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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 April 2014) | Viewed by 95040

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Dr. Igor Burstyn

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Department of Environmental and Occupational Health, School of Public Health, Drexel University, Nesbitt Hall Room 614, 3215 Market Street, Philadelphia, PA 19104, USA
Interests: maternal and child health; occupational and environmental epidemiology; occupational hygiene; exposure assessment; gene-environment interaction; bio-statistics

Special Issue Information

Dear Colleagues,

Environmental threats to the health of pregnant women, nursing mothers and children are a natural focus of public health research. Attention to the health of vulnerable individuals, especially where there is potential to affect several generation and health consequences are likely to resonate over the entire lifespan is a natural niche for research aimed at improving the health and well-being of the population as the whole. There is a considerable concern in the community at large about trans-generational health effects of ‘emerging’ environmental contaminants (especially in the context of neurodevelopment) and a plethora of unresolved issues about the most effective interventions aimed at alleviating or eliminating adverse health effects of environmental factors that are known to compromise maternal and child health. Policy implications of these matters are greatly complicated in the international settings, where contaminants/risks may cross national boundaries and little may be known about specific populations at risk (such as when evidence in one country is applied in another country). Methodological problems also continue to plague translation of research in this area to policy, ranging from difficulties of extrapolating from toxicological assays to human health risks assessment, to particular challenges of measurement error, bias and latent confounding in perinatal epidemiology. The paucity of epidemiological data and policy analyses is especially acute in the area of ‘emerging’ contaminants and their effects over the mother’s and child’s lifespan.

This special edition focuses on recent insights into the impact of environmental and occupational exposures on maternal and child health with special attention to policy implications of these findings. The objective of the articles in this special issue of the journal is not merely to report a particular result but to provide analysis of policy and/or impact on public health of the reported results. Methodological articles that address specific challenges that characterize this area of research are particularly welcome when they aim to improve the overall quality of research even if the innovations are not necessarily novel in their home disciplines (e.g. statistics, informatics).

I look forward to receiving your contributions!

Dr. Igor Burstyn
Guest Editor

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Keywords

environmental exposures
occupational health
perinatal epidemiology
pediatrics
obstetrics and gynecology
neurodevelopment
exposure pathways
policy analysis
risk assessment
international health

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Published Papers (12 papers)

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Research

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558 KiB

Open AccessArticle

Occupational Risks and Pregnancy and Infant Health Outcomes in Florida Farmworkers

by Jennifer Runkle, Joan Flocks, Jeannie Economos, J. Antonio Tovar-Aguilar and Linda McCauley

Int. J. Environ. Res. Public Health 2014, 11(8), 7820-7840; https://doi.org/10.3390/ijerph110807820 - 6 Aug 2014

Cited by 18 | Viewed by 6777

Abstract

The agricultural industry has some of the highest incidence rates and numbers of occupational injuries and illnesses in the United States. Injuries and illnesses in agriculture result from accidents, falls, excessive heat, repetitive motion and adverse pesticide exposure. Women working in agriculture are exposed to the same hazards and risks as their male counterparts, but can face additional adverse impacts on their reproductive health. Yet, few occupational risk assessment studies have considered the reproductive health of female farmworkers. The objective of this community-based participatory research study was to conduct a retrospective, cross-sectional survey to collect information on workplace conditions and behaviors and maternal, pregnancy and infant health outcomes among a sample of female nursery and fernery farmworkers in Central Florida. Survey results showed that nursery workers were more likely to report health symptoms during their pregnancy than fernery workers. We also observed a self-reported increased risk of respiratory illness in the first year of life for infants whose mothers worked in ferneries. Our findings confirm that agricultural work presents potential reproductive hazards for women of childbearing age. Full article

(This article belongs to the Special Issue Maternal and Child Health)

232 KiB

Open AccessArticle

Joint Exposure to Chemical and Nonchemical Neurodevelopmental Stressors in U.S. Women of Reproductive Age in NHANES

by Amanda M. Evans, Glenn E. Rice, Linda K. Teuschler and J. Michael Wright

Int. J. Environ. Res. Public Health 2014, 11(4), 4384-4401; https://doi.org/10.3390/ijerph110404384 - 22 Apr 2014

