Recommended acceptable levels of maternal serum typical toxic metals from the perspective of spontaneous preterm birth in Shanxi Province, China.

Preterm birth is an important issue of public reproductive health worldwide. The effects of the toxic metals on the likelihood of spontaneous preterm birth (SPB) are still under discussion. Our study aimed to investigate the association between maternal exposure to the five typical toxic metals or metalloid (i.e. arsenic (As), cadmium (Cd), chromium (Cr), mercury (Hg), and lead (Pb)) and the SPB likelihood. The mothers delivering fetus with SPB (cases) and those with term healthy birth (controls) were chosen from a prospective birth cohort of 3201 women carried out in Shanxi Province, China. A total of 147 SPB cases and 381 controls were included in our nested case-control study. We collected maternal general information by questionnaire and collected their blood sample during recruitment. The serum concentrations of the five toxic metals were measured by inductively coupled-plasma mass spectrometry. We found that the demographic information between the cases and controls were well balanced. The participants in our study had relatively higher serum As concentration. For the other toxic metals (i.e. Cd, Cr, Hg, and Pb), their serum concentrations were overall in the middle range of those from general population. There were no significant associations of the serum concentrations of the five concerned toxic metals with the SPB likelihood. Our study results overall did not support that maternal exposure to As or Cd significantly contribute to the SPB risk in the current exposure level, as well as the other three toxic metals. We further proposed their upper concentration limits in maternal serum from the perspective of SPB likelihood during the early pregnant period, i.e. 18.2 ng/mL of As, 1.05 ng/mL of Cd, 0.96 ng/mL of Cr, 1.07 ng/mL of Hg, and 1.54 ng/mL of Pb.

Congenital anomalies in the offspring of occupationally exposed mothers: a systematic review and meta-analysis of studies using expert assessment for occupational exposures.

STUDY QUESTION: Is there an association between maternal occupational exposure to solvents, pesticides and metals as assessed by expert-based assessment and congenital anomalies in the offspring? SUMMARY ANSWER: There is an association between maternal occupational exposure to solvents and congenital anomalies in the offspring, including neural tube defects, congenital heart defects and orofacial clefts. WHAT IS KNOWN ALREADY: One important environmental risk factor for development of congenital anomalies is maternal occupational exposure to chemicals in the workplace prior to and during pregnancy. A number of studies have assessed the association with often conflicting results, possibly due to different occupational exposure assessing methods. STUDY DESIGN, SIZE, DURATION: For this systematic review with meta-analysis, the search terms included maternal occupation, exposure, congenital anomalies and offspring. Electronic databases MEDLINE and EMBASE were searched for English studies up to October 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two reviewers independently screened all citations identified by the search. Case-control studies and cohort studies were included if (I) they reported on the association between maternal occupational exposure to solvents, pesticides or metals and congenital anomalies, and (II) assessment of occupational exposure was performed by experts. Data on study characteristics, confounders and odds ratios (ORs) were extracted from the included studies for four subgroups of congenital anomalies. Methodological quality was assessed using the Newcastle-Ottawa Scale. In the meta-analysis, random effects models were used to pool estimates. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 2806 titles and abstracts and 176 full text papers were screened. Finally, 28 studies met the selection criteria, and 27 studies could be included in the meta-analysis. Our meta-analysis showed that maternal occupational exposure to solvents was associated with neural tube defects (OR: 1.51, 95%CI: 1.09-2.09) and congenital heart defects (OR: 1.31, 95%CI:1.06-1.63) in the offspring. Also maternal occupational exposure to glycol ethers, a subgroup of solvents, was associated with neural tube defects (OR: 1.93, 95%CI: 1.17-3.18) and orofacial clefts (OR: 1.95, 95%CI: 1.38-2.75) in the offspring. Only one study investigated the association between maternal occupational exposure to solvents and hypospadias and found an association (OR: 3.63, 95%CI: 1.94-7.17). Results of the included studies were consistent. In our meta-analysis, we found no associations between occupational exposure to pesticides or metals and congenital anomalies in the offspring. LIMITATIONS, REASONS FOR CAUTION: A limited number of studies was included, which made it impossible to calculate pooled estimates for all congenital anomalies, analyse individual chemicals or calculate exposure-response relations. Bias could have been introduced because not all included studies corrected for potentially confounding factors. WIDER IMPLICATIONS OF THE FINDINGS: Employers and female employees should be aware of the possible teratogenic effects of solvent exposure at the workplace. Therefore, is it important that clinicians and occupational health specialist provide women with preconception advice on occupational solvent exposure, to reduce the congenital anomaly risk. STUDY FUNDING/COMPETING INTEREST(S): NSp was paid by the Graduate School of Medical Sciences (MD/PhD program), UMCG, Groningen, the Netherlands. EUROCAT Northern Netherlands is funded by the Dutch Ministry of Health, Welfare and Sports. There are no competing interests. REGISTRATION NUMBER: CRD42017053943.

