Maternal arsenic exposure and birth outcomes: A comprehensive review of the epidemiologic literature focused on drinking water

Abstract

Inorganic arsenic (iAs) is a human toxicant to which populations may be exposed through consumption of geogenically contaminated groundwater. A growing body of experimental literature corroborates the reproductive toxicity of iAs; however, the results of human studies are inconsistent. Therefore, we conducted a comprehensive review of epidemiologic studies focused on drinking water iAs exposure and birth outcomes to assess the evidence for causality and to make recommendations for future study. We reviewed 18 English language papers assessing birth weight, gestational age, and birth size. Thirteen of the studies were conducted among populations with frequent exposure to high-level groundwater iAs contamination (>10 μg/L) and five studies were conducted in areas without recognized contamination. Most studies comprised small samples and used cross-sectional designs, often with ecologic exposure assessment strategies, although several large prospective investigations and studies with individual-level measurements were also reported. We conclude that: 1) the epidemiologic evidence for an increased risk of low birth weight (<2,500 grams) is insufficient, although there exists limited evidence for birth weight decreases; 2) the evidence for increased preterm delivery is insufficient; and, 3) there exists minimal evidence for decreased birth size. In further investigation of birth weight and size, we recommend incorporation of individual susceptibility measures using appropriate biomarkers, with collection timed to windows of vulnerability and speciated arsenic analysis, as well as consideration of populations exposed primarily to drinking water iAs contamination <10 μg/L. Given the large potential public health impact, additional, high quality epidemiologic studies are necessary to more definitively assess the risk.

Low level arsenic contaminated water consumption and birth outcomes in Romania—An exploratory study

“…A growing body of epidemiologic evidence suggests increased risks for adverse birth outcomes in association with the use of highly iAs contaminated water sources by pregnant women (> 10 μg/L), including the delivery of lower birth weight babies at term [21, 22], in Argentina [23], Bangladesh [24, 25], India [26, 27], Mexico [28], and Taiwan [29]. Shorter birth length [28, 30] and smaller head and chest circumferences [25] have also been reported among mothers with high level iAs exposure.…”

Arsenic inhibits hedgehog signaling during P19 cell differentiation

“…An increasingly important source of exposure to inorganic arsenic is food, such as cereals, crops, and vegetables, which are cultured in arsenic-rich areas where farmers use groundwater for irrigation or in areas with historic arsenic-based pesticide usage. Both epidemiological and animal studies showed that arsenic exposure causes adverse developmental effects such as fetal loss, infant death, low intelligence quotient scores, reduced birth weight, and reduced weight gain (Calderon et al , 2001; Rodriguez et al , 2002; Wang et al , 2006a; Huyck et al , 2007; Rahman et al , 2007; Li et al , 2009; Bloom et al , 2014), suggesting that arsenic exposure impacts development.…”

Evidence-Based Practices During Pregnancy and Midwifery Approach

“…5 DSÖ'nün (2016) Antenatal Bakım Rehberi'nde, rutin dopler ultrason önerilmemektedir. Bununla birlikte 24. gebelik haftasından önce gestas yonel gebelik haftasını belirlemek, çoğul gebelikleri ve fetal anomaliyi saptamak amacıyla ultrason izlemi yapılabileceği belirtilmiştir.…”

“…(2014) tarafından toplam 18 çalış-manın incelendiği bir çalışma da bebek doğum ağırlığı ve gestasyonel yaş ile arsenikli içme suyunun ilişkisi incelenmiştir. 24 Araştırma sonucunda düşük doğum ağırlığı ve preterm doğum riskinde artma olduğuna dair kanıtların yetersiz olduğu ve bebeğin doğum kilosunun azalmasıyla arsenikli içme suyu arasındaki bağlantıya dair kanıtların minimal düzeyde olduğu belirtilmiştir. 24 Antenatal takiplerde ebeler, gebelere içme suyunun içerisindeki elementlere karşı duyarlı olmaları konusunda bilgilendirme yapmalı ve kanıta dayalı çalışmaların sonuçlarını onlara aktararak gebeleri aydınlatmalıdır.…”