Neural tube defects prevalence does not increase after modification of the folic acid fortification program in Chile.

BACKGROUND: In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago. METHODS: This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends. RESULTS: The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17). CONCLUSIONS: Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates.

Arsenic exposure during pregnancy and postpartum maternal glucose tolerance: evidence from Bangladesh.

BACKGROUND: Arsenic exposure has been associated with gestational diabetes mellitus. However, the extent to which arsenic exposure during pregnancy is associated with postpartum glucose intolerance is unknown. METHODS: We studied 323 women in Bangladesh. We assessed arsenic exposure in early pregnancy via toenail and water samples. We measured fasting glucose and insulin in serum at a mean (SD) of 4.0 (3.5) weeks post-delivery. We ran covariate-adjusted, linear regression models to examine associations of arsenic concentrations with HOMA-IR, a marker of insulin resistance, and HOMA-ß, a marker of beta cell function. RESULTS: Median (IQR) arsenic concentration was 0.45 (0.67) µg/g in toenails and 2.0 (6.5) µg/L in drinking water. Arsenic concentrations during pregnancy were not associated with insulin resistance or beta cell function postpartum. HOMA-IR was 0.07% (- 3.13, 3.37) higher and HOMA-ß was 0.96% (- 3.83, 1.99) lower per IQR increment in toenail arsenic, but effect estimates were small and confidence intervals crossed the null. CONCLUSIONS: Although arsenic exposure during pregnancy has been consistently associated with gestational diabetes mellitus, we found no clear evidence for an adverse effect on postpartum insulin resistance or beta cell function.

Parental metal exposures as potential risk factors for spina bifida in Bangladesh.

BACKGROUND: Neural tube defects are a pressing public health concern despite advances in prevention from folic acid-based strategies. Numerous chemicals, in particular arsenic, have been associated with neural tube defects in animal models and could influence risk in humans. OBJECTIVES: We investigated the relationship between parental exposure to arsenic and 17 metals and risk of neural tube defects (myelomeningocele and meningocele) in a case control study in Bangladesh. METHODS: Exposure assessment included analysis of maternal and paternal toenail samples using inductively coupled plasma mass spectrometry (ICP-MS). A total of 278 participants (155 cases and 123 controls) with data collected from 2016 to 2020 were included in the analysis. RESULTS: In the paternal models, a one-unit increase in the natural logarithm of paternal toenail arsenic was associated with a 74% (odds ratio: 1.74, 95% confidence interval: 1.26-2.42) greater odds of having a child with spina bifida, after adjusting for relevant covariates. Additionally, paternal exposure to aluminum, cobalt, chromium, iron, selenium, and vanadium was associated with increased odds of having a child with spina bifida in the adjusted models. In the maternal models, a one-unit increase in the natural logarithm of maternal toenail selenium and zinc levels was related to a 382% greater (odds ratio: 4.82, 95% confidence interval: 1.32-17.60) and 89% lower (odds ratio: 0.11, 95% confidence interval: 0.03-0.42) odds of having a child with spina bifida in the adjusted models, respectively. Results did not suggest an interaction between parental toenail metals and maternal serum folate. DISCUSSION: Parental toenail levels of numerous metals were associated with increased risk of spina bifida in Bangladeshi infants. Paternal arsenic exposure was positively associated with neural tube defects in children and is of particular concern given the widespread arsenic poisoning of groundwater resources in Bangladesh and the lack of nutritional interventions aimed to mitigate paternal arsenic exposure. The findings add to the growing body of literature of the impact of metals, especially paternal environmental factors, on child health.

Feasibility of Lead Exposure Assessment in Blood Spots using Energy-Dispersive X-ray Fluorescence.

Collecting blood spots from newborns is a common procedure used to diagnose multiple health conditions. Fingerstick blood samples are routinely collected from children to diagnose elevated blood lead levels. In our study, we wanted to test the feasibility of using a high-power energy-dispersive X-ray fluorescence (EDXRF) device to accurately measure the concentration of lead in blood spots. We created spotted standards of a known concentration of lead on a filter paper at different volumes and concentrations. We determined the detection limit for lead through repeated measurements of our standards and calibration line slopes. We also tested the variability of the measured lead concentration across procedures and spotted blood volumes and found no significant additions to uncertainty in measurements. Finally, we compared blood lead concentrations measured by EDXRF and atomic absorption spectroscopy (AAS) and found EDXRF to be a significant predictor of blood lead (n = 22, R = 0.98, p value <0.001) with an average detection limit of 1.7 µg/dL of blood lead. This detection limit is similar to that of the AAS technique, which is commonly used in clinical testing laboratories for blood lead surveillance. These findings provide a proof of concept that blood spots measured by EDXRF may be used as a surveillance tool for lead exposure, even at elevated blood lead levels of 2-3 µg/dL.

