Exposição ao cádmio e Síndromes Hipertensivas da Gestação: uma revisão sistemática / Cadmium exposure and Hypertensive Disorders of Pregnancy: a systematic review

RESUMO As Síndromes Hipertensivas da Gestação (SHG) são uma das principais causas de morbimortalidade materna. Evidências crescentes indicam a associação entre a exposição ao cádmio e a hipertensão arterial na população em geral, mas não as SHG. Afim de investigar esse tema, realizou-se uma revisão sistemática seguindo as diretrizes PRISMA, nas bases de dados BVS/Lilacs, PubMed/Medline e SciELO e no repositório da Universidade de São Paulo (USP) até agosto de 2021. A qualidade metodológica foi avaliada pelo checklist Downs and Black. Selecionaram-se dezenove artigos, sendo treze caso-controle, quatro coortes e dois seccionais. No total, 11.451 participantes foram avaliadas, sendo 1.445 (12,6%) com SHG e, destas, 1.071 (74,1%) com pré-eclâmpsia. Observou-se o ajuste inadequado para confundimento em onze estudos. Dos sete estudos considerados de boa qualidade metodológica, quatro relataram associação positiva e três não a observaram, enquanto somente um estudo observou diferença de média, que foi maior nas gestantes com SHG. Atribuiu-se a divergência dos resultados às diferenças metodológicas e ao ajuste inadequado para os fatores de confusão. Como o cádmio é um metal tóxico que pode levar ao aumento do estresse oxidativo, que desempenha papel importante na fisiopatologia das SHG, estudos adicionais são necessários para elucidar esta associação.

ABSTRACT Hypertensive Disorders of Pregnancy (HDP) are one of the main causes of maternal morbimortality. Strong evidence point to an association between cadmium and hypertension in the general population, but not HDP. A systematic review was carried out to investigate this potential relationship, following PRISMA guidelines, in the BVS/LILACS, PubMed/MEDLINE, and SciELO databases and a repository (University of São Paulo - USP) until August 2021. The methodological quality was assessed using the Downs and Black checklist. Nineteen articles were selected, thirteen of which were case-control, four were cohorts, and two were cross-sectional. A total of 11.451 participants were evaluated, 1.445 (12.6%) with HDP, and of these 1.071 (74.1%) with preeclampsia. The inadequate adjustment for confounding was observed in eleven studies. Out of the seven studies considered good methodological quality, four reported a positive association, and three did not observe it. In contrast, only one observed a mean difference, which was higher in HDP. The inconsistency of the results was attributed to the methodological differences and inadequate adjustment for confounding. As cadmium is a toxic metal that can induce an increase in oxidative stress, which plays an essential role in the pathophysiology of HDP, additional studies are needed to elucidate this association.

Metal exposure in a child population after a mine tailings dam failure. Projeto Bruminha.

OBJECTIVE: This study aimed to analyze the urinary concentrations of As, Cd, Pb, Hg, and Mn in children living in areas directly affected by the tailings of the Brumadinho disaster. METHODS: We performed a cross-sectional descriptive study on a population of 217 children aged 0 to 6 years, living in Córrego do Feijão (CF), Parque da Cachoeira (PC), Aranha (AR), and Tejuco (TJ), enrolled in the Longitudinal Study of Child Health in Brumadinho (Minas Gerais) - Projeto Bruminha. Socioeconomic data and urine samples were collected to determine the concentration of selected metals. RESULTS: Children living in locations not directly affected by the disaster (AR and TJ) had higher concentrations of As and Mn than those in directly affected areas (CF and PC). Additionally, children living in locations not potentially exposed to dust from tailings mud or mining activity (AR) showed higher urinary As concentrations than those potentially exposed (CF, PC, and TJ). CONCLUSION: Our results suggest the need to investigate possible sources of As exposure in children living in areas not directly affected by the disaster and not potentially exposed to dust.

Exposure of pregnant women and their children to pyrethroid insecticides in Rio de Janeiro, Brazil.

