Association between Maternal Exposure to Arsenic during Pregnancy and Risk of Preterm Birth: A Systematic Review and Meta-Analysis
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Abstract
Background: Several observational studies have suggested that maternal exposure during pregnancy to arsenic is associated with the risk of preterm birth (PTB); however, available evidence is inconsistent. Therefore, we aimed to explore the relation of maternal exposure to arsenic to PTB risk.
Methods: A comprehensive systematic search was carried out from inception to April 2023 in PubMed and Scopus to retrieve all relevant studies. A pooled odds ratio (OR) with corresponding 95% confidence interval (CI) was employed using a random effects model to test the association.
Results: As a result, 14 eligible studies, with 12,619 participants, were included in the meta-analysis. Overall, the pooled OR of all analyzed studies indicated that higher maternal arsenic exposure is significantly related to the 1.12-fold increased odds of PTB (OR = 1.12, 95% CI = 1.04-1.21), with a remarkable heterogeneity across studies (P = <0.001, I2 = 70.9%). This association was found in prospective cohort studies (OR = 1.15, 95% CI = 1.05-1.26), but not in non-cohort studies. In the stratified analysis, the majority of subgroups supported the association of arsenic with PTB.
Conclusion: Maternal exposure to arsenic during pregnancy is directly linked to the odds of PTB. Future studies are suggested to investigate the effectiveness of specific measures to decrease exposure to arsenic in high-risk communities, particularly in pregnant women.
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2. Huang H, Wei Y, Xia Y, et al (2021). Child marriage, maternal serum metal exposure, and risk of preterm birth in rural Bangladesh: evidence from mediation analysis. J Expo Sci Environ Epidemiol, 31 (3):571-580.
3. Ren M, Zhao J, Wang B, et al (2022). Associations between hair levels of trace elements and the risk of preterm birth among pregnant Wwomen: A prospective nested case-control study in Beijing Birth Cohort (BBC), China. Environ Int, 158:106965.
4. Gete DG, Waller M, Mishra GD (2020). Effects of maternal diets on preterm birth and low birth weight: a systematic review. Br J Nutr, 123 (4):446-461.
5. Comess S, Donovan G, Gatziolis D, et al (2021). Exposure to atmospheric metals using moss bioindicators and neonatal health outcomes in Portland, Oregon. Environ Pollut, 284:117343.
6. Wang H, Li J, Zhang X, et al (2018). Maternal serum arsenic level during pregnancy is positively associated with adverse pregnant outcomes in a Chinese population. Toxicol Appl Pharmacol, 356:114-119.
7. Liu H, Lu S, Zhang B, et al (2018). Maternal arsenic exposure and birth outcomes: A birth cohort study in Wuhan, China. Environ Pollut, 236:817-823.
8. Milton AH, Hussain S, Akter S, et al (2017). A review of the effects of chronic arsenic exposure on adverse pregnancy outcomes. Int J Environ Res Public Health, 14 (6):556.
9. Almberg KS, Turyk ME, Jones RM, et al (2017). Arsenic in drinking water and adverse birth outcomes in Ohio. Environ Res, 157:52-59.
10. Nyanza EC, Dewey D, Manyama M, et al (2020). Maternal exposure to arsenic and mercury and associated risk of adverse birth outcomes in small-scale gold mining communities in Northern Tanzania. Environ Int, 137:105450.
11. Banu SA, Kile ML, Christiani DC, et al (2016). Study of prenatal arsenic exposure and reproductive health outcome in Bangladesh. Bangladesh Journal of Obstetrics & Gynaecology, 28 (2):76-81.
12. Rahman ML, Kile ML, Rodrigues EG, et al (2018). Prenatal arsenic exposure, child marriage, and pregnancy weight gain: associations with preterm birth in Bangladesh. Environ Int, 112:23-32.
13. Huang H, Wei L, Chen X, et al (2021). Cord serum elementomics profiling of 56 elements depicts risk of preterm birth: evidence from a prospective birth cohort in rural Bangladesh. Environ Int, 156:106731.
14. Fano-Sizgorich D, Vásquez-Velásquez C, Yucra S, et al (2021). Total urinary arsenic and inorganic arsenic concentrations and birth outcomes in pregnant women of Tacna, Peru: A cross-sectional study. Expo Health, 13:133-140.
