing predicted to elevate the risk of atopic and certain autoimmune diseases. At the same time, host defenses against infectious agents and cancer may be reduced. Age-based exposure studies also suggest that levels of blood lead previously thought to be safe, that is, below 10 microg/dl, may be associated with later life immune alterations.
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Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA.
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19
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Jelliffe-Pawlowski LL, Miles SQ, Courtney JG, Materna B, Charlton V. Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes. J Perinatol 2006; 26:154-62. [PMID: 16453008 DOI: 10.1038/sj.jp.7211453] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth. STUDY DESIGN Among a sample of 262 mother-infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors. RESULTS Women with maximum pregnancy BLLs (max-PBLLs) > or =10 microg/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10 mug/dl was found to be associated with a decrease of -0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs > or =10 microg/dl were at a threefold increased risk for preterm birth (adjusted OR=3.2, 95% CI 1.2-7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR=4.2, 1.3-13.9). Second trimester maximum BLLs > or =10 microg/dl were associated with a steep decrease in total days of gestation (a decrease of -1.0 days per each unit increase above 10 microg/dl). CONCLUSIONS These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are > or =10 microg/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.
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Affiliation(s)
- L L Jelliffe-Pawlowski
- Childhood Lead Poisoning Prevention Branch, California Department of Health Services, Oakland, CA 94804-6403, USA.
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20
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Abstract
This review focuses on the impacts of lead exposure on reproductive health and outcomes. High levels of paternal lead exposure (>40 microg/dl or >25 microg/dl for a period of years) appear to reduce fertility and to increase the risks of spontaneous abortion and reduced fetal growth (preterm delivery, low birth weight). Maternal blood lead levels of approximately 10 microg/dl have been linked to increased risks of pregnancy hypertension, spontaneous abortion, and reduced offspring neurobehavioral development. Somewhat higher maternal lead levels have been linked to reduced fetal growth. Some studies suggest a link between increased parental lead exposure and congenital malformations, although considerable uncertainty remains regarding the specific malformations and the dose-response relationships. Common methodological weaknesses of studies include potential exposure misclassifications due to the frequent unavailability of exposure biomarker measurements at biologically appropriate times and uncertainty regarding the best exposure biomarker(s) for the various outcomes. A special concern with regard to the pregnant woman is the possibility that a fetus might be exposed to lead mobilized from bone stores as a result of pregnancy-related metabolic changes, making fetal lead exposure the result of exposure to exogenous lead during pregnancy and exposure to endogenous lead accumulated by the woman prior to pregnancy. By reducing bone resorption, increased calcium intake during the second half of pregnancy might reduce the mobilization of lead from bone compartments, even at low blood lead levels. Subgroups of women who incurred substantial exposures to lead prior to pregnancy should be considered to be at increased risk.
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Affiliation(s)
- David C Bellinger
- Children's Hospital Boston, Harvard Medical School, Harvard School of Public Health, Farley Basement Box 127, 300 Longwood Avenue, Boston, MA 02115, USA.