Background: Pyrethroids are commonly used insecticides in Brazil. Gestational and early childhood exposure to pyrethroids has been linked to adverse health effects, including neurodevelopmental delays, behavioral issues, and endocrine disruption. This study evaluated the exposure of pregnant women and their children to pyrethroid insecticides in Rio de Janeiro, Brazil. Methods: Creatinine-adjusted levels of the pyrethroid metabolites 3-phenoxy benzoic acid (3-PBA) and 4-fluoro-3-phenoxybenzyl acid (4-FPBA) were measured in the urine of 142 pregnant women and their children at birth and in the first, third, and 6th months of life. Results: The geometric mean (GM) and 95% confidence interval (95% CI) of 3-PBA and 4-FPBA urinary concentrations in pregnant women were 0.50 (0.37-0.67) and 0.37 (0.05-2.90) ng/mg, detected in 47.2 and 10.6%, respectively. Urinary concentrations of 3-PBA in the children were 0.18 (0.15-0.23) ng/mg at birth, 0.36 (0.08-1.56) ng/mg at 1-month-old, 0.68 (0.36-1.27) ng/mg at 3-month-old, and 1.36 (0.77-2.42) ng/mg at 6-month-old, and the detection rates were respectively 10.8, 9.4, 20.9, and 20.7%. Discussion: This study is one of the few that has evaluated the urinary concentrations of pyrethroids in newborns and children in their 1st year of life. The results of this study show that children's exposure to pyrethroids significantly increases after birth.

Metal exposure in a child population after a mine tailings dam failure. Projeto Bruminha / Exposição a metais em uma população infantil após rompimento de barragem de rejeitos da mineração. Projeto Bruminha

ABSTRACT Objective: This study aimed to analyze the urinary concentrations of As, Cd, Pb, Hg, and Mn in children living in areas directly affected by the tailings of the Brumadinho disaster. Methods: We performed a cross-sectional descriptive study on a population of 217 children aged 0 to 6 years, living in Córrego do Feijão (CF), Parque da Cachoeira (PC), Aranha (AR), and Tejuco (TJ), enrolled in the Longitudinal Study of Child Health in Brumadinho (Minas Gerais) — Projeto Bruminha. Socioeconomic data and urine samples were collected to determine the concentration of selected metals. Results: Children living in locations not directly affected by the disaster (AR and TJ) had higher concentrations of As and Mn than those in directly affected areas (CF and PC). Additionally, children living in locations not potentially exposed to dust from tailings mud or mining activity (AR) showed higher urinary As concentrations than those potentially exposed (CF, PC, and TJ). Conclusion: Our results suggest the need to investigate possible sources of As exposure in children living in areas not directly affected by the disaster and not potentially exposed to dust.

RESUMO Objetivo: Este estudo teve como objetivo analisar as concentrações urinárias de As, Cd, Pb, Hg e Mn em crianças residentes em localidades diretamente atingidas pelos rejeitos do desastre em Brumadinho. Métodos: Foi realizado um estudo descritivo transversal de uma população de 217 crianças de 0 a 6 anos, residentes no Córrego do Feijão (CF), Parque da Cachoeira (PC), Aranha (AR), e Tejuco (TJ) e inscritas no Estudo Longitudinal da Saúde Infantil em Brumadinho (MG) — Projeto Bruminha. Dados socioeconômicos e amostras de urina foram coletados para determinar a concentração dos metais selecionados. Resultados: Crianças residentes em localidades não diretamente atingidas pelo desastre (AR e TJ) apresentaram maiores concentrações de As e Mn do que aquelas em localidades diretamente atingidas (CF e PC). Adicionalmente, crianças residentes em localidades não potencialmente expostas à poeira da lama de rejeito ou da atividade de mineração (AR) apresentaram maiores concentrações urinárias de As do que aquelas potencialmente expostas (CF, PC e TJ). Conclusão: Nossos resultados sugerem a necessidade de se investigar possíveis fontes de exposição ao As em crianças residentes em localidades não diretamente atingidas pelo desastre e não potencialmente expostas à poeira.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review.

