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

Abstract

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.

The Cumulative Risk of Prenatal Exposures to Chemical and Non-Chemical Stressors on Birth Outcomes in Suriname

“…Women were eligible if they were 16 years or older, spoke Dutch, Saramaccan, or Trio, had a singleton gestation, were planning to give birth at one of the study sites and provided written informed consent/assent. Pregnant women were recruited at four hospitals, prenatal clinics and midwife facilities of the Regional Health Department, and at multiple health care clinics of the Medical Mission Primary Health Care Suriname (MMPHCS) in the Interior [ 20 , 23 ].…”

“…These data were uploaded in a Research Electronic Data Capture (REDCap) project site database for data cleaning and analysis purposes. REDCap is a secure web application for building and monitoring online surveys and databases to collect data for research purposes and can be used online or offline [ 20 , 24 ].…”

“…The five response options were: 0 for never, 1 for almost never, 2 for sometimes, 3 for fairly often and 4 for very often. The total score ranges from 0 to 40 points; 0 indicates the lowest stress level and 40 the highest stress level [ 20 ].…”

“…In 2019, Suriname had an overall neonatal mortality rate (NMR) of 11.2 per 1000 live births, higher than the NMR in Latin America and the Caribbean from 2008–2014 of 9 deaths per 1000 live births [ 17 , 18 , 19 ]. The prevalence in Suriname of PTB (<37 weeks of gestation) and LBW (<2500 g) is respectively 15% and 13% [ 18 , 20 ], higher than the LBW and PTB of the entire Latin America and the Caribbean region (respectively 13% and 9%) [ 21 ]. The rates of PTB and LBW in Suriname are in line with those in Jamaica and Guyana, but are higher than Cuba, Mexico and Venezuela [ 22 ].…”

“…The rates of PTB and LBW in Suriname are in line with those in Jamaica and Guyana, but are higher than Cuba, Mexico and Venezuela [ 22 ]. Findings of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)–MeKiTamara study showed high maternal levels of hair Hg (≥1.1 µg/g) in 37.5% of participants, high perceived stress (score ≥ 20) in 27.2% and probable depression (score ≥ 12) in 22.4% [ 20 ].…”