15. Bank-Nielsen PI, Long M, Bonefeld-Jørgensen EC (2019). Pregnant inuit women’s exposure to metals and association with fetal growth outcomes: ACCEPT 2010–2015. Int J Environ Res Public Health, 16 (7):1171.
16. Knobloch K, Yoon U, Vogt PM (2011). Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. J Craniomaxillofac Surg, 39 (2):91-92.
17. Mohseni R, Mohseni F, Alizadeh S, et al (2020). The association of dietary approaches to stop hypertension (DASH) diet with the risk of colorectal cancer: a meta-analysis of observational studies. Nutr Cancer, 72 (5):778-790.
18. Mohseni R, Abbasi S, Mohseni F, et al (2019). Association between dietary inflammatory index and the risk of prostate cancer: a meta-analysis. Nutr Cancer, 71 (3):359-366.
19. Goodarzi G, Mozaffari H, Raeisi T, et al (2022). Metabolic phenotypes and risk of colorectal cancer: a systematic review and meta-analysis of cohort studies. BMC Cancer, 22 (1):89.
20. Peters JL, Sutton AJ, Jones DR, et al (2006). Comparison of two methods to detect publication bias in meta-analysis. JAMA, 295 (6):676-680.
21. Rashidbeygi E, Safabakhsh M, Mohammed SH, Alizadeh S (2019). Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: Evidence from a meta-analysis on 10,603,067 subjects from 57 studies. Diabetes Metab Syndr, 13 (1):830-843.
22. Ashrap P, Watkins DJ, Mukherjee B, et al (2020). Maternal blood metal and metalloid concentrations in association with birth outcomes in Northern Puerto Rico. Environ Int, 138:105606.
23. Kim SS, Meeker JD, Carroll R, et al (2018). Urinary trace metals individually and in mixtures in association with preterm birth. Environ Int, 121(Pt 1):582-590.
24. Wai KM, Mar O, Kosaka S, et al (2017). Prenatal heavy metal exposure and adverse birth outcomes in Myanmar: a birth-cohort study. Int J Environ Res Public Health, 14 (11):1339.
25. Xu S, Hansen S, Sripada K, et al (2022). Maternal Blood Levels of Toxic and Essential Elements and Birth Outcomes in Argentina: The EMASAR Study. Int J Environ Res Public Health, 19 (6):3643.
26. Yu Y, Gao M, Wang X, et al (2019). Recommended acceptable levels of maternal serum typical toxic metals from the perspective of spontaneous preterm birth in Shanxi Province, China. Sci Total Environ, 686:599-605.
27. Ahmad SA, Sayed M, Barua S, et al (2001). Arsenic in drinking water and pregnancy outcomes. Environ Health Perspect, 109 (6):629-631.
28. Keeler C, Luben TJ, Forestieri N, et al (2023). Is residential proximity to polluted sites during pregnancy associated with preterm birth or low birth weight? Results from an integrated exposure database in North Carolina (2003–2015). J Expo Sci Environ Epidemiol, 33(2):229-236.
29. Huang H, Woodruff TJ, Baer RJ, et al (2018). Investigation of association between environmental and socioeconomic factors and preterm birth in California. Environ Int, 121(Pt 2):1066-1078.
30. Hall M, Gamble M, Slavkovich V, et al (2007). Determinants of arsenic metabolism: blood arsenic metabolites, plasma folate, cobalamin, and homocysteine concentrations in maternal–newborn pairs. Environ Health Perspect, 115 (10):1503-1509.
31. Vahter M (2009). Effects of arsenic on maternal and fetal health. Annu Rev Nutr, 29:381-399.
32. Seow WJ, Pan W-C, Kile ML, et al (2012). Arsenic reduction in drinking water and improvement in skin lesions: a follow-up study in Bangladesh. Environ Health Perspect, 120 (12):1733-1738.
33. Jamil NB, Feng H, Ahmed KM, et al (2019). Effectiveness of different approaches to arsenic mitigation over 18 years in Araihazar, Bangladesh: implications for national policy. Environ Sci Technol, 53 (10):5596-5604.