OBJECTIVE: The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP). DATA SOURCES: The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021. STUDY SELECTION: Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction. DATA COLLECTION: We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist. DATA SYNTHESIS: We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies. CONCLUSION: We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

OBJETIVO: A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). FONTES DOS DADOS: Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. SELEçãO DE ESTUDOS: Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. COLETA DE DADOS: A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. SíNTESE DE DADOS: Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. CONCLUSãO: Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review / Exposição materna a mercúrio e distúrbios hipertensivos na gestação: Uma revisão sistemática

Abstract Objective The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP). Data Sources The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021. Study Selection Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction. Data Collection We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist. Data Synthesis We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies. Conclusion We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

Resumo Objetivo A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). Fontes Dos Dados Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. Seleção de estudos Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. Coleta de Dados A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. Síntese de dados Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. Conclusão Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

Protocol of the Longitudinal Study on Child Health in Brumadinho (MG): "Bruminha Project".

OBJECTIVE: To present the research protocol and to describe the preliminary results of the Bruminha Project. METHODS: This project is part of the set of health actions proposed under the Brumadinho Health Project. It is a prospective cohort study with periodic follow-ups for four years. The eligible population was all children aged 0 to 6 years living in four rural communities of the affected municipality. Sociodemographic and health data were collected, as well as urinary samples, for assessment of exposure to metals. RESULTS: In the first year of study, we evaluated 62% (217) of the eligible population and collected 172 (79%) valid urine samples. At least one metal was detected in all samples, and in 50.6% (n=87) or them, the metal concentration was higher than the reference value. In 38% (n=82) of the children, neuropsychomotor development was considered at risk. Report of respiratory allergy was four times (4.27) more frequent and of bronchitis 62% higher (1.62) in children living in locations exposed to dust from ore residues, compared to those living more than 10 km away from the site of the dam disaster. CONCLUSION: The study protocol was proven adequate to evaluate the proposed outcomes. The strategy used for population selection required adjustments regarding the long-term community awareness process, with new participants in the upcoming follow-ups (2022 and 2023).

Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study.

Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980-2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers.

[Mercury exposure and anemia in children and adolescents from six riverside communities of Brazilian Amazon]. / Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira.

Mercury (Hg) is a toxic substance, and fish consumption is one of the main sources of exposure for the population. This article aims to evaluate the association between exposure to Hg and anemia among children and adolescents from six riverside communities in the Brazilian Amazon. Secondary data analysis from cross-sectional studies, including 1,318 individuals, divided into two groups according to gold mining exposure (group A under the influence, and group B without it). Multivariate analysis methods were performed to assess the association between exposure to Hg (hair Hg) and anemia, stratifying by groups. Three hundred and forty-eight anemia cases were observed (27.1%), with 206 from group B and 142 out of group A. There was a difference in the median of Hg levels between groups (A = 12.8µg/g and B = 4.3µg/g, p = 0.01). An association was observed between hair Hg levels ≥ 6.0µg/g and anemia (OR = 1.38; 95%CI = 1.02-1.87), a fact that was magnified for group A, when stratification was performed (OR = 2.23; 95%CI = 1.28-3.90). This study showed high Hg levels, especially in group A and this substance might be a possible risk factor for anemia. Also, geographical areas seemed to modify this effect, pointing to the influence of other factors, which should be better evaluated.

O mercúrio (Hg) é uma substância tóxica, sendo o consumo de pescados uma das principais fontes de exposição da população. Este artigo visa avaliar a associação entre anemia e exposição ao Hg na população infanto-juvenil de seis comunidades ribeirinhas da Amazônia Brasileira. Realizou-se a análise secundária de dados de estudos seccionais, incluindo 1.318 indivíduos, divididos em dois grupos segundo a influência do garimpo (grupo A sob influência, e grupo B sem influência). Métodos de análise multivariada foram realizados para verificar a associação entre variável de exposição (Hg no cabelo) e anemia, estratificando pelos grupos. Foram observados 348 casos de anemia (27,1%), sendo 206 entre o grupo B e 142 no grupo A. Houve diferença na mediana dos níveis de Hg entre os grupos (A = 12,8µg/g e B = 4,3µg/g, p = 0,01). Foi observada associação entre Hg no cabelo ≥ 6,0µg/g e anemia (OR = 1,38; IC95% = 1,02-1,87), fato que foi magnificado para o grupo A quando realizada estratificação (OR = 2,23; IC95% = 1,28-3,90). O estudo mostrou elevados níveis de Hg, principalmente no grupo A, e que essa substância pode ser um possível fator de risco para anemia. Além disso, as áreas geográficas pareceram modificar esse efeito, apontando para influência de outros fatores, fato que deve ser melhor avaliado.

Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira / Mercury exposure and anemia in children and adolescents from six riverside communities of Brazilian Amazon

Resumo O mercúrio (Hg) é uma substância tóxica, sendo o consumo de pescados uma das principais fontes de exposição da população. Este artigo visa avaliar a associação entre anemia e exposição ao Hg na população infanto-juvenil de seis comunidades ribeirinhas da Amazônia Brasileira. Realizou-se a análise secundária de dados de estudos seccionais, incluindo 1.318 indivíduos, divididos em dois grupos segundo a influência do garimpo (grupo A sob influência, e grupo B sem influência). Métodos de análise multivariada foram realizados para verificar a associação entre variável de exposição (Hg no cabelo) e anemia, estratificando pelos grupos. Foram observados 348 casos de anemia (27,1%), sendo 206 entre o grupo B e 142 no grupo A. Houve diferença na mediana dos níveis de Hg entre os grupos (A = 12,8µg/g e B = 4,3µg/g, p = 0,01). Foi observada associação entre Hg no cabelo ≥ 6,0µg/g e anemia (OR = 1,38; IC95% = 1,02-1,87), fato que foi magnificado para o grupo A quando realizada estratificação (OR = 2,23; IC95% = 1,28-3,90). O estudo mostrou elevados níveis de Hg, principalmente no grupo A, e que essa substância pode ser um possível fator de risco para anemia. Além disso, as áreas geográficas pareceram modificar esse efeito, apontando para influência de outros fatores, fato que deve ser melhor avaliado.

Abstract Mercury (Hg) is a toxic substance, and fish consumption is one of the main sources of exposure for the population. This article aims to evaluate the association between exposure to Hg and anemia among children and adolescents from six riverside communities in the Brazilian Amazon. Secondary data analysis from cross-sectional studies, including 1,318 individuals, divided into two groups according to gold mining exposure (group A under the influence, and group B without it). Multivariate analysis methods were performed to assess the association between exposure to Hg (hair Hg) and anemia, stratifying by groups. Three hundred and forty-eight anemia cases were observed (27.1%), with 206 from group B and 142 out of group A. There was a difference in the median of Hg levels between groups (A = 12.8µg/g and B = 4.3µg/g, p = 0.01). An association was observed between hair Hg levels ≥ 6.0µg/g and anemia (OR = 1.38; 95%CI = 1.02-1.87), a fact that was magnified for group A, when stratification was performed (OR = 2.23; 95%CI = 1.28-3.90). This study showed high Hg levels, especially in group A and this substance might be a possible risk factor for anemia. Also, geographical areas seemed to modify this effect, pointing to the influence of other factors, which should be better evaluated.

Persistent Organic Pollutant Levels in Maternal and Cord Blood Plasma and Breast Milk: Results from the Rio Birth Cohort Pilot Study of Environmental Exposure and Childhood Development (PIPA Study).

Levels of polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) were evaluated in the breast milk and maternal and umbilical cord blood of pregnant women and their newborns in Rio de Janeiro, Brazil. The concentration of 11 PCB and 17 OCP were measured in 135 samples of maternal, and 116 samples of cord blood plasma, as well as 40, 47, and 45 samples of breast milk at 1st, 3rd, and 6th months after birth, respectively, using gas chromatography-mass spectrometry (GC-MS-MS). Women were asked to answer an enrollment questionnaire with reproductive, lifestyle, residential and sociodemographic questions. The most commonly detected OCPs and PCBs in the maternal and cord blood were 4,4'-DDE; ß-HCH; É£-HCH; and PCB 28. 4,4'-DDE was also the most commonly detected OCP in breast milk samples. Although not statistically significant, ∑DDT levels were higher among women with pregestational BMI ≥ 30, and who were non-white and older (age > 40). Newborns with an Apgar score ≤ 8 at minute 5 of life showed significantly higher levels of ∑DDT in the cord blood. Persistent OCPs and PCBs were still detected in maternal and umbilical cord blood and breast milk, even after decades of their banishment in Brazil. They may pose a risk to maternal, fetal and children's health.

