Maternal mercury exposure, season of conception and adverse birth outcomes in an urban immigrant community in Brooklyn, New York, U.S.A

Impact of GSTT1 AND GSTM1 variants and hair mercury concentration in maternal blood pressure among coastal pregnant women in Central Java, Indonesia

The GSTT1 and GSTM1 genes have a role in mercury metabolism and excretion, as well as blood pressure response, impacting birth outcomes. The present study assesses whether GSTT1 and GSTM1 deletion variants and maternal hair Hg concentration are associated with blood pressure and birth outcomes among the Indonesian coastal pregnant mother population. A cross-sectional study was conducted on 139 pregnant women in the Jepara coastal area of Central Java, Indonesia. Maternal characteristics during pregnancy, including blood pressure and birth outcomes, were collected. GSTT1 and GSTM1 gene variants were detected using polymerase chain reaction (PCR). Hair Hg levels were measured using the reducing-vaporization mercury analyzer. The mean maternal hair Hg concentration was 0.727±0.558 μg/g. GSTT1 genotype homozygous deletion was found in 41.7% of subjects, while no GSTM1 deletion was found. No statistically significant difference was found between deletion and non-deletion groups for hair Hg. GSTT1 deletion genotype shows protection but is inconclusive toward diastolic hypertension (p=0.048, OR 0.285, CI 0.077-1.052) and insignificant with birth outcomes (all p>0.05). High hair Hg concentration and positive history of cardiovascular diseases increase the risk of systolic and diastolic hypertension during pregnancy with OR 6.871 (CI 95% 1.445-32.660) and 8.518 (CI 95% 2.126-34.125), respectively, while not in birth outcomes. Maternal Hg exposure and history of cardiovascular diseases are independent risk factors for pregnant hypertension, whereas the GSTT1 homozygous deletion genotype has no role in diastolic hypertension and birth outcomes among the Indonesian coastal pregnant mother population.

Preterm Birth and Metal Mixture Exposure among Pregnant Women from the Navajo Birth Cohort Study

BACKGROUND

Preterm birth (PTB), defined as birth before 37 wk gestation, is associated with hypertension, diabetes, inadequate prenatal care, unemployment or poverty, and metal exposure. Indigenous individuals are more likely to have maternal risk factors associated with PTB compared with other populations in the United States; however, the role of environmental metals on PTB among pregnant Indigenous women remains uncertain. Previous research identified associations between PTB and individual metals, but there is limited investigation on metal mixtures and this birth outcome.

OBJECTIVES

We used a mixtures analysis framework to investigate the association between metal mixtures and PTB among pregnant Indigenous women from the Navajo Birth Cohort Study (NBCS).

METHODS

Maternal urine and blood samples were collected at the time of study enrollment and analyzed for metals by inductively coupled plasma dynamic reaction cell mass spectrometry. Bayesian Profile Regression was used to identify subgroups (clusters) of individuals with similar patterns of coexposure and to model association with PTB.

RESULTS

Results indicated six subgroups of maternal participants with distinct exposure profiles, including one group with low exposure to all metals and one group with total arsenic, cadmium, lead, and uranium concentrations exceeding representative concentrations calculated from the National Health and Nutrition Examination Survey (NHANES). Compared with the reference group (i.e., the lowest exposure subgroup), the subgroup with the highest overall exposure had a relative risk of PTB of 2.9 times (95% credible interval: 1.1, 6.1). Exposures in this subgroup were also higher overall than NHANES median values for women 14-45 years of age.

DISCUSSION

Given the wide range of exposures and elevated PTB risk for the most exposed subgroups in a relatively small study, follow-up investigation is recommended to evaluate associations between metal mixture profiles and other birth outcomes and to test hypothesized mechanisms of action for PTB and oxidative stress caused by environmental metals. https://doi.org/10.1289/EHP10361.

Prenatal exposure to heavy metal mixtures and anthropometric birth outcomes: a cross-sectional study

BACKGROUND

Numerous studies have suggested significant associations between prenatal exposure to heavy metals and newborn anthropometric measures. However, little is known about the effect of various heavy metal mixtures at relatively low concentrations. Hence, this study aimed to investigate associations between prenatal exposures to a wide range of individual heavy metals and heavy metal mixtures with anthropometric measures of newborns.

METHODS

We recruited 975 mother-term infant pairs from two major hospitals in Israel. Associations between eight heavy metals (arsenic, cadmium, chromium, mercury, nickel, lead, selenium, and thallium) detected in maternal urine samples on the day of delivery with weight, length, and head circumference at birth were estimated using linear and Bayesian kernel machine regression (BKMR) models.

RESULTS

Most heavy metals examined in our study were observed in lower concentrations than in other studies, except for selenium. In the linear as well as the BKMR models, birth weight and length were negatively associated with levels of chromium. Birth weight was found to be negatively associated with thallium and positively associated with nickel.