Cited by 11 | Viewed by 6976

Abstract

Lead (Pb) and methyl mercury (MeHg) are well established neurodevelopmental toxicants (NDTs), but joint exposure to chemical and nonchemical (e.g., maternal stress) stressors has rarely been considered. We characterized exposure to Pb, MeHg and a measure of physiological dysregulation associated with chronic stress and examined race/ethnicity as a predictor of joint NDT exposure. Using data from the 2003−2004 NHANES, potential chronic stress exposure was estimated using allostatic load (AL), a quantitative measure of physiological dysregulation. A Hazard Index was calculated for joint exposure to Pb and MeHg (HI_NDT). Logistic regression was used to assess the relationship between an indicator of elevated joint NDT exposures (HI_NDT > 1) and race/ethnicity. The multivariate model was stratified by AL groups to examine effect measure modification. African American (adjusted odds ratio [OR] [95% confidence interval] = 2.2 [1.4, 3.3]) and Mexican American (1.4 [0.7, 2.6]) women were more likely to have an HI_NDT > 1 compared to Caucasian women. Chronic stress was identified as an effect measure modifier with the largest ORs among women with high AL scores (African Americans = 4.3 [2.0, 9.5]; Mexican Americans = 4.2 [1.3, 14.1]). Chronic stress was found to modify the association between elevated joint NDT exposure and race/ethnicity, highlighting the importance of evaluating chemical and nonchemical stressor exposures leading to a common endpoint. Full article

(This article belongs to the Special Issue Maternal and Child Health)

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238 KiB

Open AccessArticle

Clinically-Important Brain Injury and CT Findings in Pediatric Mild Traumatic Brain Injuries: A Prospective Study in a Chinese Reference Hospital

by Huiping Zhu, Qi Gao, Xin Xia, Joe Xiang, Hongli Yao and Jianbo Shao

Int. J. Environ. Res. Public Health 2014, 11(4), 3493-3506; https://doi.org/10.3390/ijerph110403493 - 26 Mar 2014

Cited by 22 | Viewed by 7136

Abstract

This study investigated injury patterns and the use of computed tomography (CT) among Chinese children with mild traumatic brain injury (MTBI). We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI) for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%), and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8). Falls were the leading cause of MTBI (61.5%), followed by blows (18.9%) and traffic collisions (14.1%) for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China. Full article

(This article belongs to the Special Issue Maternal and Child Health)

260 KiB

Open AccessArticle

Maternal Exposure to Bisphenol-A and Fetal Growth Restriction: A Case-Referent Study

by Igor Burstyn, Jonathan W. Martin, Sanjay Beesoon, Fiona Bamforth, Qiaozhi Li, Yutaka Yasui and Nicola M. Cherry

Int. J. Environ. Res. Public Health 2013, 10(12), 7001-7014; https://doi.org/10.3390/ijerph10127001 - 11 Dec 2013

Cited by 14 | Viewed by 7309

Abstract

We conducted a case-referent study of the effect of exposure to bisphenol-A on fetal growth in utero in full-term, live-born singletons in Alberta, Canada. Newborns <10 percentile of expected weight for gestational age and sex were individually matched on sex, maternal smoking and maternal age to referents with weight appropriate to gestational age. Exposure of the fetus to bisphenol-A was estimated from maternal serum collected at 15–16 weeks of gestation. We pooled sera across subjects for exposure assessment, stratified on case-referent status and sex. Individual 1:1 matching was maintained in assembling 69 case and 69 referent pools created from 550 case-referent pairs. Matched pools had an equal number of aliquots from individual women. We used an analytical strategy conditioning on matched set and total pool-level values of covariates to estimate individual-level effects. Pools of cases and referents had identical geometric mean bisphenol-A concentrations (0.5 ng/mL) and similar geometric standard deviations (2.3–2.5). Mean difference in concentration between matched pools was 0 ng/mL, standard deviation: 1 ng/mL. Stratification by sex and control for confounding did not suggest bisphenol-A increased fetal growth restriction. Our analysis does not provide evidence to support the hypothesis that bisphenol-A contributes to fetal growth restriction in full-term singletons. Full article