Protocol of the Longitudinal Study on Child Health in Brumadinho (MG): "Bruminha Project" / Protocolo do estudo longitudinal de saúde infantil em Brumadinho (MG): Projeto Bruminha

ABSTRACT: Objective: To present the research protocol and to describe the preliminary results of the Bruminha Project. Methods: This project is part of the set of health actions proposed under the Brumadinho Health Project. It is a prospective cohort study with periodic follow-ups for four years. The eligible population was all children aged 0 to 6 years living in four rural communities of the affected municipality. Sociodemographic and health data were collected, as well as urinary samples, for assessment of exposure to metals. Results: In the first year of study, we evaluated 62% (217) of the eligible population and collected 172 (79%) valid urine samples. At least one metal was detected in all samples, and in 50.6% (n=87) or them, the metal concentration was higher than the reference value. In 38% (n=82) of the children, neuropsychomotor development was considered at risk. Report of respiratory allergy was four times (4.27) more frequent and of bronchitis 62% higher (1.62) in children living in locations exposed to dust from ore residues, compared to those living more than 10 km away from the site of the dam disaster. Conclusion: The study protocol was proven adequate to evaluate the proposed outcomes. The strategy used for population selection required adjustments regarding the long-term community awareness process, with new participants in the upcoming follow-ups (2022 and 2023).

RESUMO: Objetivo: Apresentar o protocolo da pesquisa e descrever os resultados preliminares da linha de base da população de estudo do Projeto Bruminha. Métodos: Este projeto é parte do conjunto de ações propostas no âmbito do Programa de Ações Saúde Brumadinho. Trata-se de um estudo de coorte prospectiva, com seguimento periódico por quatro anos, cuja população elegível foi constituída de todas as crianças de 0 a 6 anos de idade residentes em quatro localidades situadas na zona rural do município afetado, com coleta de dados sociodemográficos e de saúde e de amostras urinárias para avaliação da exposição a metais. Resultados: No primeiro ano de estudo foi avaliada 62% (217) da população elegível e se coletaram 172 (79%) amostras de urina válidas. Em todas as amostras analisadas foi detectado pelo menos um metal, e em 50,6% (n=87) concentrações urinárias acima do valor de referência. Em 38% (n=82) das crianças a avaliação do desenvolvimento neuropsicomotor foi considerada de risco. O relato de alergia respiratória foi quatro vezes (4,27) mais frequente e de bronquite 61% maior (1,62) nas crianças residentes nas localidades expostas à poeira de resíduos de minério, proporcionalmente àquelas residentes a mais de 10 km do local do desastre. Conclusão: O protocolo do estudo mostrou-se adequado para avaliação dos desfechos propostos. A estratégia de captação da população de estudo necessitou de reajustes quanto ao processo de sensibilização da comunidade a longo prazo com entrada de novos participantes nos próximos seguimentos (2022 e 2023).

Maternal consumption of ultra-processed foods and newborn exposure to perfluoroalkyl substances (PFAS).

Evolving evidence shows that ultra-processed food consumption may increase exposure to chemicals used in food packaging and production, such as per- and poly-fluoroalkyl substances, phthalates, and bisphenols. Studies suggested that these contaminants may be transferred from mother to child through placenta, increasing concerns for both maternal and child health. This study aimed to investigate the association of maternal consumption of ultra-processed foods with newborn exposure to perfluoroalkyl substances (PFAS) in the PIPA Project (The Rio Birth Cohort Study on Environmental Exposure and Childhood Development). The pilot cohort study conducted with 131 pregnant women-child pairs in a public maternity school in Rio de Janeiro, Brazil, was assessed. Maternal dietary intake in the third trimester of pregnancy was evaluated using a qualitative food frequency questionnaire. Food items were classified as non-ultra-processed food and ultra-processed food using the NOVA system and regular consumption of ultra-processed foods was estimated. Newborns of pregnant women who weekly consumed three or more subgroups of ultra-processed food presented the highest level of PFAS (2.47ng/mL; 95%CI: 1.22; 3.72), compared to non-consumption of ultra-processed food investigated (0 ultra-processed food = 1.86ng/mL; 95%CI: 1.38; 2.50). Additionally, cluster analysis grouped ultra-processed food, fish, and PFAS levels. In conclusion, we found increased levels of PFAS in newborns whose mothers were higher consumers of ultra-processed foods.