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Nguyen A, Schaider JJ, Manzanares M, Hanaki R, Rydman RJ, Bokhari F. Elevation of Blood Lead Levels in Emergency Department Patients with Extra-articular Retained Missiles. ACTA ACUST UNITED AC 2005; 58:289-99. [PMID: 15706190 DOI: 10.1097/01.ta.0000119205.24520.1d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who survive gunshot wounds often have retained missiles. Unlike intra-articular retained missiles, extra-articular retained missiles (EARMs) are not routinely removed. Cases of lead toxicity from EARMs have been described. This study seeks to determine whether blood lead levels are elevated in emergency department patients with EARMs compared with matched controls, whether clinical symptoms of lead toxicity are more prevalent in patients with EARMs than in controls, and whether longer missile retention times or recent hypermetabolic conditions are associated with higher blood lead levels. METHODS One hundred twenty adults with EARMs and 120 age- and gender-matched controls with no history of gunshot wound were prospectively enrolled on presentation to a large urban emergency department. Whole blood lead (WBL), zinc protoporphyrin, and hemoglobin levels were obtained. Patients completed a questionnaire regarding time since gunshot injury; symptoms of lead toxicity; and occurrence within 30 days of any surgery, alcohol abuse, illicit drug abuse, diabetic ketoacidosis, hyperthyroidism, infection, fracture, pregnancy, or lactation. RESULTS Five EARM patients (4%) and no control patients (0%) had WBL greater than our threshold for medical follow-up (20 microg/dL). Mean WBL was 6.71 microg/dL (95% confidence interval [CI], 5.68-7.74 microg/dL) in EARM patients and 3.16 mug/dL (95% CI, 2.79-3.53 microg/dL) in controls. This difference was statistically significant when analyzed by matched pairs t test (p = 0.0001). There was no difference in the number of symptoms associated with lead toxicity that were noted by EARM patients versus controls (p = 0.377). Longer duration of missile retention was not associated with higher blood lead levels (r = 0.125, p = 0.172). Of the five hypermetabolic conditions analyzed, only fractures were associated with elevated blood lead levels (9.95 microg/dL [95% CI, 5.77-14.13 microg/dL] in EARM patients with fractures vs. 6.23 microg/dL [95% CI, 5.23-7.23 microg/dL] in EARM patients without fractures). CONCLUSION Patients with EARMs have significantly elevated blood lead levels compared with matched controls. The occurrence of a bony fracture within the past 30 days is associated with a higher lead level. In 96% of patients with EARMs, elevated lead levels were not clinically significant and did not change patient management.
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Affiliation(s)
- Ann Nguyen
- Department of Emergency Medicine, Bellevue Hospital Center and New York University Medical Center, New York, NY 10016, USA.
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22
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Lin C, Kim R, Tsaih SW, Sparrow D, Hu H. Determinants of bone and blood lead levels among minorities living in the Boston area. ENVIRONMENTAL HEALTH PERSPECTIVES 2004; 112:1147-51. [PMID: 15289158 PMCID: PMC1247473 DOI: 10.1289/ehp.6705] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 05/03/2004] [Indexed: 05/20/2023]
Abstract
We measured blood and bone lead levels among minority individuals who live in some of Boston's neighborhoods with high minority representation. Compared with samples of predominantly white subjects we had studied before, the 84 volunteers in this study (33:67 male:female ratio; 31-72 years of age) had similar educational, occupational, and smoking profiles and mean blood, tibia, and patella lead levels (3 microg/dL, 11.9 microg/g, and 14.2 microg/g, respectively) that were also similar. The slopes of the univariate regressions of blood, tibia, and patella lead versus age were 0.10 microg/dL/year (p < 0.001), 0.45 microg/g/year (p < 0.001), and 0.73 microg/g/year (p < 0.001), respectively. Analyses of smoothing curves and regression lines for tibia and patella lead suggested an inflection point at 55 years of age, with slopes for subjects greater than or equal to 55 years of age that were not only steeper than those of younger subjects but also substantially steeper than those observed for individuals > 55 years of age in studies of predominantly white participants. This apparent racial disparity at older ages may be related to differences in historic occupational and/or environmental exposures, or possibly the lower rates of bone turnover that are known to occur in postmenopausal black women. The higher levels of lead accumulation seen in this age group are of concern because such levels have been shown in other studies to predict elevated risks of chronic disease such as hypertension and cognitive dysfunction. Additional research on bone lead levels in minorities and their socioeconomic and racial determinants is needed.
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Affiliation(s)
- Charles Lin
- School of Medicine, University of California at San Francisco, San Francisco, CA 94122, USA.