Stunting and lead: using causal mediation analysis to better understand how environmental lead exposure affects cognitive outcomes in children.

BACKGROUND: Many children in Bangladesh experience poor nutritional status and environmental lead exposure, both of which are associated with lower scores on neurodevelopmental assessments. Recent studies have suggested that part of lead's adverse effects on neurodevelopment are caused in part by lead's effect on growth. New statistical methods are now available to evaluate potential causal pathways in observational studies. This study used a novel statistical method to test the hypothesis that stunting, a measure of linear growth related to poor nutrition, is a mediator and/or an effect modifier of the lead exposure's adverse effect on cognitive development. METHODS: Participants were 734 children from a longitudinal birth cohort established in rural Bangladesh to study the health effects of prenatal and early childhood environmental metal exposures. Lead exposure was estimated using umbilical cord blood samples obtained at birth and blood obtained via venipuncture at age 20-40 months. Stunting was determined using the World Health Organization's standards. Neurodevelopment was assessed at age 20-40 months years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). We evaluated the effect of lead on stunting and whether the effect of lead on cognitive scores is modified by stunting status in multivariable regression analyses. We then conducted a novel 4-way mediation analysis that allows for exposure-mediator interaction to assess how much of the effect of lead on cognitive scores is explained by the pathway through stunting (mediation) and how much is explained by the interaction between lead and stunt (effect modification). RESULTS: Stunting was not a mediator of the effect of lead in our analyses. Results suggested effect modification by stunting. In an area of Bangladesh with lower lead exposures (median umbilical cord blood lead concentration, 1.7 µg/dL), stunting modified the relationship between prenatal blood lead concentrations and cognitive score at age 2-3 years. A 1-unit increase in natural log cord blood lead concentration in the presence of stunting was associated with a 2.1-unit decrease in cognitive scores (ß = - 2.10, SE = 0.71, P = 0.003). This interaction was not found in a second study site where lead exposures were higher (median umbilical cord blood lead concentration, 6.1 µg/dL, ß = - 0.45, SE = 0.49, P = 0.360). CONCLUSIONS: We used a novel method of mediation analysis to test whether stunting mediated the adverse effect of prenatal lead exposure on cognitive outcomes in Bangladesh. While we did not find that stunting acted as mediator of lead's effect on cognitive development, we found significant effect modification by stunting. Our results suggest that children with stunting are more vulnerable to the adverse effects of low-level lead exposure.

A case-control analysis of maternal diet and risk of neural tube defects in Bangladesh.

OBJECTIVES: Mothers need a nutrient-rich diet for healthy neural tube development. Neural tube defect risk can be reduced through fortifying grain products with folic acid and taking folic acid supplements. Fortification is not required in Bangladesh. Maternal supplement use rates are low, similar to other countries. This study evaluates maternal dietary intake during pregnancy to identify possible interventions. METHODS: A food frequency questionnaire (FFQ) assessed maternal diet. The primary aim compared dietary intake (calories, fat, carbohydrate, protein, fiber, vitamins, and minerals) between mothers of infants with myelomeningocele (cases) and mothers of controls. Secondary aims included (i) comparing foods consumed and (ii) evaluating if rice intake correlated with arsenic exposure. Paired t-tests, Wilcoxon signed rank tests, McNemar's chi-squared test, and linear regression were used. RESULTS: This study included 110 matched mother-infant pairs (55 cases/55 controls). Mothers of cases and mothers of controls had similar caloric intake [median 2406 kcal/day vs. 2196 kcal/day (p = 0.071)]. Mothers in both groups consumed less than half the daily recommended 600 µg of folate. Diets were potentially deficient in vitamins A, D, E, potassium, sodium, and iron. Steamed rice was the primary food consumed for both groups, and this rice intake was not associated with toenail arsenic. CONCLUSIONS: Dietary interventions should increase folate, vitamins A, D, E, potassium, sodium, and iron intake in Bangladeshi mothers. Folic acid fortification of grain products maybe the only viable strategy to achieve adequate folate intake for mothers. Given the central role of rice to the Bangladeshi diet, fortifying rice may be a viable option.

