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Prenatal Environmental Metal Exposure and Preterm Birth: A Scoping Review
Rasheda Khanam1, Ishaan Kumar2, Opeyemi Oladapo-Shittu1
1International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Insights
Prenatal exposure to lead and cadmium is linked to higher rates of preterm birth (PTB), a major cause of child mortality. More research is needed, especially in low-middle-income countries, to understand environmental metal impacts on pregnancy outcomes.
Area of Science:
- Environmental Health
- Reproductive Toxicology
- Perinatal Epidemiology
Background:
- Preterm birth (PTB) is a leading cause of mortality in children under five globally.
- Environmental metal and metalloid exposures during pregnancy are implicated in PTB etiology.
- Understanding these exposures is crucial for public health interventions.
Purpose of the Study:
- To review the extent of prenatal exposure to lead, mercury, cadmium, and arsenic.
- To assess the association between these metal/metalloid exposures and PTB.
- To identify common biological pathways linking exposures to PTB.
Main Methods:
- Scoping review of original research studies.
- Searched major scientific databases (PubMed, Embase, Scopus, etc.) from 2000-2019.
- Included 36 articles for full-text review.
Main Results:
- Higher incidence of PTB associated with lead and cadmium exposures.
- Findings for mercury and arsenic exposures were inconclusive.
- Identified oxidative stress, epigenetic changes, inflammation, and endocrine disruption as key pathways.
Conclusions:
- Prenatal lead and cadmium exposure are associated with increased PTB risk.
- Further research, particularly in low-middle-income countries, is essential.
- Environmental metals pose a significant risk to pregnancy outcomes.
Abstract:
Preterm birth (PTB) and its complications are the leading causes of under-five year old child deaths, accounting worldwide for an estimated one million deaths annually. The etiology of PTB is complex and multifactorial. Exposures to environmental metals or metalloids are pervasive and prenatal exposures to them are considered important in the etiology of PTB. We conducted a scoping review to determine the extent of prenatal exposures to four metals/metalloids (lead, mercury, cadmium and arsenic) and their association with PTB. We reviewed original research studies published in PubMed, Embase, the Cochrane Library, Scopus, POPLINE and the WHO regional indexes from 2000 to 2019; 36 articles were retained for full text review. We documented a higher incidence of PTB with lead and cadmium exposures. The findings for mercury and arsenic exposures were inconclusive. Metal-induced oxidative stress in the placenta, epigenetic modification, inflammation, and endocrine disruptions are the most common pathways through which heavy metals and metalloids affect placental functions leading to PTB. Most of the studies were from the high-income countries, reflecting the need for additional data from low-middle-income countries, where PTB rates are higher and prenatal exposure to metals are likely to be just as high, if not higher.
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