Association Between Prenatal Exposure to Metals and Atopic Dermatitis Among Children Aged 4 Years in Taiwan

Abstract

IMPORTANCEThe prevalence of atopic dermatitis has substantially increased in recent decades, and atopic dermatitis could lead to allergic airway inflammation later in life. A previous study found that inorganic arsenic exposure was associated with allergic airway inflammation in children aged 8 to 14 years. However, the association between prenatal exposure to arsenic and other metals and the risk of atopic dermatitis among young children remains unknown. OBJECTIVETo assess the association between prenatal exposure to arsenic and other metals and the occurrence of atopic dermatitis in children at age 4 years. DESIGN, SETTING, AND PARTICIPANTS In total, 1152 pregnant women were enrolled in the original Taiwan Maternal and Infant Cohort Study (TMICS), a multicenter birth cohort study conducted at 9 hospitals in northern, central, southern, and eastern Taiwan from October 2012 to May 2015. Of those, 586 mothers and children aged 4 years participated in follow-up questionnaire interviews from August 2016 to January 2019. After excluding 216 participants with missing data, the final statistical analysis of follow-up data included 370 mother and child pairs from the central and eastern regions of Taiwan. Data were analyzed from February 2 to August 12, 2021.EXPOSURES Arsenic, cadmium, lead, cobalt, copper, nickel, thallium, and zinc during pregnancy. MAIN OUTCOMES AND MEASURESThe outcome was parent-reported atopic dermatitis history among children aged 4 years. The presence of atopic dermatitis was defined as a positive response to the question, "Has your child ever had atopic dermatitis diagnosed by a physician?" During the initial TMICS study period, concentrations of arsenic, cadmium, lead, cobalt, copper, nickel, thallium, and zinc were measured in maternal urine during the third trimester of pregnancy using an inductively coupled plasma mass spectrometer. Estimated total inorganic arsenic exposure was calculated using a model that included data on both total arsenic and arsenic species (arsenite, arsenate, monomethylarsonate, and dimethylarsenate) obtained from a previous TMICS cohort. RESULTS Among 370 children included in the analysis, the mean (SD) age was 3.94 (0.59) years; 208 children (56.2%) were male, and 267 children (72.2%) were from the central region of Taiwan.A total of 110 children (29.7%) had atopic dermatitis at age 4 years. Maternal estimated total inorganic arsenic exposure during pregnancy was associated with increased odds of atopic dermatitis among children at age 4 years (odds ratio [OR], 2.42 [95% CI, for every doubled increase of total inorganic arsenic) after adjusting for parental allergies, child's sex, geographic area, maternal educational level, and exposure to tobacco smoke. Every increased unit in the weighted quantile sum index of maternal metal exposure was significantly associated with atopic dermatitis (OR, 1.63; 95% CI, 1.28-2.07). Arsenic (40.1%) and cadmium (20.5%) accounted for most of the metal mixture index. (continued) Key Points Question Is prenatal exposure to arsenic an...

The Imprint of Exposome on the Development of Atopic Dermatitis across the Lifespan: A Narrative Review

“…Exposure to lead in late pregnancy increases the risk of AD in boys at 6 months of age. Prenatal exposure to inorganic arsenic and co-exposure to inorganic arsenic and cadmium were associated with a higher risk of AD in young children [ 17 ]. Mono-benzyl phthalate (MBzP) increased the risk of developing eczema in early childhood [ 18 ].…”

Associations between the Maternal Exposome and Metabolome during Pregnancy

“…Most studies of the impact of prenatal exposure have examined a small number of specific chemicals ( Tsai et al. 2021 ).…”

“…Most studies of the impact of prenatal exposure have examined a small number of specific chemicals (Tsai et al 2021). There is growing interest in examining a larger range of exposures at once.…”

Errors in Methods

“…In the Original Investigation titled “Association Between Prenatal Exposure to Metals and Atopic Dermatitis Among Children Aged 4 Years in Taiwan,” 1 published October 27, 2021, data errors have been corrected in the Methods section. Under “Assessment of Metals in Maternal Urine,” the sentence on the limits of detection now reads as follows: “The limits of detection were 0.399 μg/L for arsenic, 0.066 μg/L for cadmium, 0.022 μg/L for lead, 0.016 μg/L for cobalt, 0.225 μg/L for copper, 0.090 μg/L for nickel, 0.008 μg/L for thallium, and 0.417 μg/L for zinc.” This article has been corrected.…”

“…Under “Assessment of Metals in Maternal Urine,” the sentence on the limits of detection now reads as follows: “The limits of detection were 0.399 μg/L for arsenic, 0.066 μg/L for cadmium, 0.022 μg/L for lead, 0.016 μg/L for cobalt, 0.225 μg/L for copper, 0.090 μg/L for nickel, 0.008 μg/L for thallium, and 0.417 μg/L for zinc.” This article has been corrected. 1 …”