The goal of this study was to assess the effect of prenatal and postnatal lead exposure on early cognitive development of infants using the Bayley Scale of Infant Development (BSID-I) at the age of 6, 12, 18, and 24 months in a longitudinal study. Based on the results of 653 cord blood lead levels, infants were classified into three groups for neuropsychological assessments: low lead risk (<10th percentile) and high lead risk (>10th percentile) of the distribution of cord blood lead level were designated as low (< or = 1.045 microg/dL) and high (> or = 3.466 microg/dL) lead risk groups. Blood lead levels in between the <10th and >90th percentile were designated as mid lead risk group. A total of 66 infants were supposed to be selected from each group for a follow-up study. Of these, only 106 participated 6 months after the study. During the follow-up study, the dropout was very high with attrition rates of 74.5%, 52.8%, and 39.6% during the 12, 18, and 24 months. Mean blood lead levels increased from 3.36 to 4.45 microg/dL between the ages of 6 and 24 months, but the standardized Mental Development Index (MDI) and Psychomotor Development Index (PDI) decreased from 99.26 and 98.13 (6 months old) to 93.29 and 82.52, respectively (24 months old). Due to the high rate of attrition, most of the infants in the low group were lost. Therefore, we used the 75th percentile of blood lead levels as a cutoff in the statistical analyses. After adjustment for a large number of confounding variables, prenatal lead exposure was found to be significantly associated with the standardized MDI and PDI scores at the age of 6 months old with a P value of 0.02 for both. A borderline significant effect of prenatal lead exposure was also seen on standardized PDI scores at the age of 24 months (P = 0.09). On the other hand, no relationship was seen between postnatal blood lead levels and concurrent cognitive development scores. Such an observation is not conclusive because of low statistical power due to small sample size. Our results provide additional evidence for low prenatal lead exposure effects on cognitive development in Saudi infants living in a rural area.
Extensive data shows a direct link between low-level lead exposure during early development and deficits in neurobehavioral-cognitive performance evident late in childhood through adolescence. Our previous studies confirmed the transfer of lead from the mother to the fetus as well as the effect of low lead exposure on neuropsychological behavior in school children. Such results led us to design a longitudinal survey to evaluate the effect of prenatal and/or postnatal lead exposure on early cognitive development among selected group of children from birth to 2 years of age. During the first stage of this study (between March and July 2004), we measured lead levels in 653 umbilical cord blood samples taken from healthy Saudi mothers delivering at King Khalid Hospital, Al-Kharj. This gave a good opportunity to look at the prevalence of increased blood lead levels in umbilical cord blood and to identify risk factors for prenatal lead exposure. The mean cord lead levels were 2.21 +/- 1.691 microg/dl in the range of 0.284-17.276 microg/dl. Only 1.23% of the newborns had blood lead levels >10 microg/dl, the Center for Disease Control level of concern. To investigate risk factors affecting cord blood lead levels, only subjects with lead levels above the 75th percentile (2.475 microg/dl) were selected in the multiple regression models. We observed that cord blood lead levels were significantly influenced by maternal age, the location of residence and intake of prenatal supplements. Controlling for newborn's head circumferences confounders, it was found that cord blood lead levels were significantly and negatively associated with newborn's head circumference (beta = -0.158, p = 0.036). The negative association was seen between intake of prenatal supplements and cord blood lead levels emphasizing the role of prenatal supplementations during pregnancy. The significant reductions in newborns, head circumferences due to lead exposure may have serious implications for their future performance and achievement. This study reveals that even at low prenatal lead exposure, all possible measures to inspect lead sources in our environment and reduce lead exposure should be taken.
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