The geochemistry of geophagic material consumed in Onangama Village, Northern Namibia: a potential health hazard for pregnant women in the area.

Ingestion of geophagic materials might affect human health and induce diseases by different ways. The purpose of this study is to determine the geochemical composition of geophagic material consumed especially by pregnant women in Onangama Village, Northern Namibia and to assess its possible health effects. X-ray fluorescence and inductively coupled plasma mass spectrometry were used in order to determine the major, and trace elements as well as anions concentrations of the consumed material. The geochemical analysis revealed high concentrations of aluminium (Al), calcium (Ca), iron (Fe), magnesium (Mg), manganese (Mn), potassium (K), sodium (Na), and silica (Si); and trace elements including arsenic (As), chromium (Cr), mercury (Hg), nickel (Ni) and vanadium (V) as well as sulphate (SO42-), nitrate (NO3-), and nitrite (NO2-) anions comparing to the recommended daily allowance for pregnant women. The pH for some of the studied samples is alkaline, which might increase the gastrointestinal tract pH (pH < 2) and cause a decrease in the bioavailability of elements. The calculated health risk index (HRI > 1) revealed that Al and Mn might be a potential risk for human consumption. Based on the results obtained from the geochemical analysis, the consumption of the studied material might present a potential health risk to pregnant women including concomitant detrimental maternal and foetal effects.

Ingesta de flúor a través del consumo de agua de abastecimiento público en la cohorte INMA-Gipuzkoa / Fluoride intake through consumption of water from municipal network in the INMA-Gipuzkoa cohort

Objetivo: Estimar la ingesta de flúor en mujeres embarazadas y sus hijos/as de la cohorte INMA-Gipuzkoa a través del consumo de agua de la red municipal y comparar estas ingestas con los valores recomendados. En Euskadi, la fluoración del agua de consumo es obligatoria en abastecimientos de más de 30.000 habitantes. Método: Se han incluido 575 mujeres embarazadas (reclutamiento en 2006-2008) y 424 niños/as de 4 años (seguimiento en 2010-2012). Las concentraciones de fluoruros en el agua se obtuvieron del sistema de información de aguas de consumo de Euskadi (EKUIS). Los hábitos de consumo de agua y las variables socioeconómicas se obtuvieron mediante cuestionario. Resultados: El 74,9% de las mujeres y el 87,7% de los/las niños/as consumían agua de red municipal. En agua fluorada, el valor medio de fluoruro fue de 0,805mg/l (desviación estándar [DE]: 0,194) durante el periodo de reclutamiento, y de 0,843mg/l (DE: 0,080) durante el seguimiento de los/las niños/as. La ingesta media de flúor y el percentil 95 en las zonas fluoradas fueron de 0,015 y 0,026mg/kg al día en las mujeres y de 0,033 y 0,059mg/kg al día en los/las niños/as. Considerando solo el flúor aportado por el agua, el 8,71% de los/las niños/as residentes en zonas con fluoración superaban la ingesta de 0,05mg/kg al día recomendada por la European Food Safety Authority. Conclusión: Los resultados obtenidos muestran que las ingestas de flúor a través del agua de consumo pueden superar lo recomendado en población infantil, y propician futuros estudios que aporten evidencias que puedan ayudar en las políticas de fluoración de las aguas de consumo público