Using Public Health Data for Soil Pb Hazard Management in Ohio.

OBJECTIVES: To evaluate how frequently elevated soil lead (Pb) hazards (≥400 ppm Pb) were identified in existing blood Pb site investigations in Ohio. DESIGN: This study evaluated 3050 site investigations from the Ohio Department of Health for children with blood Pb levels at or above 10 µg dL that contained bare soil Pb data. SETTING: Data were collected from existing databases maintained by the Ohio Department of Health. PARTICIPANTS: All data were de-identified prior to analysis. The data used included blood Pb level test results for children (18 years or younger) in Ohio, with most data coming from children younger than 6 years. MAIN OUTCOME MEASURES: The main outcome measures were blood Pb levels and identified Pb concentrations in environmental media, including soil, paint, and dust. METHODS: Data were organized and summarized according to county. Summary statistics were generated on the basis of type of environmental media and county. RESULTS: Soil samples were collected in approximately 5% of all blood Pb cases in Ohio between 1999 and 2015. Median bare soil Pb was 1030 mg Pb kg (range, 0-345 021 mg Pb kg soil). Fifty-six of Ohio's 88 counties had at least 1 soil sample above 10 000 ppm (mg Pb kg). Multiple Pb hazards were identified, including bare soil (74% frequency), deteriorated exterior Pb paint (74%), deteriorated interior Pb paint (72%), and settled Pb dust (72%). Bare soil collected from identified dripline areas contained 2638 ppm Pb above soils collected from bare soil play areas (P = .02). Ninety assessments (3%) contained a bare soil hazard, with no other identified hazards. No trend was found comparing county mean or median Pb with county population. Previously identified high-risk counties for elevated blood Pb levels did not have an elevated prevalence of bare soil Pb hazards compared with other counties (P = .64). CONCLUSIONS: Site investigators should anticipate finding and managing elevated bare soil Pb in locations throughout Ohio. When communicating with the public about bare soil Pb hazards, practitioners and policy makers should emphasize the importance of addressing all potential Pb exposure sources. Findings demonstrate the importance of the individual home environment for exposure, as previously identified high-risk counties for elevated blood Pb levels were not different from other counties.

Management Options for Contaminated Urban Soils to Reduce Public Exposure and Maintain Soil Health.

Soil management in urban areas faces dual challenges of reducing public exposure to soil contaminants, such as lead (Pb) and polycyclic aromatic hydrocarbons, and maintaining soil function. This study evaluated three management options for an urban lot in Cleveland, OH, containing 185 to 5197 mg Pb kg and 0.28 to 5.50 mg benzo(a)pyrene kg. Treatment options included: (i) cap the site with a soil blend containing compost and beneficially reused dredged sediments, (ii) mix compost with the soil, and (iii) mix compost and sediments with the soil. The soil blend cap reduced surface soil Pb to 12.4 mg Pb kg and benzo(a)pyrene content to 0.99 ± 0.41 mg kg. Aggregate stability for 2- to 0.25-mm aggregates in the soil blend cap was 13% compared with the 38% aggregate stability in the urban soil. Mixing compost with the soil reduced benzo(a)pyrene content, but sample variability indicated that elevated spots likely remained exposed at the surface. Compost addition diluted soil Pb and increased aggregate stability to 60%. Mixing compost and sediments with the soil was the only management option accomplishing both management goals of reducing surface soil contaminants and maintaining soil health. For this combined mixing option, aggregate stability was 37%, soil Pb was 15 mg kg, and benzo(a)pyrene was 0.99 ± 0.09 mg kg. Food-grade oil addition did not increase benzo(a)pyrene degradation. Future studies should evaluate how incorporating soil blends in different soil types with a range of contaminants may offer a suitable long-term management option for urban soil contaminants.

Evaluating Public and Regulatory Acceptance for Urban Soil Management Approaches.