CONCLUSION

By using a large sample size and advanced statistical models, we could examine the association between prenatal exposure to metals in relatively low concentrations and anthropometric measures of newborns. Chromium was suggested to be the most influential metal in the mixture, and its associations with birth weight and length were found negative. Head circumference was neither associated with any of the metals, yet the levels of metals detected in our sample were relatively low. The suggested associations should be further investigated and could shed light on complex biochemical processes involved in intrauterine fetal development.

Maternal Metals Exposure and Infant Weight Trajectory: The Japan Environment and Children's Study (JECS)

BACKGROUND

To our knowledge, the association of maternal exposure to metallic elements with weight trajectory pattern from the neonatal period has not been investigated.

OBJECTIVES

The goals of this study were to identify infant growth trajectories in weight in the first 3 y of life and to determine the associations of maternal blood levels of lead, cadmium, mercury, selenium, and manganese with growth trajectory.

METHODS

This longitudinal study, part of the Japan Environment and Children Study, enrolled 103,099 pregnant women at 15 Regional Centres across Japan between 2011 and 2014. Lead, cadmium, mercury, selenium, and manganese levels were measured in blood samples collected in the second (14-27 wk gestational age) or third trimester (≥28wk). Growth trajectory of 99,014 children was followed until age 3 y. Raw weight values were transformed to age- and sex-specific weight standard deviation (SD) scores, and latent-class group-based trajectory models were estimated to determine weight trajectories. Associations between maternal metallic element levels and weight trajectory were examined using multinomial logistic regression models after confounder adjustment.

RESULTS

We identified 5 trajectory patterns based on weight SD score: 4.74% of infants were classified in Group I, very small to small; 31.26% in Group II, moderately small; 21.91% in Group III, moderately small to moderately large; 28.06% in Group IV, moderately large to normal; and 14.03% in Group V, moderately large to large. On multinomial logistic regression, higher maternal lead and selenium levels tended to be associated with increased odds ratios (ORs) of poor weight SD score trajectories (Groups I and II), in comparison with Group III. Higher levels of mercury were associated with decreased ORs, whereas higher levels of manganese were associated with increased ORs of "moderately large" trajectories (Groups IV and V).

DISCUSSION

Maternal lead, mercury, selenium, and manganese blood levels affect infant growth trajectory pattern in the first 3 y of life. https://doi.org/10.1289/EHP10321.

The First Exposure Assessment of Mercury Levels in Hair among Pregnant Women and Its Effects on Birth Weight and Length in Semarang, Central Java, Indonesia

(1) Background: Methylmercury (MeHg) exposure during pregnancy is an important issue due to its possible adverse health effects on fetus. To contribute the development of assessment system of Hg exposure through fish consumption and health effects on children, we examined the hair Hg levels in pregnant women and birth weight and length. (2) Methods: In 2018, a cohort study was conducted on 118 pregnant women-infant pairs from six community health centers in the northern coastal area in Central Java Indonesia. Data on mothers' characteristics during pregnancy, birth outcomes, and fish consumption were collected. Total Hg concentrations were determined from hair samples. (3) Results: The median (min-max) of the maternal hair Hg level was 0.434 (0.146-8.105) µg/g. Pregnant women living in lowland areas, near the sea, showed higher hair Hg concentration and fish consumption than those in highland areas {[0.465 (0.146-8.105) vs. 0.385 (0.150-1.956) µg/g; p = 0.043] and [(85.71 (0-500.0) vs. 49.76 (0.0-428.57) g/day; p < 0.01], respectively}. The maternal hair Hg level had no association with baby's birth weight and length. (4) Conclusions: The median maternal hair Hg is at a low level and had no association with infant birth weight and length in this study subjects.

Associations of maternal blood mercury with preeclampsia and birth outcomes

BACKGROUND

Mercury (Hg) is a highly toxic substance, and its harmful effects on maternal and infant health have been reported. Yet, the associations of Hg exposure with preeclampsia (PE) and adverse birth outcomes are not well understood.

OBJECTIVE

The aim of this study was to investigate the potential effects of maternal Hg exposure on PE and birth outcomes.

METHODS

We conducted a case-control study with 84 participants in China. Logistic models were used to estimate odds ratios for PE risk and birth outcomes according to maternal blood Hg levels, adjusting for potential confounding factors.

RESULTS

Elevated blood Hg levels were associated with increased risks of mild PE (aOR, 7.03; 95% CI, 1.61, 30.62; P < 0.01) and severe PE (aOR, 47.55; 95% CI, 5.27, 429.05; P < 0.05). We also found that increased blood Hg levels were associated with low birth weight (aOR, 1.12; 95% CI, 1.00, 1.25; P < 0.05) and preterm birth (PTB) (aOR, 1.22; 95% CI, 1.08, 1.38; P < 0.05).

CONCLUSIONS

Our study provided evidence that elevated blood Hg levels were significantly associated with an increased risk of PE. In addition, our findings support that increased blood Hg levels might be associated with low birth weight and PTB.