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23
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Lowry LK, Cherry DC, Brady CF, Huggins B, D'Sa AM, Levin JL. An unexplained case of elevated blood lead in a Hispanic child. ENVIRONMENTAL HEALTH PERSPECTIVES 2004; 112:222-5. [PMID: 14754577 PMCID: PMC1241832 DOI: 10.1289/ehp.6486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A 6-month-old child presented to a local pediatrician with an elevated blood lead level (BLL) of 41 microg/dL. The child was treated as an outpatient for chelation therapy by a toxicologist. Subsequent BLLs obtained at 8 and 13 months of age were 40 microg/dL and 42 microg/dL, respectively. Siblings and family members had BLLs < 5 microg/dL except for the mother, who had a BLL of 14 microg/dL when the child was 6 months of age. Home inspections and phone calls to the family revealed no sources of lead from paint, dust, toys, mini-blinds, keys, food, water, or any take-home exposure. The family denied use of folk remedies such as Greta and Azarcon. The child was breast-fed, but the mother's BLL was not sufficiently high to explain the elevated BLL in the child. Housekeeping was excellent. The mother did admit to cooking beans in Mexican pottery (pieces found outside were positive for lead), but she discontinued use after the initial lead check at 6 months. The bean pot was not a likely source, as none of the family had elevated BLLs including a 5-year-old sister. Follow-up testing of blood lead when the child was 15 months of age revealed values of 28 microg/dL for the child and 9 microg/dL for the mother. Subsequent testing of the child shows a slow decline. The slow release of lead suggests depletion of bone stores acquired during pregnancy, possibly due to pica behavior of the mother during pregnancy.
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Affiliation(s)
- Larry K Lowry
- Southwest Center for Pediatric Environmental Health, The University of Texas Health Center at Tyler, Tyler, Texas 75708-3154, USA.
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24
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Falcón M, Viñas P, Osuna E, Luna A. Environmental exposures to lead and cadmium measured in human placenta. ARCHIVES OF ENVIRONMENTAL HEALTH 2002; 57:598-602. [PMID: 12696659 DOI: 10.1080/00039890209602094] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pregnant women exposed to even low levels of environmental lead and cadmium may experience adverse perinatal effects. To evaluate the usefulness of the placenta for monitoring environmental lead and cadmium exposure, concentrations of both metals were measured in placentas (n = 86) with atomic absorption spectrometry. Environmental exposure was assessed in accordance with the degree of industrial activity and transport pollution near the places of residence. The authors found significantly higher lead and cadmium levels in placentas of women living in urban-industrial areas than in placentas of women living in rural areas. Lead concentrations in placenta reflect environmental exposures; smoking during gestation explained a large portion of placental cadmium. This finding suggests that when a pregnant woman is a heavy smoker, tobacco exposure masks environmental cadmium exposure, especially in areas with low levels of cadmium pollution.
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Affiliation(s)
- María Falcón
- Department of Forensic Medicine, University of Murcia, Espinardo, Murcia, Spain
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Klitzman S, Sharma A, Nicaj L, Vitkevich R, Leighton J. Lead poisoning among pregnant women in New York City: risk factors and screening practices. J Urban Health 2002; 79:225-37. [PMID: 12023498 PMCID: PMC3456812 DOI: 10.1093/jurban/79.2.225] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This article presents information on pregnant women with incident blood lead levels (BLLs) of 20 microg per deciliter or greater as reported to the New York City Department of Health between September 1996 and June 1999 (n = 33). Almost half of the women were diagnosed during their third trimester of pregnancy, often at their first prenatal visit. The median BLLs at incidence and at last report among women who were retested were 25 and 15 gamma/dL, respectively, a 40% decline. The median incident BLL among newborns (n = 25) was 12 microg/dL. The BLLs were inversely associated with maternal age and length of time in the United States and directly associated with gestational age and pica behavior. Cases were more than twice as likely to be foreign-born women than all women who gave birth in New York City. Prenatal care facilities employing a policy of universal blood lead testing of all pregnant women at the time of their first visit reported disproportionate numbers of cases, accounting for 77% of cases yet only 11% of all births citywide. The findings suggest that (1) the promulgation of recent rules and guidelines for lead risk assessment and screening among pregnant women appears to have been effective in identifying cases that might not have otherwise come to light; (2) case management and environmental interventions were initiated promptly; (3) cases experienced, on average, significant BLL reductions over time; and (4) there is a need for additional public health interventions for pregnant women in urban, multicultural centers. While the data suggest that universal screening may increase case finding among high-risk, immigrant populations, further studies and surveillance are needed to determine systematically the most effective approach.
