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Prenatal Arsenic Exposure and Consequences for Pregnancy Outcome and Infant Health: Epidemiological Studies in Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to analyse possible effects of prenatal arsenic exposure on foetal and infant health. The setting is Bangladesh, where two cohorts were studied, both part of a health and demographic surveillance system in Matlab. A historical cohort 1991-2000 included 29,134 pregnant women with information on drinking water sources and arsenic testing of tube well water. A prospective cohort study included pregnant women 2002 - 2003 where urinary arsenic concentrations were assessed twice during pregnancy; 2,924 women and their pregnancy outcomes were evaluated for foetal loss, perinatal and infant mortality; 1,578 mother-infant pairs were analysed for size at birth; and 1,552 were analysed for morbidity during infancy.

Women exposed to arsenic levels ≥ 50 µg/L in water had an increased risk of foetal loss and infant death in comparison with women exposed to arsenic levels < 50 µg/L. These findings were confirmed in the prospective cohort study. Women with urine arsenic concentrations at the 5th quintile had 62% increased risk of spontaneous abortion (OR 1.62, 95% CI 1.04 - 2.55) in comparison with women who had arsenic concentrations at the 1st quintile level. Increased risks of perinatal morality (RR 3.01, 95% CI 1.07 - 8.45) and infant mortality (RR 5.01; 95% CI: 1.41 - 17.84) were also observed at the 5th quintile of exposure.

Significant negative dose-effect associations were found between arsenic exposure and birth weight, head and chest circumferences at a relatively low level of exposure (<100 µg/L in urine). In this range of exposure birth weight decreased by 1.68 g (SE 0.62) for each 1 µg/L increase of arsenic in urine.

In comparison with exposure at the 1st quintile level the risk of lower respiratory tract infection was significantly increased (RR 1.68, 95% CI 1.35-2.07) for women who had urinary arsenic concentrations at the 5th quintile level. The risk was also increased for diarrhoeal diseases.

The study findings highlight the negative effects of arsenic exposures on pregnancy outcomes and infant health. Mitigation programs need to be strengthened and women of reproductive ages should be prioritized in arsenic affected regions worldwide.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 61
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 450
Keywords [en]
arsenic, groundwater, foetal loss, birth weight, lower respiratory tract infection, diarrhoeal diseases, infant mortality, cohort, Bangladesh
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-100770ISBN: 978-91-554-7502-4 (print)OAI: oai:DiVA.org:uu-100770DiVA, id: diva2:210970
Public defence
2009-05-19, Rosénsalen, Akademiska sjukhuset, Ing. 95/96 nbv, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2009-04-27 Created: 2009-04-07 Last updated: 2009-04-30Bibliographically approved
List of papers
1. Association of Arsenic Exposure during Pregnancy with Fetal Loss and Infant Death: A Cohort Study in Bangladesh
Open this publication in new window or tab >>Association of Arsenic Exposure during Pregnancy with Fetal Loss and Infant Death: A Cohort Study in Bangladesh
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2007 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 165, no 12, p. 1389-1396Article in journal (Refereed) Published
Abstract [en]

The authors evaluated the effect of arsenic exposure on fetal and infant survival in a cohort of 29,134 pregnancies identified by the health and demographic surveillance system in Matlab, Bangladesh, in 1991-2000. Arsenic exposure, reflected by drinking water history and analysis of arsenic concentrations in tube-well water used by women during pregnancy, was assessed in a separate survey conducted in 2002-2003. Data on vital events, including pregnancy outcome and infant mortality, were collected by monthly surveillance at the household level. The risk of fetal loss and infant death in relation to arsenic exposure was estimated by a Cox proportional hazards model. Drinking tube-well water with more than 50 microg of arsenic per liter during pregnancy significantly increased the risks of fetal loss (relative risk = 1.14, 95% confidence interval: 1.04, 1.25) and infant death (relative risk = 1.17, 95% confidence interval: 1.03, 1.32). There was a significant dose response of arsenic exposure to risk of infant death (p = 0.02). Women of reproductive age should urgently be prioritized for mitigation activities where drinking water is contaminated by arsenic.

Keywords
arsenic, Bangladesh, fetal death, infant, mortality, pregnancy outcome, water
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-100716 (URN)10.1093/aje/kwm025 (DOI)000247240700008 ()17351293 (PubMedID)
Available from: 2009-04-07 Created: 2009-04-06 Last updated: 2018-11-28Bibliographically approved
2. Arsenic Exposure in Pregnancy Increases the Risk of Fetal Loss and Infant Death: A Prospective Cohort Study in Bangladesh
Open this publication in new window or tab >>Arsenic Exposure in Pregnancy Increases the Risk of Fetal Loss and Infant Death: A Prospective Cohort Study in Bangladesh
Show others...
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:uu:diva-100759 (URN)
Available from: 2009-04-07 Created: 2009-04-07 Last updated: 2010-01-14
3. Arsenic exposure during pregnancy and size at birth: a prospective cohort study in Bangladesh
Open this publication in new window or tab >>Arsenic exposure during pregnancy and size at birth: a prospective cohort study in Bangladesh
Show others...
2009 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 169, no 3, p. 304-312Article in journal (Refereed) Published
Abstract [en]

The authors evaluated the association of prenatal arsenic exposure with size at birth (birth weight, birth length, head and chest circumferences). This prospective cohort study, based on 1,578 mother-infant pairs, was conducted in Matlab, Bangladesh, in 2002-2003. Arsenic exposure was assessed by analysis of arsenic in urine collected at around gestational weeks 8 and 30. The association of arsenic exposure with size at birth was assessed by linear regression analyses. In analysis over the full range of exposure (6-978 microg/L), no dose-effect association was found with birth size. However, significant negative dose effects were found with birth weight and head and chest circumferences at a low level of arsenic exposure (<100 microg/L in urine). In this range of exposure, birth weight decreased by 1.68 (standard error (SE), 0.62) g for each 1-microg/L increase of arsenic in urine. For head and chest circumferences, the corresponding reductions were 0.05 (SE, 0.03) mm and 0.14 (SE, 0.03) mm per 1 microg/L, respectively. No further negative effects were shown at higher levels of arsenic exposure. The indicated negative effect on birth size at a low level of arsenic exposure warrants further investigation.

Keywords
arsenic, Bangladesh, birth weight, cohort studies, maternal exposure, urine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-100722 (URN)10.1093/aje/kwn332 (DOI)000263162200007 ()19037006 (PubMedID)
Available from: 2009-04-07 Created: 2009-04-06 Last updated: 2017-12-13Bibliographically approved
4. Arsenic exposure in pregnancy is associated with increased risk of lower respiratory tract infection and diarrhea: A prospective cohort study in Bangladesh
Open this publication in new window or tab >>Arsenic exposure in pregnancy is associated with increased risk of lower respiratory tract infection and diarrhea: A prospective cohort study in Bangladesh
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:uu:diva-100761 (URN)
Available from: 2009-04-07 Created: 2009-04-07 Last updated: 2010-01-14

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