Mercury and Prenatal Growth: A Systematic Review

The intrauterine environment is critical for healthy prenatal growth and affects neonatal survival and later health. Mercury is a toxic metal which can freely cross the placenta and disrupt a wide range of cellular processes. Many observational studies have investigated mercury exposure and prenatal growth, but no prior review has synthesised this evidence. Four relevant publication databases (Embase, MEDLINE/PubMed, PsycINFO, and Scopus) were systematically searched to identify studies of prenatal mercury exposure and birth weight, birth length, or head circumference. Study quality was assessed using the NIH Quality Assessment Tool, and results synthesised in a narrative review. Twenty-seven studies met the review criteria, these were in 17 countries and used 8 types of mercury biomarker. Studies of birth weight (total = 27) involving populations with high levels of mercury exposure, non-linear methods, or identified as high quality were more likely to report an association with mercury, but overall results were inconsistent. Most studies reported no strong evidence of association between mercury and birth length (n = 14) or head circumference (n = 14). Overall, our review did not identify strong evidence that mercury exposure leads to impaired prenatal growth, although there was some evidence of a negative association of mercury with birth weight.

Exposure to toxic metals and per- and polyfluoroalkyl substances and the risk of preeclampsia and preterm birth in the United States: a review

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.

Prenatal Environmental Metal Exposure and Preterm Birth: A Scoping Review

Preterm birth (PTB) and its complications are the leading causes of under-five year old child deaths, accounting worldwide for an estimated one million deaths annually. The etiology of PTB is complex and multifactorial. Exposures to environmental metals or metalloids are pervasive and prenatal exposures to them are considered important in the etiology of PTB. We conducted a scoping review to determine the extent of prenatal exposures to four metals/metalloids (lead, mercury, cadmium and arsenic) and their association with PTB. We reviewed original research studies published in PubMed, Embase, the Cochrane Library, Scopus, POPLINE and the WHO regional indexes from 2000 to 2019; 36 articles were retained for full text review. We documented a higher incidence of PTB with lead and cadmium exposures. The findings for mercury and arsenic exposures were inconclusive. Metal-induced oxidative stress in the placenta, epigenetic modification, inflammation, and endocrine disruptions are the most common pathways through which heavy metals and metalloids affect placental functions leading to PTB. Most of the studies were from the high-income countries, reflecting the need for additional data from low-middle-income countries, where PTB rates are higher and prenatal exposure to metals are likely to be just as high, if not higher.

Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen's Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05-5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03-46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

Prenatal Mercury Exposure in Pregnant Women from Suriname's Interior and Its Effects on Birth Outcomes

Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health’s environmental epidemiologic prospective cohort study of pregnant women living in Suriname’s interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher’s exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 μg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 μg/g, was associated with LBW (OR = 7.2; 95% CI 1.5–35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92–13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.

Identifying a critical window of maternal metal exposure for maternal and neonatal thyroid function in China: A cohort study

BACKGROUND

China, a developing country, has a particularly serious problem with metal pollution. We evaluated the association of metal exposure during pregnancy with maternal and neonatal thyroid function, and identified the critical window for maternal metal exposure effects on maternal and neonatal thyroid functions.

METHODS

The maternal urinary concentrations of mercury (Hg), cadmium (Cd), arsenic (As) and cesium (Cs) were determined in pregnant women during their first (n = 389) or third (n = 257) trimesters in a prospective cohort from 2014 to 2015 in Nanjing, China, using an inductively coupled plasma mass spectrometry (ICP-MS) instrument. Maternal serum-free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured by electrochemiluminescent microparticle immunoassays in the second and third trimesters. Neonatal TSH levels were detected 72 h after birth.

RESULTS

Hg (>0.162 µg/L), Cd (>0.084 µg/L), As (>0.348 µg/L) and Cs (>0.093 µg/L) were detectable in 76.9%, 90.1%, 100% and 100% of maternal urine samples from women in the first trimester of pregnancy. In the multiple adjusted linear regression models, maternal exposures to Hg and Cd in the first trimester were positively associated with maternal TSH levels in the second trimester (P < 0.01, P = 0.02). Moreover, maternal exposures to Cd and Cs in the first trimester were positively associated with neonatal TSH levels (P = 0.04, P = 0.02). In the Bayesian kernel machine regression (BKMR) model, the results were stable and consistent with the linear regression model.

CONCLUSIONS

Maternal exposure to Hg, Cd and Cs in the first trimester was related to TSH levels in mothers and newborns. Efforts to identify maternal and neonatal thyroid disruptors should carefully consider the effects of exposure to these metals.

Maternal exposure to arsenic and mercury and associated risk of adverse birth outcomes in small-scale gold mining communities in Northern Tanzania

BACKGROUND

Exposure to arsenic and mercury in artisanal and small-scale gold mining (ASGM) communities is an issue that predominantly affects low and middle-income countries. Large epidemiology studies in these communities are rare, and the impact of such exposures on reproductive outcomes are not well understood.