34. Wu M-M, Chiou H-Y, Ho I-C, et al (2003). Gene expression of inflammatory molecules in circulating lymphocytes from arsenic-exposed human subjects. Environ Health Perspect, 111 (11):1429-1438.
35. Challis JR, Lockwood CJ, Myatt L, et al (2009). Inflammation and pregnancy. Reprod Sci, 16(2):206-215.
36. Bunderson M, Coffin JD, Beall HD (2002). Arsenic induces peroxynitrite generation and cyclooxygenase-2 protein expression in aortic endothelial cells: possible role in atherosclerosis. Toxicol Appl Pharmacol, 184 (1):11-18.
37. Jomova K, Jenisova Z, Feszterova M, et al (2011). Arsenic: toxicity, oxidative stress and human disease. J Appl Toxicol, 31 (2):95-107.
38. Betteridge DJ (2000). What is oxidative stress? Metabolism, 49(2 Suppl 1):3-8.
39. Martin A, Faes C, Debevec T, et al (2018). Preterm birth and oxidative stress: Effects of acute physical exercise and hypoxia physiological responses. Redox Biol, 17:315-322.
40. Sultana Z, Maiti K, Aitken J, et al (2017). Oxidative stress, placental ageing‐related pathologies and adverse pregnancy outcomes. Am J Reprod Immunol, 77 (5): 10.1111/aji.12653.
41. Thang NQ, Huy BT, Van Tan L, Phuong NTK (2017). Lead and arsenic accumulation and its effects on plasma cortisol levels in Oreochromis sp. Bull Environ Contam Toxicol, 99:187-193.
42. Holzman C, Jetton J, Siler-Khodr T, et al (2001). Second trimester corticotropin-releasing hormone levels in relation to preterm delivery and ethnicity. Obstet Gynecol, 97(5 Pt 1):657-63.
43. Kwok RK, Kaufmann RB, Jakariya M (2006). Arsenic in drinking-water and reproductive health outcomes: a study of participants in the Bangladesh Integrated Nutrition Programme. J Health Popul Nutr, 24(2):190-205.
44. Li C-S, Loch-Caruso R (2007). Sodium arsenite inhibits migration of extravillous trophoblast cells in vitro. Reprod Toxicol, 24 (3-4):296-302.
45. Yamauchi H, Aminaka Y, Yoshida K, et al (2004). Evaluation of DNA damage in patients with arsenic poisoning: urinary 8-hydroxydeoxyguanine. Toxicol Appl Pharmacol, 198 (3):291-296.
2. Huang H, Wei Y, Xia Y, et al (2021). Child marriage, maternal serum metal exposure, and risk of preterm birth in rural Bangladesh: evidence from mediation analysis. J Expo Sci Environ Epidemiol, 31 (3):571-580.
3. Ren M, Zhao J, Wang B, et al (2022). Associations between hair levels of trace elements and the risk of preterm birth among pregnant Wwomen: A prospective nested case-control study in Beijing Birth Cohort (BBC), China. Environ Int, 158:106965.
4. Gete DG, Waller M, Mishra GD (2020). Effects of maternal diets on preterm birth and low birth weight: a systematic review. Br J Nutr, 123 (4):446-461.
5. Comess S, Donovan G, Gatziolis D, et al (2021). Exposure to atmospheric metals using moss bioindicators and neonatal health outcomes in Portland, Oregon. Environ Pollut, 284:117343.
6. Wang H, Li J, Zhang X, et al (2018). Maternal serum arsenic level during pregnancy is positively associated with adverse pregnant outcomes in a Chinese population. Toxicol Appl Pharmacol, 356:114-119.
7. Liu H, Lu S, Zhang B, et al (2018). Maternal arsenic exposure and birth outcomes: A birth cohort study in Wuhan, China. Environ Pollut, 236:817-823.
8. Milton AH, Hussain S, Akter S, et al (2017). A review of the effects of chronic arsenic exposure on adverse pregnancy outcomes. Int J Environ Res Public Health, 14 (6):556.
9. Almberg KS, Turyk ME, Jones RM, et al (2017). Arsenic in drinking water and adverse birth outcomes in Ohio. Environ Res, 157:52-59.