Serum levels of perfluorooctanoic acid and perfluorooctane sulfonic acid in pregnant women: Maternal predictors and associations with birth outcomes in the PIPA Project.

AIM: Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) are persistent pollutants associated with adverse birth outcomes. This study aimed to identify predictors of blood PFOA and PFOS concentrations in pregnant women and to estimate their associations with birth outcomes in Brazil. METHODS: We conducted a cross-sectional study with 139 pregnant women enrolled in the pilot study of the Rio Birth Cohort Study on Environmental Exposure and Childhood Development (PIPA Project). Multiple linear regression was used to estimate associations between PFOA and PFOS with maternal predictors and birth outcomes. RESULTS: Higher levels of PFOA were observed in women aged 16-19 and 20-39 years, while fish consumption from 0.6 to 2.0 times per week was associated with lower levels of the substance. PFOS levels were higher in women living in houses with up to four rooms but lower in those who reported passive exposure to smoking. Increased newborn length and head circumference were also associated with higher maternal levels of PFOA. CONCLUSIONS: In our study, age, fish consumption, passive smoking, and the number of rooms in the house were predictors of maternal PFAS levels. However, we did not observe significant associations between maternal plasma PFAS concentrations and birth outcomes.

Hypercupremia in female munitions workers using taking oral contraceptives: a case series.

Copper is an essential trace element for homeostasis and is mostly obtained through the diet. Copper can also enter the body through occupational and accidental exposure, resulting in the elevation of serum copper levels (hypercupremia). Other factors associated with hypercupremia include smoking, use of oral contraceptives, and several clinical conditions. This case series describes the presence of hypercupremia in workers exposed to copper while also taking oral contraceptives. Serum copper levels of the sample remained high, even after participants spent time away from work, normalizing only after a change in contraceptive methods. The present results underscore the importance of considering oral contraceptives as a possible cause of hypercupremia in women with occupational exposure to copper, regardless of symptomatic status.

Maternal consumption of ultra-processed foods and newborn exposure to perfluoroalkyl substances (PFAS) / O consumo materno de alimentos ultraprocessados e exposição intrauterina a compostos perfluoroalquil (PFAS) / Consumo materno de comidas ultraprocesadas y exposición de recién nacidos a sustancias perfluoroalquílicas (PFAS)

Abstract: Evolving evidence shows that ultra-processed food consumption may increase exposure to chemicals used in food packaging and production, such as per- and poly-fluoroalkyl substances, phthalates, and bisphenols. Studies suggested that these contaminants may be transferred from mother to child through placenta, increasing concerns for both maternal and child health. This study aimed to investigate the association of maternal consumption of ultra-processed foods with newborn exposure to perfluoroalkyl substances (PFAS) in the PIPA Project (The Rio Birth Cohort Study on Environmental Exposure and Childhood Development). The pilot cohort study conducted with 131 pregnant women-child pairs in a public maternity school in Rio de Janeiro, Brazil, was assessed. Maternal dietary intake in the third trimester of pregnancy was evaluated using a qualitative food frequency questionnaire. Food items were classified as non-ultra-processed food and ultra-processed food using the NOVA system and regular consumption of ultra-processed foods was estimated. Newborns of pregnant women who weekly consumed three or more subgroups of ultra-processed food presented the highest level of PFAS (2.47ng/mL; 95%CI: 1.22; 3.72), compared to non-consumption of ultra-processed food investigated (0 ultra-processed food = 1.86ng/mL; 95%CI: 1.38; 2.50). Additionally, cluster analysis grouped ultra-processed food, fish, and PFAS levels. In conclusion, we found increased levels of PFAS in newborns whose mothers were higher consumers of ultra-processed foods.

