Academic journal article Environmental Health Perspectives

Association of Arsenic with Adverse Pregnancy Outcomes/infant Mortality: A Systematic Review and Meta-Analysis

Academic journal article Environmental Health Perspectives

Association of Arsenic with Adverse Pregnancy Outcomes/infant Mortality: A Systematic Review and Meta-Analysis

Article excerpt

Introduction

Arsenic contamination of drinking water, air, food, and beverages is one of the major global health problems (Essumang 2009; Essumang et al. 2007; Hughes 2006; Navas-Acien and Nachman 2013; Obiri et al. 2010) that affect > 300 million people worldwide. This includes an estimated 13 million people in the United States and about 70 million people in Bangladesh (Murcott 2012). At concentrations > 50 [micro]g/L, inorganic arsenic (iAs) has been associated with elevated risk of cancer (e.g., bladder, kidney, liver, lung, skin, prostate) (Ahamed et al. 2006b; McDonald et al. 2007; Mink et al. 2008; Steinmaus et al. 2000, 2003; Walvekar et al. 2007), cardiovascular diseases (Moon et al. 2013; Navas-Acien et al. 2005), high blood pressure (Abhyankar et al. 2012; Moon et al. 2013; NavasAcien et al. 2005), anemia in pregnancy (Hopenhayn et al. 2006; Navas-Acien et al. 2006), mortality from respiratory diseases in both adults and children (Ahamed et al. 2006a; Ferreccio and Sancha 2006; Walvekar et al. 2007), diabetes in adults (Navas-Acien et al. 2006), and neurodevelopment problems (Hamadani et al. 2011). At concentrations around 10 [micro]g/L, which is considered safe by the World Health Organization's (WHO) provisional guideline (WHO 2011), iAs may still cause cancer in approximately 0.1--0.3% and increased systolic blood pressure in women 6 weeks postpartum (International Agency for Research on Cancer 2004; Kwok 2007). iAs easily crosses human and animal placenta and has been demonstrated to increase the risk of impaired fetal growth and infant mortality in laboratory animal studies (Navarro et al. 2004; Smith and Steinmaus 2009; Vahter 2009). Several epidemiologic studies (e.g., Cherry et al. 2010; Myers et al. 2010; Rahman et al. 2010) have examined the relation between arsenic and adverse pregnancy outcomes/infant mortality, and the findings are equivocal. Our understanding of arsenic exposure and adverse pregnancy outcomes is limited and, at best, fragmented. To our knowledge, no systematic review and/or meta-analysis has reported on the effect of arsenic on human pregnancy and infant health. Given the widespread low, moderate, and high arsenic exposure in the general population, an understanding of the impact of iAs on maternal and fetal health is relevant for public health policy.

To fill this gap, we conducted a systematic review and meta-analysis of epidemiologic studies to examine the association between arsenic exposure and the risk of spontaneous abortion, stillbirth, preterm delivery, birth weight, and neonatal/infant mortality.

Methods

Search strategy and study selection. This study was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) group (Moher et al. 2009). We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and Ovid MEDLINE (http://ovidsp.tx.ovid.com) (from 1946 through July 2013) and EMBASE (http://www.embase.com/login) (from 1988 through July 2013) databases (Figure 1), using the terms "arsenic," "arsenicals," "arsenite," "arsenate" and "abortion, spontaneous," "fetal mortality," "preterm delivery," "low birthweight," "birthweight," "infant mortality," "neonatal mortality" (see Supplemental Material, "Search Strategy"). In addition, we searched the reference lists of reviews (Bloom et al. 2010; Smith and Steinmaus 2009; Vahter 2009) and potentially relevant articles. Two authors (R.Q. and F.A.A.) independently evaluated the articles. Studies that fulfilled the following a priori eligibility criteria were included if the study a) was an original study; b) was a cross-sectional, or a case-control or a cohort design; c) reported on any one or more of the following outcomes: spontaneous abortion, stillbirth, preterm delivery, birth weight, and neonatal/infant mortality; and d) presented data on arsenic exposure determined using environmental measures (arsenic in drinking water or airborne arsenic, or arsenic in soil), biomarkers, or indirect measures (e. …

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