10. Nyanza EC, Dewey D, Manyama M, et al (2020). Maternal exposure to arsenic and mercury and associated risk of adverse birth outcomes in small-scale gold mining communities in Northern Tanzania. Environ Int, 137:105450.
11. Banu SA, Kile ML, Christiani DC, et al (2016). Study of prenatal arsenic exposure and reproductive health outcome in Bangladesh. Bangladesh Journal of Obstetrics & Gynaecology, 28 (2):76-81.
12. Rahman ML, Kile ML, Rodrigues EG, et al (2018). Prenatal arsenic exposure, child marriage, and pregnancy weight gain: associations with preterm birth in Bangladesh. Environ Int, 112:23-32.
13. Huang H, Wei L, Chen X, et al (2021). Cord serum elementomics profiling of 56 elements depicts risk of preterm birth: evidence from a prospective birth cohort in rural Bangladesh. Environ Int, 156:106731.
14. Fano-Sizgorich D, Vásquez-Velásquez C, Yucra S, et al (2021). Total urinary arsenic and inorganic arsenic concentrations and birth outcomes in pregnant women of Tacna, Peru: A cross-sectional study. Expo Health, 13:133-140.
15. Bank-Nielsen PI, Long M, Bonefeld-Jørgensen EC (2019). Pregnant inuit women’s exposure to metals and association with fetal growth outcomes: ACCEPT 2010–2015. Int J Environ Res Public Health, 16 (7):1171.
16. Knobloch K, Yoon U, Vogt PM (2011). Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. J Craniomaxillofac Surg, 39 (2):91-92.
17. Mohseni R, Mohseni F, Alizadeh S, et al (2020). The association of dietary approaches to stop hypertension (DASH) diet with the risk of colorectal cancer: a meta-analysis of observational studies. Nutr Cancer, 72 (5):778-790.
18. Mohseni R, Abbasi S, Mohseni F, et al (2019). Association between dietary inflammatory index and the risk of prostate cancer: a meta-analysis. Nutr Cancer, 71 (3):359-366.
19. Goodarzi G, Mozaffari H, Raeisi T, et al (2022). Metabolic phenotypes and risk of colorectal cancer: a systematic review and meta-analysis of cohort studies. BMC Cancer, 22 (1):89.
20. Peters JL, Sutton AJ, Jones DR, et al (2006). Comparison of two methods to detect publication bias in meta-analysis. JAMA, 295 (6):676-680.
21. Rashidbeygi E, Safabakhsh M, Mohammed SH, Alizadeh S (2019). Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: Evidence from a meta-analysis on 10,603,067 subjects from 57 studies. Diabetes Metab Syndr, 13 (1):830-843.
22. Ashrap P, Watkins DJ, Mukherjee B, et al (2020). Maternal blood metal and metalloid concentrations in association with birth outcomes in Northern Puerto Rico. Environ Int, 138:105606.
23. Kim SS, Meeker JD, Carroll R, et al (2018). Urinary trace metals individually and in mixtures in association with preterm birth. Environ Int, 121(Pt 1):582-590.
24. Wai KM, Mar O, Kosaka S, et al (2017). Prenatal heavy metal exposure and adverse birth outcomes in Myanmar: a birth-cohort study. Int J Environ Res Public Health, 14 (11):1339.
25. Xu S, Hansen S, Sripada K, et al (2022). Maternal Blood Levels of Toxic and Essential Elements and Birth Outcomes in Argentina: The EMASAR Study. Int J Environ Res Public Health, 19 (6):3643.
26. Yu Y, Gao M, Wang X, et al (2019). Recommended acceptable levels of maternal serum typical toxic metals from the perspective of spontaneous preterm birth in Shanxi Province, China. Sci Total Environ, 686:599-605.
27. Ahmad SA, Sayed M, Barua S, et al (2001). Arsenic in drinking water and pregnancy outcomes. Environ Health Perspect, 109 (6):629-631.
28. Keeler C, Luben TJ, Forestieri N, et al (2023). Is residential proximity to polluted sites during pregnancy associated with preterm birth or low birth weight? Results from an integrated exposure database in North Carolina (2003–2015). J Expo Sci Environ Epidemiol, 33(2):229-236.