OBJECTIVE

To examine associations between prenatal maternal arsenic and mercury exposure and birth outcomes in both ASGM and non-ASGM communities in Northern Tanzania.

METHODS

This longitudinal prospective study included 961 women (ASGM = 788, non-ASGM = 173) of the original cohort of 1056 who were followed until a pregnancy outcome was registered. Maternal spot urine samples and dried blood spots were used to measure total arsenic (T-As) and total mercury (T-Hg) in the second trimester of pregnancy. Data on adverse birth outcomes were collected in 5 categories: spontaneous abortion, stillbirth, preterm birth, low birth weight, and visible congenital anomalies. Mann-Whitney U-tests were used to test for differences between median T-As and T-Hg by area of residence. Logistic regression models were used to estimate the odds of stillbirth and visible congenital anomalies given maternal T-As and T-Hg levels. Modified Poisson regressions were used to estimate relative risk ratios between maternal T-As and T-Hg levels and composite adverse birth outcome, spontaneous abortion, low birth weight, and preterm birth.

RESULTS

Statistically significant differences were found in median T-As (9.6 vs. 6.3 µg/L, Mann-Whitney U-tests, Z = -3.50, p < 0.001) and median T-Hg blood concentrations (1.2 vs. 0.70 µg/L, Z = -9.88, p-value < 0.001) between women living in ASGM and non-ASGM areas respectively. In ASGM areas, the adjusted relative risk (aRR) of a composite adverse birth outcome increased with increasing T-As (aRR 1.23, 95%CI: 1.14-1.33, p < 0.0001) and T-Hg (aRR 1.17, 95%CI: 1.1-1.25, p < 0.0001) exposure. Spontaneous abortion (aRR 1.53, 95%CI: 1.28-1.83), stillbirth (adjusted odds ratio (aOR) 1.97, 95%CI: 1.45-2.66) and preterm birth (1.17, 95%CI: 1.01-1.36) were significantly associated with elevated T-As, whereas elevated T-Hg was significantly associated with stillbirth (aOR 2.49, 95%CI: 1.88-3.29) and visible congenital anomalies (aOR 2.24, 95%CI: 1.3-3.87).

CONCLUSION

Over half (54.7%) of women in ASGM areas of Northern Tanzania had adverse birth outcomes and the risk of adverse birth outcomes was significantly associated with increased prenatal exposure to arsenic and mercury.

Characterization of urinary concentrations of heavy metals among socioeconomically disadvantaged black pregnant women

The objective of this study was to characterize exposures to metals using biological samples collected on socioeconomically disadvantaged black pregnant women. We obtained 131 anonymous urine samples provided by black pregnant women visiting a Medicaid-serving prenatal clinic in Houston, TX, from March 27, 2017 to April 11, 2017. We analyzed urine samples for 15 metals including cadmium (Cd), arsenic (As), lead (Pb), and nickel (Ni) and for creatinine and cotinine. We found that median concentrations of zinc (Zn), selenium (Se), and aluminum (Al) among black pregnant women in this study were 1.5 to 3 times higher than levels reported among a cohort of well-educated non-Hispanic white pregnancy planners. We also observed elevated levels of urinary Cd and antimony (Sb) as compared with those reported for a nationally representative sample of adult women in the USA. Based on the results of an exploratory factor analysis, potential sources of metal exposures in this population may arise in home environments or be due to diet, industrial and natural sources, or traffic.

Recommended acceptable levels of maternal serum typical toxic metals from the perspective of spontaneous preterm birth in Shanxi Province, China

Preterm birth is an important issue of public reproductive health worldwide. The effects of the toxic metals on the likelihood of spontaneous preterm birth (SPB) are still under discussion. Our study aimed to investigate the association between maternal exposure to the five typical toxic metals or metalloid (i.e. arsenic (As), cadmium (Cd), chromium (Cr), mercury (Hg), and lead (Pb)) and the SPB likelihood. The mothers delivering fetus with SPB (cases) and those with term healthy birth (controls) were chosen from a prospective birth cohort of 3201 women carried out in Shanxi Province, China. A total of 147 SPB cases and 381 controls were included in our nested case-control study. We collected maternal general information by questionnaire and collected their blood sample during recruitment. The serum concentrations of the five toxic metals were measured by inductively coupled-plasma mass spectrometry. We found that the demographic information between the cases and controls were well balanced. The participants in our study had relatively higher serum As concentration. For the other toxic metals (i.e. Cd, Cr, Hg, and Pb), their serum concentrations were overall in the middle range of those from general population. There were no significant associations of the serum concentrations of the five concerned toxic metals with the SPB likelihood. Our study results overall did not support that maternal exposure to As or Cd significantly contribute to the SPB risk in the current exposure level, as well as the other three toxic metals. We further proposed their upper concentration limits in maternal serum from the perspective of SPB likelihood during the early pregnant period, i.e. 18.2 ng/mL of As, 1.05 ng/mL of Cd, 0.96 ng/mL of Cr, 1.07 ng/mL of Hg, and 1.54 ng/mL of Pb.

