Association between prenatal cadmium exposure and cognitive development of offspring: A systematic review

Due to the lack of substantial and reliable evidence on the relationship between prenatal cadmium (Cd) exposure and cognitive development of offspring, we conducted the present systematic review. Leading electronic databases-including Pubmed, Embase, Web of Science, the Cochrane Library, PsycINFO, PsycARTICLES, and the Psychology and Behavioral Sciences Collection-were searched on February 14, 2019. There was no date, study design or language limit imposed in our search. All of the included studies satisfied our predetermined study population (pregnant mothers and their offspring), exposure (prenatal Cd exposure), and outcome measurements (adverse effects on cognitive development). The quality assessment for the included studies was conducted with the Newcastle-Ottawa Scale (NOS). Nine prospective cohort studies met the inclusion criteria, and six of them were assessed to be of high quality based on the NOS (NOS score ≥ 7). The prenatal Cd exposure was tested in maternal blood samples (4/9), umbilical cord blood samples (4/9), or maternal urinary samples (3/9). Among the nine studies included, six reported at least one inverse association between prenatal Cd exposure and the cognitive development of offspring, mainly in terms of language development (4/8), performance ability development (3/5), and general cognitive development (3/8). Furthermore, among six studies with high methodological quality (NOS score ≥ 7), prenatal Cd exposure was reported to be associated with language development in three studies (3/5), performance ability development in three studies (3/4), and general cognitive development in three studies (3/5). This systematic review provides convincing evidence that prenatal exposure to Cd is inversely associated with neurodevelopment of offspring. Larger prospective studies using standardized criteria and assessments of cognitive development are needed to confirm the dose-response effect and gender difference of prenatal Cd exposure on cognitive development of offspring.