Objective: To estimate fluoride intake through consumption of water from the municipal network in pregnant women and their children from the INMA-Gipuzkoa cohort and to compare these intakes with recommended levels. In Euskadi (Spain), fluoridation of drinking water is compulsory in water supplies for more than 30,000 inhabitants. Method: 575 pregnant women (recruitment, 2006-2008) and 424 4-year-old children (follow-up, 2010-2012) have been included. Fluoride levels in drinking water were obtained from the water consumption information system of the Basque Country (EKUIS). Water consumption habits and socioeconomic variables were obtained by questionnaire. Results: 74.9% and 87.7% of women and children consumed water from the municipal network. Average fluoride levels in fluoridated water were 0.805 (SD: 0.194) mg/L during baseline recruitment and 0.843 (SD: 0.080) mg/L during follow up, at 4 years old of the children. Average and 95th percentile of fluoride intake were 0.015 and 0.026mg/kg per day in women and 0.033 and 0.059mg/kg per day in children. Considering only fluoride provided by drinking water, 8.71% of children living in fluoridated areas exceeded intake level recommended by the European Food Safety Authority, consisting in 0.05mg/kg per day. Conclusion: The results show that ingested levels of fluoride through consumption of municipal water can exceed the recommended levels in children and encourages further studies that will help in fluoridation policies of drinking water in the future

Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation.

Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.

Radiation fear: Impact on compliance with trauma imaging guidelines in the pregnant patient.

BACKGROUND: The Royal Melbourne Hospital is a Level 1 adult trauma center, and due to its colocation with The Royal Women's Hospital, it functions as the state's major obstetric trauma center. Obstetric trauma guidelines have been established to facilitate management of pregnant patients, yet adherence to these recommendations has not been evaluated. The aim of this study was to assess compliance with recommended imaging guidelines in obstetric trauma patients. METHODS: The prospectively collated trauma registry at Royal Melbourne Hospital was used to identify obstetric trauma presentations to the emergency department from January to December 2012. Demographics, mechanism of injury, clinical examination findings, and the use of diagnostic radiology were collected to determine adherence to recommended imaging guidelines. RESULTS: Of 74 obstetric trauma patients, the most common mechanisms of injury were motor vehicle collisions (81%), assaults (8%), and falls (7%). Despite the mechanism and severity of injury, 29 patients (39%) did not undergo imaging during their initial emergency department assessment. All of the remaining 45 patients (61%) were imaged as part of their assessment; however, plain x-rays were often used to avoid imaging with computed tomography.Of the 32 patients identified with a high-risk mechanism, chest x-ray was used in 84.4%, pelvic x-ray in 28.1%, and computed tomography-angiography in 34.4%. In the high-risk mechanism group, the compliance rate with guidelines was only 18.8% (6 patients had the recommended radiologic assessment). CONCLUSION: Concerns about fetal radiation have resulted in a low compliance rate with recommended trauma guidelines at our institution. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.

Effects of maternal and dietary selenium (Se-enriched yeast) on the expression of Sel P and apoER2 of germ cells of their offspring in goats.

In this experiment the effect of maternal dietary selenium on the expression of Sel P and apoER2 of goat offspring was studied. The experiment was conducted on 119 Taihang Black Goats randomly divided into 4 groups which were fed with a basal diet, supplemented with 0 (control), 0.5, 2 and 4 mg kg(-1) DM Se. Testis samples were collected from young male of each treatment group at the end of the study (30 d after weaning) for mRNA expression using real-time PCR and for protein expression by immunohistochemistry assay. A significant decrease was observed in mRNA expression of Sel P and apoER2 in the testis of the Se-deficient (Group 1) and the Se-excess (Group 4) compared with that in Groups 2 and 3. A similar trend of the protein expression of Sel P and apoER2 was also found. These data indicate that maternal and dietary selenium has an effect on the expression of Sel P and apoER2 in testis of their offspring. In addition, both groups were similar suggesting that the relationship between Sel P and apoER2, and apoER2 is a receptor of Sel P in the seminiferous epithelium to uptake the selenium.

Radiation protection for pregnant workers and their offspring: a recommended approach for monitoring.

Radiation protection of pregnant workers and their offspring is an issue that has been referenced in the literature by the International Commission on Radiological Protection (ICRP), the International Atomic Energy Agency (IAEA) and other international institutions. Several documents of the ICRP address the issue of the protection of the pregnant workers. The new ICRP recommendations refer to the control of working conditions of a pregnant worker, after declaration of pregnancy, such that it is unlikely that the additional dose to the fetus will exceed about 1 mSv during the remainder of pregnancy. The IAEA Basic Safety Standards present similar recommendations. The IAEA is preparing a technical document that provides guidance on these issues.

The influence of smoking during pregnancy on fetal growth. Considering daily cigarette consumption and the SGA rate according to length of gestation.