Placental metal concentrations and birth outcomes: The Environment and Childhood (INMA) project

OBJECTIVE

To examine the association of placental levels of arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb), manganese (Mn), and chromium (Cr) with birth outcomes (birth weight, length, and head circumference, low birth weight [LBW], gestational age, preterm delivery, and small for gestational age [SGA]) in mother-child pairs from the Environment and Childhood (INMA) Project in Spain.

METHODS

Metal concentrations were measured in placenta tissue samples randomly selected from five INMA cohorts. Data on birth outcomes were obtained from medical records. Associations were assessed in a sub-sample of 327 mother-infant pairs by regression models adjusted for confounding factors and for all metals simultaneously. Effect modification by sex was also evaluated.

RESULTS

Elevated placental Cd levels (>5.79 vs. <3.30 ng/g) were associated with reduced birth weight (-111.8 g, 95%CI = -215.6; -8.06, p-trend = 0.01) and length (-0.62 cm, 95%CI = -1.20; -0.04, p-trend = 0.02), while a 10% increase in Cd was associated with 1.21-fold increased odds (95%CI = 1.01; 1.43) of LBW in the global sample but with 14% lower odds (95%CI = 0.78; 0.96) of preterm delivery in males (P_interaction = 0.10). Detected (vs. undetected) Hg was associated with reduced head circumference (-0.49 cm, 95%CI = -1.00; 0.03) in females (P_interaction = 0.03). A 10% increase in placental Mn was associated with slight increases in gestational age (0.04 weeks, 95%CI = 0.01; 0.07) in the global sample and in head circumference (0.05 cm, 95%CI = -0.01; 0.10) in females (P_interaction = 0.03). Elevated Cr levels (>99.6 vs. <56.1 ng/g) were associated with reduced birth length (-0.68 cm, 95%CI = -1.33; -0.04, p-trend = 0.02) and slightly increased gestational age (0.35 weeks, 95%CI = -0.07; 0.77, p-trend = 0.08) in the global sample. As and Pb were detected in few placentas (27% and 13%, respectively) and were not associated with any studied birth outcome.

CONCLUSIONS

Data suggest that in utero exposure to Cd, Hg, and Cr could adversely affect fetal growth, whereas Mn and Cr appear to have a positive effect on gestational age. Given the relatively small number of subjects, sex-specific associations should be interpreted with caution.

Prenatal Exposure to Ambient Pesticides and Preterm Birth and Term Low Birthweight in Agricultural Regions of California

Findings from studies of prenatal exposure to pesticides and adverse birth outcomes have been equivocal so far. We examined prenatal exposure to agricultural pesticides in relation to preterm birth and term low birthweight, respectively, in children born between 1998 and 2010, randomly selected from California birth records. We estimated residential exposure to agriculturally applied pesticides within 2 km of residential addresses at birth by pregnancy trimester for 17 individual pesticides and three chemical classes (organophosphates, pyrethroids, and carbamates). Among maternal addresses located within 2 km of any agricultural pesticide application, we identified 24,693 preterm and 220,297 term births, and 4412 term low birthweight and 194,732 term normal birthweight infants. First or second trimester exposure to individual pesticides (e.g., glyphosates, paraquat, imidacloprid) or exposure to 2 or more pesticides in the three chemical classes were associated with a small increase (3⁻7%) in risk for preterm birth; associations were stronger for female offspring. We did not find associations between term low birthweight and exposure to pesticides other than myclobutanil (OR: 1.11; 95% CI: 1.04⁻1.20) and possibly the pyrethroids class. Our improved exposure assessment revealed that first and second trimester exposure to pesticides is associated with preterm delivery but is rarely linked with term low birthweight.

Risk assessment of environmental exposure to heavy metals in mothers and their respective infants