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26
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Bonde JP, Joffe M, Apostoli P, Dale A, Kiss P, Spano M, Caruso F, Giwercman A, Bisanti L, Porru S, Vanhoorne M, Comhaire F, Zschiesche W. Sperm count and chromatin structure in men exposed to inorganic lead: lowest adverse effect levels. Occup Environ Med 2002; 59:234-42. [PMID: 11934950 PMCID: PMC1740274 DOI: 10.1136/oem.59.4.234] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To obtain knowledge on male reproductive toxicity of inorganic lead at current European exposure levels and to establish lowest adverse effect levels, if any. METHODS A cross sectional survey of the semen of 503 men employed by 10 companies was conducted in the United Kingdom, Italy, and Belgium. The mean blood lead concentration was 31.0 microg/dl (range 4.6-64.5) in 362 workers exposed to lead and 4.4 microg/dl (range below the detection limit of 19.8) in 141 reference workers. Semen volume and sperm concentration were determined in a fresh semen sample according to an agreed protocol subject to quality assurance. The sperm chromatin structure assay (SCSA) was performed at a centralised laboratory. Extraneous determinants including centre, period of sexual abstinence, and age were taken into account in the statistical analysis. If appropriate, possible thresholds were examined by iterative threshold slope linear regression. RESULTS The median sperm concentration was reduced by 49% in men with blood lead concentration above 50 microg/dl. There was no indication of a linear trend of lower sperm concentration with increasing blood lead values, but threshold slope least square regression identified a blood lead concentration of 44 microg/dl (beta=-0.037, F=4.35, p=0.038) as a likely threshold. Abnormal sperm chromatin structure was not related to blood lead concentration, but some indications of deterioration of sperm chromatin was found in men with the highest concentrations of lead within spermatozoa. Biological monitoring data did not indicate long term effects of lead on semen quantity or sperm chromatin. CONCLUSION Adverse effects of lead on sperm concentration and susceptibility to acid induced denaturation of sperm chromatin are unlikely at blood lead concentrations below 45 microg/dl. Effects of low level exposure to lead on other measures of testicular function cannot be ruled out.
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Affiliation(s)
- J P Bonde
- Department of Occupational Medicine, University Hospital of Aarhus, Denmark.
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27
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Stevens YW, Williams-Johnson MM, De Rosa CT, Cibulas W. Findings and accomplishments of ATSDR's Superfund-mandated Substance-Specific Applied Research Program. Int J Hyg Environ Health 2002; 205:29-39. [PMID: 12018014 DOI: 10.1078/1438-4639-00127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Priority research needs determined by the Agency for Toxic Substances and Disease Registry (ATSDR) for the agencies top-ranked hazardous substances are being filled via regulatory mechanisms, private sector voluntarism, and university-based research. To date, 17 studies have been completed, 12 are ongoing, and 12 are currently planned. Under the direction of the Substance-Specific Applied Research Program (SSARP), ATSDR-supported research has filled research needs that significantly improved the information base available for making appropriate public health decisions. With the knowledge and understanding gained from this research, health professionals are better able to identify and interdict significant exposure and mitigate toxicity when exposure occurs. Thus, the SSARP has played, and continues to play, a vital role in contributing towards improving ATSDR's efforts to meet its mission and goals in environmental public health. In addition to addressing research needs of interest to ATSDR, findings from the program have contributed to the overall scientific knowledge about the effects of toxic substances in the environment.