BACKGROUND: Smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations and is associated with, amongst other adverse effects, a higher rate of small-for-gestational-age (SGA) neonates. The rate of SGA neonates born before 32 weeks and its association with smoking have so far not been the focus of attention. MATERIAL AND METHODS: Using data of 643,288 primiparous women from the German perinatal statistics of 1995-2000, we aimed to investigate this relationship. We also analyzed our data according to daily cigarette consumption. RESULTS: We found that smoking during pregnancy was strongly associated with lower birth weight and higher SGA rates. This effect was especially pronounced in women >or=31 years. There was clear dose dependence with regard to daily cigarette consumption. An increase in SGA rates in smokers versus non-smokers can already be seen for very early preterm deliveries (31 weeks of gestation or less). CONCLUSIONS: Our results allow the definition of groups of women who are at higher risk of SGA births. We show that especially older primiparous women (aged >or=31 years) who smoke >10 cigarettes a day are at increased risk of experiencing fetal growth restriction.

Is radiation protection for the unborn child guaranteed by radiation protection for female workers?

ICRP Publication 88 recommends doses to the embryo and fetus from intakes of radionuclides by the mother for various intake scenarios. Mainly by answering the question 'Is radiation protection for the unborn child guaranteed by radiation protection for female workers?' it has been assessed if the intake scenarios given in ICRP Publication 88 are adequate for radiation protection purposes. This is generally the case, but the consideration of an additional chronic intake scenario for early pregnancy would be helpful. It is demonstrated that following chronic intake by inhalation, for most radionuclides radiation protection for (female) workers is also adequate for protection of the unborn child, considered as a member of the public. However, there are a number of radionuclides for which possible intakes in routine operations should be more restricted (up to 1% of the annual limits on intake for workers in the case of nickel isotopes) to ensure radiation protection for the unborn child.

[Measurement of absorbed dose and proposed radiation exposure level].

Absorbed dose was measured in clinical X-ray examinations using TLD. Moreover, we distributed the levels of radiation exposure into 3 classes. The presumed dose of the internal organs, e.g., uterus dose, was computed to depth doses with a surface dose. This information provides a prediction of the influence of radiation, and the examination can be performed with the informed consent of the patient. Moreover, we examined the distribution of the level of absorbed dose. We proposed two kinds of radiation exposure level, one to the fetus in a pregnant woman and a general level of radiation exposure that is not applied to pregnant women. The levels were as follows: 0.5 mGy and 100 mGy were considered the boundaries for fetal radiation exposure in a pregnant woman, and 200 mGy and 3 Gy were considered the boundaries for the general level of radiation exposure (excluding pregnant women).

Is it safe to work with iodine-131 if you are pregnant? A risk assessment for nuclear medicine staff involved with cleaning and decontamination.

In the UK, Regulation 8(5) of the Ionising Radiation Regulations 1999 (In: Work with ionising radiation. London: HSE Books, 2000) requires employers to ensure that the dose to the foetus of a pregnant worker is unlikely to exceed 1 mSv. Risk assessments are required which are capable of predicting the total foetal dose. Work involving 131I is a particular problem. Foetal dose coefficients from the maternal intake of 131I for all stages of pregnancy have been published (Phipps AW, Smith TJ, Fell TP, Harrison JD. Doses to the embryo/fetus and neonate from intake of radionuclides by the mother. NRPB contract research report 397/2001. Didcot, Oxon.: National Radiological Protection Board (NRPB), 2001. Available on website www.hse.gov.uk/research/crr_pdf/2001/crr01397.pdf), and range from 0.08 microSv x kBq(-1) at conception to 55 microSv x kBq(-1) at week 35. This paper examines one aspect of work in a nuclear medicine department in which the source of 131I is uncontrolled to determine whether the risk assessment indicates that restrictions should apply to a pregnant member of staff. Following in-patient treatment with 131I, rooms are checked and decontaminated before being decontrolled. Cleaning staff were monitored immediately after the cleaning process with hand-held detectors and by whole-body monitoring. Total body contamination ranged up to 3.2 kBq; after a change of clothing, the maximum remaining activity was 0.68 kBq. Acquired contamination correlated with the total activity administered to the patient. Hand-held monitoring rarely detected contamination. Whole-body monitoring indicated that the levels of contamination encountered could lead to a dose limit for the foetus being exceeded. These levels are very difficult to detect with hand-held monitoring. The conclusion to be drawn is that pregnant staff should be excluded from situations in which accidents could arise, or where the source of 131I is uncontrolled or unpredictable.