Resumo: Evidências crescentes demonstram que o consumo de alimentos ultraprocessados pode aumentar a exposição a substâncias químicas utilizadas na produção e embalagem desses alimentos, como os compostos per- e polifluoroalquil, ftalatos e bisfenóis. Os estudos sugerem que esses contaminantes podem ser transferidos da mãe para o feto pela via transplacentária, o que aumenta as preocupações em relação à saúde tanto materna quanto infantil. O estudo buscou investigar a associação entre o consumo materno de alimentos ultraprocessados e a exposição intrauterina aos compostos perfluoroalquil (PFAS) no Projeto PIPA Rio - Projeto Infância e Poluentes Ambientais. Foi avaliada a coorte-piloto com 131 pares gestante-feto em uma maternidade-escola pública no Rio de Janeiro. A ingestão materna no terceiro trimestre da gestação foi avaliada com um questionário qualitativo de frequência alimentar. Os itens alimentares foram classificados entre não ultraprocessados e ultraprocessados, usando o sistema NOVA, e foi estimado o consumo regular de ultraprocessados. Os PFAS foram medidos no sangue do cordão umbilical. Os recém-nascidos de mães que haviam consumido três ou mais subgrupos de ultraprocessados por semana apresentaram os níveis séricos mais elevados de PFAS (2,47ng/mL; IC95%: 1,22; 3,72), comparado com nenhum consumo dos subgrupos de alimentos ultraprocessados (0 alimento ultraprocessado = 1,86ng/mL; IC95%: 1,38; 2,50). Além disso, a análise de clusters agrupou ultraprocessados, peixe e níveis de PFAS. Em conclusão, o estudo mostrou níveis elevados de PFAS em neonatos de gestantes com maior consumo de alimentos ultraprocessados.

Resumen: Evidencias recientes han mostrado que el consumo de comida ultraprocesada puede incrementar la exposición a sustancias químicas usadas en el empaquetado de comida y producción, tales como las sustancias per- y poli- fluoroalquílicas, ftalatos, y bisfenoles. Los estudios han sugerido que estos contaminantes pueden transmitirse de la madre al niño, a través de la placenta, incrementando los problemas de salud de la madre y el niño. El objetivo de este estudio fue investigar la asociación del consumo materno de comidas ultraprocesadas con la exposición de los recién nacidos a las sustancias perfluoroalquílicas (PFAS) en el Proyecto PIPA (Estudio de Cohorte de Nacimiento en Río sobre la Exposición Ambiental y Desarrollo en la Infancia). El estudio de la cohorte piloto evaluó a parejas constituidas por 131 mujeres embarazadas y sus hijo/as en una escuela de maternidad pública en Río de Janeiro, Brasil. Se evaluó la ingesta alimentaria materna en el tercer trimestre de embarazo, usando un cuestionario de calidad de frecuencia de la comida. Los ítems alimentarios fueron clasificados como no-comida ultraprocesada y comida ultraprocesada usando el sistema NOVA y se estimó el consumo regular de comidas ultraprocesadas. Las PFAS se determinaron en la sangre del cordón umbilical. Los recién nacidos de mujeres embarazadas que consumieron tres o más subgrupos de comidas ultraprocesada semanalmente presentaron el nivel más alto de PFAS (2,47ng/mL; IC95%: 1,22; 3,72), comparado con ninguno consumo de comida ultraprocesada (0 comida ultraprocesada = 1,86ng/mL; IC95%: 1,38; 2,50). Asimismo, el análisis de conglomerados agrupó comida ultraprocesada, pescado y niveles de PFAS. En conclusión, se encontraron niveles elevados de PFAS en recién nacidos, cuyas madres eran grandes consumidoras de comidas ultraprocesadas.

Metal mixtures in pregnant women and umbilical cord blood at urban populations-Rio de Janeiro, Brazil.

This study aims to assess interrelationships between serum lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) concentrations in pregnant women in their third trimester and umbilical cord blood, while inter-metal correlations were also determined. This study is part of the PIPA project (Childhood and Environmental Pollutant Project), whose pilot study was carried out from October 2017 to August 2018 and will be presented here. Blood samples were obtained from 117 mother-umbilical cord pairs and analyzed concerning metal concentrations. A positive correlation was found between metal concentrations in mother and cord blood (R > 0.7, p < 0.001). The results indicate that mother metal concentrations are able to determine child metal concentrations (p < 0.001). The correlations between maternal blood metal concentrations were positive for all assessed metals except for As and Hg. The strongest correlations in this matrix were observed between Cd and Pb (R = 0.471 p = 0.000), Cd and Hg (R = 0.425 p = 0.000), and Pb and Hg (R = 0.427 p = 0.000). Umbilical cord correlations were lower compared to mother blood correlations. In general, the four analyzed metals displayed significant correlations to serum concentrations in both maternal and cord blood.

Human exposure to mercury and its hematological effects: a systematic review.

