Shih Yu-Hsuan, Islam Tariqul, Hore Samar Kumar, Sarwar Golam, Shahriar Mohammad Hasan, Yunus Mohammad, Graziano Joseph H, Harjes Judith, Baron John A, Parvez Faruque, Ahsan Habibul, Argos Maria
Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, United States.
UChicago Research Bangladesh, Dhaka, Bangladesh.
Environ Res. 2017 Oct;158:456-461. doi: 10.1016/j.envres.2017.07.004. Epub 2017 Aug 1.
Chronic arsenic exposure is a public health concern in many parts of the world, with elevated concentrations in groundwater posing a threat to millions of people. Arsenic is associated with various cancers and an array of chronic diseases; however, the relationship with adverse pregnancy outcomes and child mortality is less established.
We evaluated associations between individual-level prenatal arsenic exposure with adverse pregnancy outcomes and child mortality in a pregnancy study among 498 women nested in a larger population-based cohort in rural Bangladesh.
Creatinine-adjusted urinary total arsenic concentration, a comprehensive measure of exposure from water, food, and air sources, reflective of the prenatal period was available for participants. Self-reported pregnancy outcomes (livebirth, stillbirth, spontaneous/elective abortion) were ascertained. Generalized estimating equations, accounting for multiple pregnancies of participants, were used to estimate odds ratios and 95% confidence intervals in relation to adverse pregnancy outcomes. Vital status of livebirths was subsequently ascertained through November 2015. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals in relation to child mortality.
We observed a significant association between prenatal arsenic exposure and the risk of stillbirth (greater than median; adjusted OR = 2.50; 95% CI = 1.04, 6.01). We also observed elevated risk of child mortality (greater than median; adjusted HR = 1.92; 95% CI = 0.78, 4.68) in relation to prenatal arsenic exposure.
Prospective studies should continue to evaluate prenatal and early life health effects of arsenic exposure and arsenic remediation strategies for women of child-bearing age.
在世界许多地区，慢性砷暴露都是一个公共卫生问题，地下水中砷浓度升高对数以百万计的人构成威胁。砷与多种癌症及一系列慢性疾病有关；然而，其与不良妊娠结局和儿童死亡率之间的关系尚不明确。
在孟加拉国农村一个以人群为基础的大型队列中的498名女性参与的妊娠研究中，我们评估了个体水平的产前砷暴露与不良妊娠结局及儿童死亡率之间的关联。
参与者可获得肌酐校正的尿总砷浓度，这是一种综合衡量来自水、食物和空气来源暴露的指标，反映了产前时期。确定自我报告的妊娠结局（活产、死产、自然/选择性流产）。使用广义估计方程，考虑参与者的多次妊娠情况，来估计与不良妊娠结局相关的比值比和95%置信区间。随后通过2015年11月确定活产儿的生命状况。使用Cox比例风险模型来估计与儿童死亡率相关的风险比和95%置信区间。
我们观察到产前砷暴露与死产风险之间存在显著关联（高于中位数；校正OR = 2.50；95% CI = 1.04, 6.01）。我们还观察到，与产前砷暴露相关的儿童死亡风险升高（高于中位数；校正HR = 1.92；95% CI = 0.78, 4.68）。
前瞻性研究应继续评估砷暴露对产前和生命早期健康的影响以及针对育龄妇女的砷修复策略。