29. Huang H, Woodruff TJ, Baer RJ, et al (2018). Investigation of association between environmental and socioeconomic factors and preterm birth in California. Environ Int, 121(Pt 2):1066-1078.
30. Hall M, Gamble M, Slavkovich V, et al (2007). Determinants of arsenic metabolism: blood arsenic metabolites, plasma folate, cobalamin, and homocysteine concentrations in maternal–newborn pairs. Environ Health Perspect, 115 (10):1503-1509.
31. Vahter M (2009). Effects of arsenic on maternal and fetal health. Annu Rev Nutr, 29:381-399.
32. Seow WJ, Pan W-C, Kile ML, et al (2012). Arsenic reduction in drinking water and improvement in skin lesions: a follow-up study in Bangladesh. Environ Health Perspect, 120 (12):1733-1738.
33. Jamil NB, Feng H, Ahmed KM, et al (2019). Effectiveness of different approaches to arsenic mitigation over 18 years in Araihazar, Bangladesh: implications for national policy. Environ Sci Technol, 53 (10):5596-5604.
34. Wu M-M, Chiou H-Y, Ho I-C, et al (2003). Gene expression of inflammatory molecules in circulating lymphocytes from arsenic-exposed human subjects. Environ Health Perspect, 111 (11):1429-1438.
35. Challis JR, Lockwood CJ, Myatt L, et al (2009). Inflammation and pregnancy. Reprod Sci, 16(2):206-215.
36. Bunderson M, Coffin JD, Beall HD (2002). Arsenic induces peroxynitrite generation and cyclooxygenase-2 protein expression in aortic endothelial cells: possible role in atherosclerosis. Toxicol Appl Pharmacol, 184 (1):11-18.
37. Jomova K, Jenisova Z, Feszterova M, et al (2011). Arsenic: toxicity, oxidative stress and human disease. J Appl Toxicol, 31 (2):95-107.
38. Betteridge DJ (2000). What is oxidative stress? Metabolism, 49(2 Suppl 1):3-8.
39. Martin A, Faes C, Debevec T, et al (2018). Preterm birth and oxidative stress: Effects of acute physical exercise and hypoxia physiological responses. Redox Biol, 17:315-322.
40. Sultana Z, Maiti K, Aitken J, et al (2017). Oxidative stress, placental ageing‐related pathologies and adverse pregnancy outcomes. Am J Reprod Immunol, 77 (5): 10.1111/aji.12653.
41. Thang NQ, Huy BT, Van Tan L, Phuong NTK (2017). Lead and arsenic accumulation and its effects on plasma cortisol levels in Oreochromis sp. Bull Environ Contam Toxicol, 99:187-193.
42. Holzman C, Jetton J, Siler-Khodr T, et al (2001). Second trimester corticotropin-releasing hormone levels in relation to preterm delivery and ethnicity. Obstet Gynecol, 97(5 Pt 1):657-63.
43. Kwok RK, Kaufmann RB, Jakariya M (2006). Arsenic in drinking-water and reproductive health outcomes: a study of participants in the Bangladesh Integrated Nutrition Programme. J Health Popul Nutr, 24(2):190-205.
44. Li C-S, Loch-Caruso R (2007). Sodium arsenite inhibits migration of extravillous trophoblast cells in vitro. Reprod Toxicol, 24 (3-4):296-302.
45. Yamauchi H, Aminaka Y, Yoshida K, et al (2004). Evaluation of DNA damage in patients with arsenic poisoning: urinary 8-hydroxydeoxyguanine. Toxicol Appl Pharmacol, 198 (3):291-296.
| Files | ||
| Issue | Vol 53 No 4 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i4.15553 | |
| Keywords | ||
| Arsenic Preterm birth Pregnancy Meta-analysis | ||
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How to Cite
1.
Ding Y, Xu Y, Tan X, Alizadeh M, Alizadeh H. Association between Maternal Exposure to Arsenic during Pregnancy and Risk of Preterm Birth: A Systematic Review and Meta-Analysis. Iran J Public Health. 2024;53(4):760-773.
