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A prospective cohort study of the association between drinking water arsenic exposure and self-reported maternal health symptoms during pregnancy in Bangladesh.

Kile-ML; Rodrigues-EG; Mazumdar-M; Dobson-CB; Diao-N; Golam-M; Quamruzzaman-Q; Rahman-M; Christiani-DC
Environ Health Glob Access Sci Source 2014 Apr; 13:29
BACKGROUND: Arsenic, a common groundwater pollutant, is associated with adverse reproductive health but few studies have examined its effect on maternal health. METHODS: A prospective cohort was recruited in Bangladesh from 2008-2011 (N=1,458). At enrollment (<16 weeks gestational age [WGA]), arsenic was measured in personal drinking water using inductively-coupled plasma mass spectrometry. Questionnaires collected health data at enrollment, at 28 WGA, and within one month of delivery. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) for self-reported health symptoms were estimated for each arsenic quartile using logistic regression. RESULTS: Overall, the mean concentration of arsenic was 38 g/L (Standard deviation, 92.7 g/L). A total of 795 women reported one or more of the following symptoms during pregnancy (cold/flu/infection, nausea/vomiting, abdominal cramping, headache, vaginal bleeding, or swollen ankles). Compared to participants exposed to the lowest quartile of arsenic (<0.9 g/L), the aOR for reporting any symptom during pregnancy was 0.62 (95% CI=0.44-0.88) in the second quartile, 1.83 (95% CI=1.25-2.69) in the third quartile, and 2.11 (95% CI=1.42-3.13) in the fourth quartile where the mean arsenic concentration in each quartile was 1.5 g/L, 12.0 g/L and 144.7 g/L, respectively. Upon examining individual symptoms, only nausea/vomiting and abdominal cramping showed consistent associations with arsenic exposure. The odds of self-reported nausea/vomiting was 0.98 (95% CI: 0.68, 1.41), 1.52 (95% CI: 1.05, 2.18), and 1.81 (95% CI: 1.26, 2.60) in the second, third and fourth quartile of arsenic relative to the lowest quartile after adjusting for age, body mass index, second-hand tobacco smoke exposure, educational status, parity, anemia, ferritin, medication usage, type of sanitation at home, and household income. A positive trend was also observed for abdominal cramping (P for trend <0.0001). A marginal negative association was observed between arsenic quartiles and odds of self-reported cold/flu/infection (P for trend=0.08). No association was observed between arsenic and self-reported headache (P for trend=0.19). CONCLUSION: Moderate exposure to arsenic contaminated drinking water early in pregnancy was associated with increased odds of experiencing nausea/vomiting and abdominal cramping. Preventing exposure to arsenic contaminated drinking water during pregnancy could improve maternal health.
Arsenic-compounds; Pollutants; Hazards; Exposure-levels; Prenatal-exposure; Pregnancy; Questionnaires; Humans; Women; Author Keywords: Arsenic; Maternal health; Nausea; Vomiting; Cramping; Environmental health; Reproductive health
Molly L Kile, Department of Public Health, College of Public Health and Human Sciences, Oregon State University, 15 Milam, Corvallis, OR 97331
Publication Date
Document Type
Journal Article
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Fiscal Year
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Identifying No.
Grant-Number-T42-OH-008416; M102014
Source Name
Environmental Health: A Global Access Science Source
Performing Organization
Harvard School of Public Health