Regulators ( = 14) and the public ( = 30) were surveyed to compare how they perceived contaminated soil management strategies, including bioavailability assessments, using a mental models approach. Both groups proposed similar soil contamination definitions and agreed laboratory tests were needed to identify contaminants. When responding to open-ended questions about management options, regulators emphasized the risk assessment process, whereas the public noted specific treatment options. The majority of the public (68%) and regulators (86%) were concerned about particular contaminants. The public emphasized general contaminant categories, such as petroleum products and chemicals. Regulators listed specific compounds, including arsenic and dioxin. Both groups mentioned lead. Public and regulators had similar levels of agreement for soil removal ( = 0.96) and allowing soils with low bioavailability to remain in place ( = 0.66). The public were most opposed (43% disagree or strongly disagree) to using soil capping. Both groups were willing to consider using bioavailability assessments for contaminated soils. All regulators had heard of bioavailability, whereas 21 of the 24 (88%) public had not heard of this concept. Across all soil management options, the public tended to have higher rates of strongly disagree/disagree and neutral responses compared with regulators ( = 0.01). The neutral responses may indicate public ambivalence or insufficient information to respond about treatment options. Communication and public education efforts should emphasize the analytical process used to justify site-specific treatments. Additional surveys should evaluate public and regulator definitions of successful soil management and contaminant remediation in specific situations (i.e., case studies with specific contaminants and receptors of interest).

Soil solution interactions may limit Pb remediation using P amendments in an urban soil.

Lead (Pb) contaminated soils are a potential exposure hazard to the public. Amending soils with phosphorus (P) may reduce Pb soil hazards. Soil from Cleveland, OH containing 726 ± 14 mg Pb kg-1 was amended in a laboratory study with bone meal and triple super phosphate (TSP) at 5:1 P:Pb molar ratios. Soil was acidified, neturalized and re-acidified to encourage Pb phosphate formation. PRSTM-probes were used to evaluate changes in soil solution chemistry. Soil acidification did not decrease in vitro bioaccessible (IVBA) Pb using either a pH 1.5, 0.4 M glycine solution or a pH 2.5 solution with organic acids. PRSTM-probe data found soluble Pb increased 10-fold in acidic conditions compared to circumnetural pH conditions. In acidic conditions (p = 3-4), TSP treated soils increased detected P 10-fold over untreated soils. Bone meal application did not increase PRSTM-probe detected P, indicating there may have been insufficient P to react with Pb. X-ray absorption spectroscopy suggested a 10% increase in pyromorphite formation for the TSP treated soil only. Treatments increased soil electrical conductivity above 16 mS cm-1, potentially causing a new salinity hazard. This study used a novel approach by combining the human ingestion endpoint, PRSTM-probes, and X-ray absorption spectroscopy to evaluate treatment efficacy. PRSTM-probe data indicated potentially excess Ca relative to P across incubation steps that could have competed with Pb for soluble P. More research is needed to characterize soil solutions in Pb contaminated urban soils to identify where P treatments might be effective and when competing cations, such as Ca, Fe, and Zn may limit low rate P applications for treating Pb soils.

Phosphorus Amendment Efficacy for In Situ Remediation of Soil Lead Depends on the Bioaccessible Method.

A validated method is needed to measure reductions of in vitro bioaccessible (IVBA) Pb in urban soil remediated with amendments. This study evaluated the effect of in vitro extraction solution pH and glycine buffer on bioaccessible Pb in P-treated soils. Two Pb-contaminated soils (790-1300 mg Pb kg), one from a garden and one from a city lot in Cleveland, OH, were incubated in a bench scale experiment for 1 yr. Six phosphate amendments, including bone meal, fish bone, poultry litter, monoammonium phosphate, diammonium phosphate, and triple superphosphate, were added to containers at two application rates. Lead IVBA was assessed using USEPA Method 1340 and three modified versions of this method. Modifications included using solutions with pH 1.5 and 2.5 as well as using solutions with and without 0.4 mol L glycine. Soil amendments were ineffective in reducing IVBA Pb in these soils as measured by pH 1.5 with glycine buffer. The greatest reductions in IVBA Pb, from 5 to 26%, were found using pH 2.5 extractions. Lead mineral results showed several soil amendments promoted Pb phosphate formation, an indicator of remediation success. A significant negative linear relationship between reduction in IVBA Pb and Pb-phosphate formation was found only for pH 2.5 without glycine extraction solution. A modified USEPA Method 1340 without glycine and using pH 2.5 has the potential to predict P soil treatment efficacy and reductions in bioavailable Pb.