Exposure to heavy metals can cause renal injury, which has been well documented in occupational exposure. Studies of low exposure in the general population, however, are still scarce, particularly for vulnerable populations such as mothers and young children. This study evaluated exposure to heavy metals, and biomarkers of renal function and oxidative stress in 944 lactating mothers and their infants and investigated the role of the interaction between heavy metals and oxidative stress in altering renal function. Mother and infant urine samples were analyzed to measure mercury (Hg), cadmium (Cd), and lead (Pb) concentrations for determining body-burden exposure; N-acetyl-β-d-glucosaminidase (NAG), α₁-microglobulin (α₁-MG), albumin (ALB), and creatinine (Cr) concentrations for determining early renal injury; and 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) concentrations for determining oxidative stress. The median concentrclearlyations in mothers presented as μg/g Cr (infants as μg/l) for Hg, Cd, and Pb were 0.695 (0.716), 0.322 (0.343), and 3.97 (5.306) respectively. The mothers and their infants had clearly been exposed to heavy metals and had levels higher than the reference values reported for the general populations of USA, Germany, and Canada. Multiple regression analyses clearly demonstrated associations between urinary heavy metals in quartiles and several renal and oxidative biomarkers in mothers and to a lesser extent their infants. ß coefficients for urinary excretions of MDA, 8-OHdG, ALB, α₁-MG, NAG, and Cr in mothers were high in the highest quartile of Hg (1.183-51.29μg/g Cr or 1.732-106.95μg/l), Cd (0.565-765.776μg/g Cr or 0.785-1347.0μg/l), and Pb (6.606-83.937μg/g Cr or 9.459-80.826μg/l), except Pb was not associated with ALB. Infants in the highest Pb quartile (9.293-263.098μg/l) had the highest ß coefficients of urinary excretion of MDA, 8-OHdG, ALB, NAG, and Cr. Significant increasing trend in biomarkers across the quartiles of the three metals was seen in both mothers and infants (p_trend <0.001). A receiver operating characteristic analysis supported the predictive abilities of the four renal biomarkers in discriminating between low versus high metal quartiles. The interaction between heavy metals and oxidative stress contributed to the high excretions of renal biomarkers, but the mechanism remains unclear. These findings add to the limited evidence that low exposure to heavy metals in the general population is associated with alterations in renal function that could eventually progress to renal damage if exposure continues and that children are more susceptible due to the immaturity of their body organs.

Exposure to endocrine disruptors during adulthood: consequences for female fertility

Endocrine disrupting chemicals are ubiquitous chemicals that exhibit endocrine disrupting properties in both humans and animals. Female reproduction is an important process, which is regulated by hormones and is susceptible to the effects of exposure to endocrine disrupting chemicals. Disruptions in female reproductive functions by endocrine disrupting chemicals may result in subfertility, infertility, improper hormone production, estrous and menstrual cycle abnormalities, anovulation, and early reproductive senescence. This review summarizes the effects of a variety of synthetic endocrine disrupting chemicals on fertility during adult life. The chemicals covered in this review are pesticides (organochlorines, organophosphates, carbamates, pyrethroids, and triazines), heavy metals (arsenic, lead, and mercury), diethylstilbesterol, plasticizer alternatives (di-(2-ethylhexyl) phthalate and bisphenol A alternatives), 2,3,7,8-tetrachlorodibenzo-p-dioxin, nonylphenol, polychlorinated biphenyls, triclosan, and parabens. This review focuses on the hypothalamus, pituitary, ovary, and uterus because together they regulate normal female fertility and the onset of reproductive senescence. The literature shows that several endocrine disrupting chemicals have endocrine disrupting abilities in females during adult life, causing fertility abnormalities in both humans and animals.

Environmental chemicals and preterm birth: Biological mechanisms and the state of the science

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.

Prenatal mercury exposure and birth outcomes

BACKGROUND

Results regarding the association between mercury exposure and anthropometry at birth, gestational length and placental weight are inconsistent, as is the role of seafood intake in these associations.

OBJECTIVE

We assessed whether prenatal mercury exposure is associated with anthropometry at birth, placental weight and gestational length in a population with a relatively high exposure to mercury from seafood consumption.

METHODS

Total mercury (T-Hg) was determined in cord blood from 1869 newborns with birth outcome measures, within the Spanish multicenter INMA cohort from 2004 to 2008. We adjusted cohort specific linear and Cox regression models to evaluate the association between T-Hg and birth anthropometry (weight, length, and head circumference), placental weight and gestational length. Non-spontaneous labor was taken to be censoring in the survival analysis. Final estimates were obtained using meta-analysis.

RESULTS

Geometric mean T-Hg was 8.2μg/L. A doubling of T-Hg was associated with a 7.7g decrease in placental weight (95% CI: -13.6, -1.8) and marginally with head circumference (beta: -0.052cm, 95% CI: -0.109, 0.005). T-Hg was also inversely related to weight and length, although with weaker estimates. Mercury exposure was not associated with the length of gestation. The inverse relation between T-Hg and growth was enhanced when the intake of different seafood groups was adjusted for in the models.

CONCLUSIONS

Prenatal mercury exposure may be associated with reduced placental and fetal growth. Confounding by fish intake should be considered when assessing these relationships.

Sex specific influence on the relationship between maternal exposures to persistent chemicals and birth outcomes