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (ß) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.

Human exposure to mercury and its hematological effects: a systematic review / Exposição humana ao mercúrio e seus efeitos hematológicos: uma revisão sistemática / Exposición humana al mercurio y sus efectos hematológicos: una revisión sistemática

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.

O mercúrio é um metal que pode ser encontrado naturalmente no meio ambiente e através de fontes antropogênicas. É altamente tóxico para ecossistemas e seres vivos. A maior parte da exposição humana provém da ingestão de pescados contaminados, da liberação de gases da amálgama dentária ou da exposição ocupacional (p.ex.: extração de ouro). Vastas populações são expostas ao mercúrio, tornando-se uma questão de saúde pública muito importante. Efeitos adversos à saúde são comumente observados no sistema nervoso, mas todos os órgãos são alvos em potencial, como a medula óssea. O principal objetivo do estudo foi avaliar as evidências disponíveis sobre a exposição humana ao mercúrio e seus efeitos hematológicos. Uma estratégia de busca foi realizada, incluindo termos chave (palavras-chave, palavras do texto e equivalentes), para pesquisar dois repositórios de dissertações de mestrado e teses de doutorado (Fiocruz/ARCA e Universidade de São Paulo) e quatro bases de dados eletrônicas: BVS/LILACS, MEDLINE/PubMed, Scopus e TOXLINE/NIH (artigos publicados de 1950 até fevereiro de 2018). Não houve restrições de linguagem e uma ferramenta (EPHPP) foi utilizada para avaliar a qualidade dos estudos incluídos. De acordo com os critérios pré-estabelecidos, foram encontrados 80 estudos, todos observacionais (48 relatos de caso, 24 estudos transversais, 6 séries de casos e 2 coortes), que compreendiam 9.284 pessoas. Apesar do fato de que as pessoas mais expostas (6.012) tinham contagens de células sanguíneas normais, e os efeitos hematológicos do mercúrio não pareciam muito comuns (1.914 casos, 14 graves e 29 mortes), três estudos relataram a associação de (β) anemia, linfopenia, neutrofilia e basofilia. Concluímos que as informações coletadas indicam efeitos hematotóxicos do mercúrio, alguns dos quais podem ser muito graves e até fatais.

El mercurio es un metal que se puede encontrar de forma natural en el ambiente y mediante fuentes antropogénicas. Es altamente tóxico para los ecosistemas y seres vivos. Entre otras, la mayor parte de la exposición humana, proviene de la ingestión de pescado contaminado, liberación de gases de amalgamas dentales o exposición ocupacional (p.ej. extracción de oro). Vastas poblaciones están expuestas al mercurio, convirtiéndolo en un asunto muy importante desde la perspectiva de la salud pública. Los efectos adversos para la salud se observan comúnmente en el sistema nervioso, pero cada órgano es un objetivo potencial, como la médula ósea. El objetivo principal del estudio fue evaluar las evidencias disponibles sobre la exposición humana al mercurio y sus efectos hematológicos. Se realizó una estrategia de búsqueda, incluyendo términos clave (palabras-clave, palabras del texto y equivalentes), se consultaron 2 registros de trabajos finales de máster y tesis de doctorado (Fiocruz/ARCA y Universidad de São Paulo) y 4 bases de datos electrónicas diferentes: BVS/LILACS, MEDLINE/PubMed, Scopus y TOXLINE/NIH, para artículos publicados desde el año 1950, hasta febrero de 2018. No hubo restricciones de lengua y se usó la herramienta (EPHPP) para evaluar la calidad de los estudios incluidos. De acuerdo con los criterios preestablecidos, se recopilaron 80 estudios, todos observacionales (48 informes de casos, 24 estudios transversales, 6 series de casos, y 2 cohortes), que comprendieron a 9.284 personas. A pesar de que la mayoría de los expuestos (6.012) tenían un recuento normal de células sanguíneas y los efectos hematológicos del mercurio no parecían muy comunes (1.914 casos: 14 severos y 29 muertes), tres estudios informaron de la asociación (β) para anemia, linfopenia, neutrofilia y basofilia. Concluimos que la información recabada indicaba los efectos hematotóxicos del mercurio, algunos de los cuales pueden ser muy serios e incluso fatales.