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Affiliation(s)
- Yee-Wan Stevens
- Division of Toxicology, Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services, Atlanta, Georgia, USA.
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28
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Bulleova S, Rothenberg SJ, Manalo MA. Lead levels in blood bank blood. ARCHIVES OF ENVIRONMENTAL HEALTH 2001; 56:312-3. [PMID: 11572273 DOI: 10.1080/00039890109604461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although blood bank blood is usually screened for dangerous pathogens, the presence of toxic metals in blood has received little attention. Population blood lead levels have been declining in the United States, but occasional high outliers in blood lead concentration can be found--even when mean levels of blood lead are low. We sampled 999 consecutive blood bank bags from the King/Drew Medical Center, used between December 1999 and February 2000. The geometric mean blood lead level was 1.0 microg/dl (0.048 micromol/l), but 0.5% of the samples had lead levels that exceeded 10 microg/dl, and 2 samples had lead levels that exceeded 30 microg/dl. The 2 samples with the highest lead levels could have presented an additional risk to infants if they were used for blood replacement. Therefore, even in countries with generally low population blood lead levels, blood bank blood should be screened for lead concentration prior to use with infants.
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Affiliation(s)
- S Bulleova
- King-Drew Medical Center, Los Angeles, California, USA
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Abstract
Serum lead concentrations measured by stable isotope dilution with a thermal ionization mass spectrometer and blood lead concentrations measured by graphite furnace atomic absorption spectrophotometry are reported for 73 women of child bearing age resident in Los Angeles, California. The two quantities are related by the line y=0.00030+0.00241x (r=0.83), where y is serum lead concentration and x is blood lead concentration, both being expressed in units of microg/L. The linearity of the relationship appears to hold to a blood lead concentration of at least 60 microg Pb/L. The slope of the line indicates that lead in serum is 0.24% of that in whole blood in contrast to recent reports of between 0.32 and 0.35% determined by inductively coupled plasma (ICP) mass spectrometry with bismuth used as an internal standard. The discrepancy stems from the ICP mass spectrometer-generated curves not passing through the origin.
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Affiliation(s)
- W I Manton
- Department of Geology, University of Texas at Dallas, Richardson, Texas 75083, USA
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Rothenberg SJ, Kondrashov V, Manalo M, Manton WI, Khan F, Todd AC, Johnson C. Seasonal variation in bone lead contribution to blood lead during pregnancy. ENVIRONMENTAL RESEARCH 2001; 85:191-194. [PMID: 11237506 DOI: 10.1006/enrs.2000.4238] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Population blood lead level (PbB) often shows seasonal variation, frequently being higher in summer and lower in winter. As vitamin D metabolites also show seasonal variability, and the metabolites are associated with bone metabolism, some authors have posited a role for bone lead release in seasonal PbB changes. We made third trimester and postdelivery PbB measurements on 414 immigrant women (98% Latina) in Los Angeles. We measured in vivo tibia and calcaneus (heel) lead concentration postdelivery via K-shell X-ray fluorescence. We saw evidence of seasonal variation in prenatal PbB, but not postnatal PbB. PbB was highest in spring and lowest in autumn. Tibia lead concentration was associated with prenatal PbB, as reported before. The contribution of tibia lead to prenatal PbB varied seasonally, with the greatest contribution occurring in the winter quarter and the least in the summer quarter. The temporal pattern of bone lead contribution to PbB follows the seasonal alteration of insolation. There was no seasonal component in prenatal PbB associated with calcaneus lead, nor were there seasonal variations in either calcaneus or tibia lead contributions to postnatal PbB. Bone turnover in the third trimester of pregnancy may be higher in winter months than in summer months, resulting in greater fetal lead exposure in spring than at other times of the year.