Prenatal exposure to persistent pollutants has been associated with adverse birth outcomes, although few studies have investigated the influence of the sex of the infant. Sex specific differences have been associated with neurobehavioural impacts from environmental exposures with limited and contrary findings in relation to persistent pollutants. This study investigated the relationships between maternal exposure to a range of metals, polychlorinated biphenyls and pesticides measured in biological samples and birth outcomes with a specific focus on the sex of the infant. Outcome measures used included birth weight, birth length and head circumference, proportion of optimal birth weight (POBW), proportion of optimal birth length, proportion of optimal head circumference (POHC) and ponderal index. In general maternal urinary and blood metals, plasma polychlorinated biphenyl and pesticide concentrations were low. In adjusted regression models, a ln-unit increase in plasma β-hexachlorocyclohexane concentrations was associated with decreased birth weight (-76g, 95% CI -149, -33), ponderal index (-0.048, 95% CI 0.102, 0.007) and proportion of optimal birth weight (-1.5%, 95% CI -3.6, 0.5) in the whole study population, with stronger associations observed for male infants. Maternal p,p'-dichlorodiphenyldichloroethylene concentrations were associated with reduced ponderal index in male infants (β=-0.171, 95% CI -0.269, -0.074). A ln-unit increase in plasma hexachlorobenzene concentrations was associated with a 5% increase in POBW in male infants (95% CI 0.67, 9.5). Increased urinary barium was associated with increased birth length and POBL and decreased ponderal index in boys. Conversely, urinary concentrations of caesium and rubidium were found to be associated with decreased foetal growth in female infants. This study supports the growing body of evidence regarding the reductions in foetal growth associated with β-hexachlorocyclohexane and p,p'-Dichlorodiphenyldichloroethylene as well as reporting new relationships between metals exposures and birth outcomes. The finding that maternal exposure to barium, strontium, rubidium and caesium was associated with birth outcomes requires confirmation in larger studies. Similarly the apparent differences in susceptibility based on sex of the infant requires further investigation.

Alterations in biochemical markers due to mercury (Hg) exposure and its influence on infant's neurodevelopment

This study examined the role of oxidative stress due to mercury (Hg) exposure on infant's neurodevelopmental performance. A total of 944 healthy Saudi mothers and their respective infants (aged 3-12 months) were recruited from 57 Primary Health Care Centers in Riyadh City. Total mercury (Hg) was measured in mothers and infants urine and hair samples, as well as mother's blood and breast milk. Methylmercury (MeHg) was determined in the mothers and infants' hair and mother's blood. Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and porphyrins were used to assess oxidative stress. The infant's neurodevelopment was evaluated using Denver Developmental Screening Test II (DDST-II) and Parents' Evaluation of Developmental Status. The median total Hg levels in mother's urine, infant's urine, mother's hair, infant's hair, and mother's blood and breast milk were 0.995μg/l, 0.716μg/l, 0.118μg/g dw, 0.101μg/g dw, 0.635μg/l, and 0.884μg/l respectively. The median MeHg levels in mother's hair, infant's hair, and mother's blood were 0.132μg/g dw, 0.091μg/g dw, and 2.341μg/l respectively. A significant interrelationship between mothers and infants Hg measures in various matrices was noted. This suggests that mother's exposure to different forms of Hg (total and/or MeHg) from various sources contributed significantly to the metal body burden of their respective infants. Even though Hg exposure was low, it induced high oxidative stress in mothers and infants. The influence of multiplicative interaction terms between Hg measures and oxidative stress biomarkers was tested using multiple regression analysis. Significant interactions between the urinary Hg levels in mothers and infants and oxidative stress biomarkers (8-OHdG and MDA) were noted. The MeHg levels in mother-infant hair revealed similar interaction patterns. The p-values for both were below 0.001. These observations suggest that the exposure of our infants to Hg via mothers either during pregnancy and/or neonatal life, promoted oxidative stress that might have played a role in infant neurodevelopmental delays that we reported previously. The results confirmed that the interaction between infant's MeHg in hair and 8-OHdG and MDA levels was significantly associated with a delay in DDST-II performance (ß=-0.188, p=0.028). This finding provides an insight into the potential consequences of Hg-induced oxidative stress to infant's cognitive neurodevelopment for the first time. This observation still needs future studies to be validated. Given the low MeHg levels in our population, these findings are of particular importance.

Cord Blood Methylmercury and Fetal Growth Outcomes in Baltimore Newborns: Potential Confounding and Effect Modification by Omega-3 Fatty Acids, Selenium, and Sex

BACKGROUND

Methylmercury (MeHg) may affect fetal growth; however, prior research often lacked assessment of mercury speciation, confounders, and interactions.

OBJECTIVE

Our objective was to assess the relationship between MeHg and fetal growth as well as the potential for confounding or interaction of this relationship from speciated mercury, fatty acids, selenium, and sex.

METHODS

This cross-sectional study includes 271 singletons born in Baltimore, Maryland, 2004-2005. Umbilical cord blood was analyzed for speciated mercury, serum omega-3 highly unsaturated fatty acids (n-3 HUFAs), and selenium. Multivariable linear regression models controlled for gestational age, birth weight, maternal age, parity, prepregnancy body mass index, smoking, hypertension, diabetes, selenium, n-3 HUFAs, and inorganic mercury (IHg).

