High prevalence of kaolin consumption in migrant women living in a major urban area of France: A cross-sectional investigation

The role of geophagy and artisanal gold mining as risk factors for elevated blood lead levels in pregnant women in northwestern Tanzania

Neither artisanal and small-scale gold mining (ASGM) or geophagy practices have received substantial attention related to blood lead levels despite the well documented deleterious effects of lead. This cross-sectional analytical study aimed to document the risk of lead exposure from geophagy and mining-related occupational activities for pregnant women. The study recruited 1056 pregnant women (883 in an ASGM area and 173 in a non-ASGM area) between April 2015 -April 2017. Generalized Linear Model with an identity link function was used to model the association between blood lead levels (BLLs) and geophagy practices and involvement in gold mining. The prevalence of geophagy was 36.2% (95% CI: 33.6, 39.4%) and 6.3% engaged in mining as a primary occupation. Practicing geophagy increased BLLs by 22% (β = 1.22, 95% CI: 1.116, 1.309, p<0.0001). Living in a gold mining area increased BLLs by 33.4% (β = 1.334, 95% CI: 1.2, 1.483, p<0.0001). Having mining as a primary occupation increased BLLs by 1.3% β = 1.013, 95% CI: 0.872, 1.176, p = 0.869) even though the association was not statistically significant. Socioeconomic wealth quantile (β = 1.037, 95% CI: 1.021, 1.054, p<0.001) increased blood lead levels by 3.7%. Developing a comprehensive inventory capturing sources of community-level lead exposure is essential. Further, increasing public health campaigns and education are crucial to limit geophagy practices and to minimize work in gold mining activities during pregnancy.

Potential drug-drug interactions when managing status epilepticus patients in intensive care: A cohort study

AIMS

The risk for drug-drug interactions (DDIs) associated with antiseizure drugs (ASDs) used to manage status epilepticus (SE) patients in the intensive care unit (ICU) has been poorly investigated. We aimed to quantify and describe those potential DDIs and determine SE patient risk profiles.

METHODS

We conducted an observational bi-centric cohort study including all SE patients admitted to the ICU in the period 2016-2020.

RESULTS

Overall, 431 SE patients were included and 5504 potential DDIs were identified including 1772 DDIs (33%) between ASDs, 2610 DDIs (47%) between ASDs and previous usual treatments (PUTs), and 1067 DDIs (20%) between ASDs and ICU treatments (ICUTs). DDIs were moderate (n = 4871), major (n = 562) or severe (n = 16). All patients exhibited potential DDIs, which were major-to-severe DDIs in 47% of the cases. DDIs were pharmacokinetic (n = 1972, 36%), mostly involving cytochrome P450 modulators, and pharmacodynamic (n = 3477, 64%), mainly leading to increased sedation. ASD/PUT DDIs were the most frequent and severe. Age, PUT and ASD drug numbers and length of ICU stay were significantly associated with increased DDI number. We identified four SE patient profiles with different DDI risks and outcomes including (1) epileptic or brain trauma patients, (2) withdrawal syndrome patients, (3) older patients with comorbidities and (4) self-poisoned patients with psychiatric disorders and/or past epilepsy.

CONCLUSION

SE patients are subject to potential DDIs between ASDs, ASD/PUT and ASD/ICUT. Major-to-severe DDIs mostly occur between ASDs and PUTs. Physicians should pay attention to SE patient characteristics and history to limit DDI numbers and prevent their consequences.

Kaolin consumption in pregnant women: what impact on the weight of newborns?

BACKGROUND

Geophagy is an ancestral practice particularly found among African women who describe beneficial effects on the sympathetic signs of pregnancy. Studies have reported a significant prevalence of consumption of kaolin, known as geophagy, within migrant population. However, this behavior, like other environmental factors, could lead to obstetrical and neonatal risks.

OBJECTIVE

The objective of our study was to evaluate the obstetrical and neonatal impact of kaolin consumption, especially on Z-SCORE for weight-for-gestational age in the newborn.

METHODS

This mono-centric historical cohort study was carried out on the basis of questionnaires and patients' obstetrical records. It was conducted between January 1 and July 1, 2017. Patients were divided into two groups: 1) women who consumed kaolin (at least once during their pregnancy), and 2) women who did not consume kaolin. Morphometric characteristics of the newborn were retrieved in obstetrical records.

RESULTS

Results: 105 pregnant women were included: 26 exposed and 79 non exposed. Women who consumed kaolin were more frequently without social protection at their first consultation (p < .01). Multivariate analysis did not show a significant association between Z-SCORE for weight-for gestational age in the newborn and kaolin consumption (β = 0.13, p = .54) after adjusting on age, precariousness, BMI, intake of toxic substances, anemia and beginning eclampsia. Among these covariates, precariousness was significantly associated with both a decrease in Z-SCORE for weight (β = -0.87, p < .002) and size (β = -0.68, p < .01).

CONCLUSION

Geophagy is not to be neglected in socially advantaged countries due to increased immigration. This study found no association between kaolin consumption and birth weight. However, there was a correlation between precariousness and low birth weight which reinforces the importance of tightening the follow-up during pregnancies in the most precarious women.