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Affiliation(s)
- S J Rothenberg
- Department of Anesthesiology and Environmental Research Center, Drew University of Medicine and Science, Los Angeles, California 90059, USA
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Affiliation(s)
- L Morales
- Division of General Internal Medicine and Health Services Research Department of Medicine University of California, Los Angeles School of Medicine 911 Broxton Plaza, Rm 211 Box 951736 Los Angeles, CA 90095-1736, USA
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Simpson E, Mull JD, Longley E, East J. Pica during pregnancy in low-income women born in Mexico. West J Med 2000; 173:20-4; discussion 25. [PMID: 10903283 PMCID: PMC1070964 DOI: 10.1136/ewjm.173.1.20] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe pica behavior (ingestion of nonfood items) in pregnant low-income Mexican-born women in Mexico and the United States. DESIGN A convenience sample of informants was interviewed with a questionnaire containing open-ended and closed-ended questions. SETTING A low-income community on the outskirts of Ensenada, Mexico, and clinics serving low-income people in southern California (Santa Ana, Bakersfield, and Los Angeles). PARTICIPANTS Of a total of 225 Mexican-born women, 75 (33%) were interviewed in Ensenada, and 150 (67%) were interviewed in southern California. RESULTS The prevalence of pica during pregnancy was 44% (n = 33) in the Ensenada group and 31% (n = 46) in the southern California group. Those who reported pica behavior more commonly had a relative who also practiced pica. CONCLUSION The high reported rate of pica in this sample indicates that pregnant Mexican-born women should be screened for pica and educated about the potentially serious effects on the fetus and mother.
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Affiliation(s)
- E Simpson
- Division of Human Genetics Department of Pediatrics University of California, Irvine Medical Center Orange, CA 92668, USA
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Azcona-Cruz MI, Rothenberg SJ, Schnaas L, Zamora-Muñoz JS, Romero-Placeres M. Lead-glazed ceramic ware and blood lead levels of children in the city of Oaxaca, Mexico. ARCHIVES OF ENVIRONMENTAL HEALTH 2000; 55:217-22. [PMID: 10908106 DOI: 10.1080/00039890009603409] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although Mexico substantially reduced use of leaded gasoline during the 1990s, lead-glazed pottery remains a significant source of population exposure. Most previous studies of lead in nonoccupationally exposed groups in Mexico have been conducted in the Mexico City metropolitan area. Oaxaca, a poor southern state of Mexico, has a centuries-old tradition of use of low temperature lead-glazed ceramic ware manufactured mainly by small family businesses. We measured blood lead levels in 220 8-10-y-old children (i.e., not from pottery-making families) who were students in the innercity of Oaxaca and in the mothers of all children. The geometric mean blood lead level of the children was 10.5 microg/dl (+7.0/-4.3 microg/dl standard deviation; range = 1.3-35.5 microg/dl). The corresponding mean value for the mothers was 13.4 (+9.0/-5.4 microg/dl standard deviation; range = 2.8-45.3 microg/dl). We used cutoffs that were greater than or equal to 10 microg/dl, 20 microg/dl, and 30 microg/dl, and we determined that 54.9%, 10.3%, and 3.0% of the children were at or above the respective criteria. We accounted for 25.2% of the variance in blood lead levels of the children, using maternal responses to a questionnaire that assessed possible lead sources in a linear multiple-regression model. The most important factors related to lead levels were family use of lead-glazed pottery, use of animal fat in cooking, and family income. The addition of maternal blood lead level to the model increased accounted variance in blood lead to 48.0%. In logistic-regression modeling of children's blood lead levels, we used a cutoff of greater than or equal to 10 microg/dl, and we found that use of lead-glazed pottery was the most important of all questionnaire items that were predictive of blood lead levels (odds ratio = 2.98). In Oaxaca, as is the case elsewhere in Mexico, lead-glazed ceramic ware remains a significant risk factor for elevated blood lead levels in children.
