Kile Molly L, Rodrigues Ema G, Mazumdar Maitreyi, Dobson Christine B, Diao Nancy, Golam Mostofa, Quamruzzaman Quazi, Rahman Mahmudar, Christiani David C
Department of Public Health, College of Public Health and Human Sciences, Oregon State University, 15 Milam, Corvallis, OR 97331, USA.
Environ Health. 2014 Apr 16;13(1):29. doi: 10.1186/1476-069X-13-29.
Arsenic, a common groundwater pollutant, is associated with adverse reproductive health but few studies have examined its effect on maternal health.
A prospective cohort was recruited in Bangladesh from 2008-2011 (N = 1,458). At enrollment (<16 weeks gestational age [WGA]), arsenic was measured in personal drinking water using inductively-coupled plasma mass spectrometry. Questionnaires collected health data at enrollment, at 28 WGA, and within one month of delivery. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) for self-reported health symptoms were estimated for each arsenic quartile using logistic regression.
Overall, the mean concentration of arsenic was 38 μg/L (Standard deviation, 92.7 μg/L). A total of 795 women reported one or more of the following symptoms during pregnancy (cold/flu/infection, nausea/vomiting, abdominal cramping, headache, vaginal bleeding, or swollen ankles). Compared to participants exposed to the lowest quartile of arsenic (≤0.9 μg/L), the aOR for reporting any symptom during pregnancy was 0.62 (95% CI = 0.44-0.88) in the second quartile, 1.83 (95% CI = 1.25-2.69) in the third quartile, and 2.11 (95% CI = 1.42-3.13) in the fourth quartile where the mean arsenic concentration in each quartile was 1.5 μg/L, 12.0 μg/L and 144.7 μg/L, respectively. Upon examining individual symptoms, only nausea/vomiting and abdominal cramping showed consistent associations with arsenic exposure. The odds of self-reported nausea/vomiting was 0.98 (95% CI: 0.68, 1.41), 1.52 (95% CI: 1.05, 2.18), and 1.81 (95% CI: 1.26, 2.60) in the second, third and fourth quartile of arsenic relative to the lowest quartile after adjusting for age, body mass index, second-hand tobacco smoke exposure, educational status, parity, anemia, ferritin, medication usage, type of sanitation at home, and household income. A positive trend was also observed for abdominal cramping (P for trend <0.0001). A marginal negative association was observed between arsenic quartiles and odds of self-reported cold/flu/infection (P for trend = 0.08). No association was observed between arsenic and self-reported headache (P for trend = 0.19).
Moderate exposure to arsenic contaminated drinking water early in pregnancy was associated with increased odds of experiencing nausea/vomiting and abdominal cramping. Preventing exposure to arsenic contaminated drinking water during pregnancy could improve maternal health.
砷是一种常见的地下水污染物，与不良生殖健康有关，但很少有研究考察其对孕产妇健康的影响。
2008年至2011年在孟加拉国招募了一个前瞻性队列（N = 1458）。在入组时（妊娠周龄[WGA]<16周），使用电感耦合等离子体质谱法测量个人饮用水中的砷含量。通过问卷在入组时、妊娠28周时以及分娩后一个月内收集健康数据。使用逻辑回归估计每个砷四分位数组自我报告的健康症状的调整比值比（aORs）和95%置信区间（95%CI）。
总体而言，砷的平均浓度为38μg/L（标准差，92.7μg/L）。共有795名女性在孕期报告了以下一种或多种症状（感冒/流感/感染、恶心/呕吐、腹部绞痛、头痛、阴道出血或脚踝肿胀）。与暴露于最低砷四分位数组（≤0.9μg/L）的参与者相比，第二四分位数组孕期报告任何症状的aOR为0.62（95%CI = 0.44 - 0.88），第三四分位数组为1.83（95%CI = 1.25 - 2.69），第四四分位数组为2.11（95%CI = 1.42 - 3.13），各四分位数组的平均砷浓度分别为1.5μg/L、12.0μg/L和144.7μg/L。在检查个体症状时，只有恶心/呕吐和腹部绞痛与砷暴露存在一致的关联。在调整了年龄、体重指数、二手烟暴露、教育程度、产次、贫血、铁蛋白、用药情况、家庭卫生类型和家庭收入后，相对于最低四分位数组，第二、第三和第四砷四分位数组自我报告恶心/呕吐的比值分别为0.98（95%CI：0.68，1.41）、1.52（95%CI：1.05，2.18）和1.81（95%CI：1.26，2.60）。腹部绞痛也观察到呈正相关趋势（趋势P<0.0001）。在砷四分位数组与自我报告的感冒/流感/感染比值之间观察到边缘负相关（趋势P = 0.08）。未观察到砷与自我报告头痛之间的关联（趋势P = 0.19）。
孕期早期适度暴露于受砷污染的饮用水与恶心/呕吐和腹部绞痛的几率增加有关。预防孕期暴露于受砷污染的饮用水可改善孕产妇健康。
