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Toxins and Biliary Atresia: Is Karenia Brevis (Red Tide) The Culprit?
Rita Wyrebek1, Jamie L Fierstein2, Rebecca G Wells3
1Johns Hopkins All Children's Hospital, Department of Maternal, Fetal and Neonatal Medicine, Division of Neonatology, 501 6th Ave S, St. Petersburg, FL 33701, USA.
Insights
This study found no link between pregnant women
Area of Science:
- Environmental health
- Pediatric health
- Toxicology
Background:
- Harmful algal blooms caused by Karenia brevis (K. brevis) can impact coastal populations.
- Biliary atresia (BA) is a rare but serious liver disease in infants.
- Understanding environmental risk factors for BA is crucial for public health.
Purpose of the Study:
- To investigate the potential association between maternal exposure to Karenia brevis (K. brevis) during pregnancy and the development of biliary atresia (BA) in offspring.
- To quantify K. brevis exposure levels based on proximity to the mother's residence.
- To determine if gestational exposure to K. brevis is a risk factor for BA.
Main Methods:
- A hospital-based, case-control study matched 1:4 for age.
- Infants diagnosed with BA (cases) were compared to healthy infants (controls).
- Maternal K. brevis exposure was estimated using historical data at 10- and 50-mile radii from the mother's zip code.
Main Results:
- No significant differences in race/ethnicity, season of birth, or coastal residence between cases and controls.
- While a higher proportion of BA cases had no K. brevis exposure at a 10-mile radius, this did not translate to a significant association.
- Adjusted analyses revealed no significant link between gestational K. brevis exposure and BA at either 10- or 50-mile radii.
Conclusions:
- This study found no evidence of an association between maternal gestational exposure to Karenia brevis (K. brevis) and the prevalence of biliary atresia (BA) in offspring.
- The findings suggest that K. brevis blooms may not be a significant environmental risk factor for BA.
- Further research may explore other potential environmental or genetic factors contributing to BA.
Objective:
The study objective was to evaluate the association between Karenia brevis (K. brevis) exposure during pregnancy and the prevalence of biliary atresia (BA) in offspring.
Study Design:
This was a hospital-based, case-control study in which cases were infants diagnosed with BA at Johns Hopkins All Children's Hospital from October 2001 to December 2019. Cases were matched 1:4 by age to controls who were randomly selected from a pool of healthy infants hospitalized during the study period for common pediatric diagnoses. Infants were excluded if they had congenital anomalies and/or were non-Florida residents. Gestational K. brevis exposure levels (cells/liter) were determined from Florida Fish and Wildlife Conservation Commission exposure data at 10- and 50 mile radii from the mother's zip code of residence. Multivariable conditional logistic regression determined odds of BA in offspring in relation to maternal gestational K. brevis exposure adjusted for infant sex, race/ethnicity, coastal residence, and seasonality.
Results:
Of 38 cases and 152 controls, no significant inter-group differences were observed for infant race/ethnicity, season of birth, or coastal residence. Median gestational exposure at the 10 mile radius was 0 cells/liter in both groups. A greater proportion of cases had no gestational K. brevis exposure (63.2 %, n = 24) in comparison to controls (37.5 %, n = 57; p = .04) at a 10 mile radius. At a 50 mile radius, cases had a peak median exposure at 6 months of gestation compared to controls' peak at 9 months. After adjustment for sex, seasonality, race/ethnicity, and coastal residence, there was no significant association between BA and maximum K. brevis exposure per trimester of pregnancy observed at a 10- or 50 mile radius.
Conclusion:
In this matched case-control study, we observed no association between gestational K. brevis (cells/liter) exposure at a 10- or 50 mile radius from maternal zip code of residence and BA in offspring.