RESULTS

Geometric mean cord blood MeHg was 0.94 μg/L (95% CI: 0.84, 1.07). In adjusted models for ponderal index, βln(MeHg) = -0.045 (g/cm(3)) × 100 (95% CI: -0.084, -0.005). There was no evidence of a MeHg × sex interaction with ponderal index. Contrastingly, there was evidence of a MeHg × n-3 HUFAs interaction with birth length [among low n-3 HUFAs, βln(MeHg) = 0.40 cm, 95% CI: -0.02, 0.81; among high n-3 HUFAs, βln(MeHg) = -0.15, 95% CI: -0.54, 0.25; p-interaction = 0.048] and head circumference [among low n-3 HUFAs, βln(MeHg) = 0.01 cm, 95% CI: -0.27, 0.29; among high n-3 HUFAs, βln(MeHg) = -0.37, 95% CI: -0.63, -0.10; p-interaction = 0.042]. The association of MeHg with birth weight and ponderal index was affected by n-3 HUFAs, selenium, and IHg. For birth weight, βln(MeHg) without these variables was -16.8 g (95% CI: -75.0, 41.3) versus -29.7 (95% CI: -93.9, 34.6) with all covariates. Corresponding values for ponderal index were -0.030 (g/cm(3)) × 100 (95% CI: -0.065, 0.005) and -0.045 (95% CI: -0.084, -0005).

CONCLUSION

We observed an association of increased MeHg with decreased ponderal index. There is evidence for interaction between MeHg and n-3 HUFAs; infants with higher MeHg and n-3 HUFAs had lower birth length and head circumference. These results should be verified with additional studies.

The extent of mercury (Hg) exposure among Saudi mothers and their respective infants

A total of 1016 healthy Saudi mothers and their respective infants (aged 3-12 months) were recruited from 57 Primary Health Care Centers (PHCCs) in Riyadh, Saudi Arabia, to evaluate the extent of mercury (Hg) exposure and predict its sources in the healthy Saudi population. Total Hg levels were measured in maternal urine, breast milk, blood, and hair and in the infants' urine and hair. Only 1.9% of the mothers had urinary Hg (UHg)>10 μg/l, the limit for asymptomatic adults recommended by the World Health Organization, but the median (0.99 μg/l) was higher than in other countries. Also, 49.3% of the mothers had UHg>1 μg/l, the German reference value for adults. Median infant UHg was 0.729 μg/l, and 77 and 93 % of the infants had levels higher than 0.4 and 0.1 μg/l, the reference values of the Centers for Disease Control and Prevention and for Germany, respectively. The median Hg level in breast milk was 0.884 μg/l. Even though 43.2% of the milk samples were above the background level for Hg in human milk (1 μg/l), our results were lower than those reported from other countries. Median maternal total Hg in blood was 0.637 μg/l, and only 0.4 and 6.9% of samples were higher than the Hg reference levels of 5.8 μg/l of the Environmental Protection Agency (EPA) and of 2 μg/l for Germany, respectively. Total Hg levels in hair (HHg) varied widely among mothers and infants, but only 3.9% of the mothers and 2.8% of the infants had HHg>1 μg/g (the EPA reference level). Median HHg values were 0.117 μg/g dry weight in mothers and 0.1 μg/g dry weight in infants; both were lower than in other countries. The Hg levels in mothers and their respective infants were relatively low, but our results were consistent with other studies indicating that dental amalgam fillings and fish consumption were the main predictors of maternal Hg exposure. Among the several biomarkers of Hg exposure, Hg levels in maternal hair and urine were the strongest predictors of infant exposure. The lack of an association between Hg in breast milk and Hg in infant urine and hair suggested that the infants were exposed to Hg predominately during pregnancy rather than during breastfeeding. We expect that our data can serve as a baseline for further biomonitoring and follow-up studies, particularly of the long-term impact of Hg on childhood neurodevelopment.

Low-level prenatal mercury exposure in north China: an exploratory study of anthropometric effects

In order to investigate anthropometric effects of mercury (Hg) exposure, we examined the status of human prenatal exposure to Hg species, including total mercury (THg), methylmercury (MeHg) and inorganic mercury (IHg), in North China, as well as their potential effects on fetal and infant growth. Hg concentrations in various bioindicators were measured from 50 Chinese women and newborns in 2011. The participants were followed for 12 months to collect anthropometric information. Linear and two-level regression analyses were performed to determine the associations between Hg levels and body growth. The geometric mean levels of THg in the placenta, cord blood, fetal hair, and maternal blood, hair, and urine were 25.88 μg/kg dry wt, 2.73 μg/L, 572.98 μg/kg, 2.29 μg/L, 576.54 μg/kg, and 0.58 μg/g creatinine, respectively. Nearly 100% of Hg presented as IHg in urine, and the percentage of IHg in other bioindicators was 14.86-48.73%. We observed significantly negative associations between Hg levels in some matrixes and anthropometry of neonates (weight and height) and infants (height) (p < 0.05). THg levels in maternal hair were also negatively associated with infant growth rate of weight during 12 months after delivery (p = 0.017). This study suggests that low-level prenatal Hg exposure could play a role in attenuating fetal and infant growth, and the effects of MeHg and IHg are different.