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Affiliation(s)
- M I Azcona-Cruz
- School of Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Rothenberg SJ, Khan F, Manalo M, Jiang J, Cuellar R, Reyes S, Acosta S, Jauregui M, Diaz M, Sanchez M, Todd AC, Johnson C. Maternal bone lead contribution to blood lead during and after pregnancy. ENVIRONMENTAL RESEARCH 2000; 82:81-90. [PMID: 10677148 DOI: 10.1006/enrs.1999.4007] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We examined bone lead contribution to blood lead in a group of 311 immigrant women, 99% from Latin America, during the third trimester of pregnancy and 1 to 2 months after delivery. We measured in vivo tibia and calcaneus (heel) bone lead concentration in the postdelivery period with K shell X-ray fluorescence. Prenatal and postnatal geometric mean (range) blood lead level was 2.2 microg/dL (0.4 to 38.7) and 2.8 microg/dL (0.4 to 25.4), reflecting low current exposure. Postnatal blood lead level was significantly higher than prenatal (P<0.0001). Mean (range) tibia and calcaneus lead concentration was 6.7 microg/g (-33.7 to 62.2) and 8.4 microg/g (- 30.1 to 66.4), reflecting varying but elevated past lead exposure. Mean calcaneus lead concentration was significantly higher than mean tibia lead concentration (P = 0.055). Variance-weighted multiple regression and structural equation models showed that both calcaneus and tibia lead were directly associated with prenatal blood lead but only calcaneus lead was associated with postnatal blood lead. Increasing natural log years in the United States independently predicted decreasing calcaneus and third-trimester blood lead. The data suggest that while some exogenous lead sources and modulators of blood lead level, such as use of lead-glazed pottery and calcium in the diet, control lead exposure during and after pregnancy, endogenous lead sources from past exposure before immigration continue to influence blood lead levels in this sample.
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Affiliation(s)
- S J Rothenberg
- Department of Anesthesiology, Drew University of Medicine and Science, Los Angeles, California 90059, USA
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Rothenberg SJ, Manalo M, Jiang J, Cuellar R, Reyes S, Sanchez M, Diaz M, Khan F, Aguilar A, Reynoso B, Juaregui M, Acosta S, Johnson C. Blood lead level and blood pressure during pregnancy in South Central Los Angeles. ARCHIVES OF ENVIRONMENTAL HEALTH 1999; 54:382-9. [PMID: 10634227 DOI: 10.1080/00039899909603369] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In many studies in which the relationship between blood pressure and blood lead level has been examined, investigators have found significant--but small--associations. There was only one previous report of a significant association of blood lead with blood pressure in pregnant women. We measured blood lead level and sitting blood pressure of 1,627 women in their third trimester of pregnancy. We eliminated subjects with known causes of hypertension. Most women (98.4%) were normotensive. We controlled for body mass index, age, and stress--among other factors--and constructed multiple-regression models of lead association with diastolic and systolic blood pressures. Immigrants (73% of total) had significantly higher blood lead levels and different blood pressures than nonimmigrants, suggesting that analysis be stratified by "immigrant, nonimmigrant" status. Positive relationships between blood lead level and blood pressure were found only for immigrants (p < or = .001). From the 5th to 95th blood-lead percentiles (0.9-6.2 microg/dl) in immigrants, systolic blood pressure increased 2.8 mm Hg, and diastolic blood pressure increased 2.4 mm Hg. Higher prior lead exposure of immigrants (97.7% from Latin countries) than nonimmigrants might explain the differential effect of these low levels of blood lead on blood pressure in nonimmigrants. Perhaps some immigrants are at higher risk than nonimmigrants for lead-associated elevated blood pressure during pregnancy, despite blood lead levels within the currently considered acceptable range.
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Affiliation(s)
- S J Rothenberg
- Environmental Research Center, Department of Anesthesiology, Drew University of Medicine and Science, Los Angeles, California 90059, USA
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