(This article belongs to the Special Issue Maternal and Child Health)

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146 KiB

Open AccessArticle

Prenatal Secondhand Smoke Exposure and Infant Birth Weight in China

by Nora L. Lee, Jonathan M. Samet, Gonghuan Yang, Maigeng Zhou, Jie Yang, Adolfo Correa and Peter S. J. Lees

Int. J. Environ. Res. Public Health 2012, 9(10), 3398-3420; https://doi.org/10.3390/ijerph9103398 - 26 Sep 2012

Cited by 15 | Viewed by 7596

Abstract

Epidemiologic evidence provides some support for a causal association between maternal secondhand smoke (SHS) exposure during pregnancy and reduction in infant birth weight. The purpose of this cross-sectional study is to examine the magnitude of this association in China, where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. Women who gave birth in Beijing and Changchun September 2000–November 2001 were interviewed to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (≥37 weeks gestation) were included in the study (N = 2,770). Nearly a quarter of the women (24%) reported daily SHS exposure, 47% reported no prenatal exposure, and 75% denied any SHS exposure from the husband smoking at home. Overall, no deficit in mean birth weight was observed with exposure from all sources of SHS combined (+11 grams, 95% CI: +2, +21). Infants had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Future studies on SHS exposure and infant birth weight in China should emphasize more objective measures of exposure to quantify and account for any exposure misclassification. Full article

(This article belongs to the Special Issue Maternal and Child Health)

193 KiB

Open AccessArticle

Primary Prevention of Lead Exposure—Blood Lead Results at Age Two Years

by Carla Campbell, Edward Gracely, Mary Tran, Naomi Starkey, Hans Kersten, Peter Palermo, Nancy Rothman, Laura Line and Tine Hansen-Turton

Int. J. Environ. Res. Public Health 2012, 9(4), 1216-1226; https://doi.org/10.3390/ijerph9041216 - 11 Apr 2012

Cited by 6 | Viewed by 7099

Abstract

Objectives: The Philadelphia Lead Safe Homes (LSH) Study was designed to evaluate whether educational and environmental interventions in the first year of life for families of newborns increased knowledge of lead exposure prevention and were associated with less elevation of blood lead levels (BLLs) for these children, when compared to children receiving standard care. Methods: The current study performed descriptive statistics on the second-year BLL data for both groups and compared these using chi-square tests for proportions and unpaired t-tests for means. Results: A BLL result was found for 159 (50.6%) of the 314 LSH cohort children and 331 (52.7%) of the 628 control children (p = 0.1). Mean and standard deviation for age at draw was 23.8 (3.4) months versus 23.6 (3.1) months (P = 0.6). Geometric mean BLLs were 3.7 versus 3.5 µg/dL (P = 0.4). The percentages of the cohort group with a BLL of ≥20, ≥10 and ≥5 μg/dL, respectively, were 0.6%, 5% and 30%; for the controls 1.2%, 6.6%, and 25%. These percentages were not significantly different between groups. Conclusion: A comparison of geometric mean BLLs and percentages above several BLL cut points drawn at age two years in a group of urban newborns benefitting from study interventions versus a group of similar urban children did not yield statistically significant differences. Both groups had relatively lower lead levels when compared to historical cohort groups, which may reflect a continuing downward trend in BLLs in U.S. children. The interventions did result in benefits to the families such as an increase in parental knowledge about lead exposure prevention and in-home wet cleaning activity, and a decrease in lead dust levels in study homes. Full article

(This article belongs to the Special Issue Maternal and Child Health)

250 KiB

Open AccessArticle

The Association Between Community Stressors and Asthma Prevalence of School Children in Winnipeg, Canada

by Tyler P. Pittman, Candace I. J. Nykiforuk, Javier Mignone, Piush J. Mandhane, Allan B. Becker and Anita L. Kozyrskyj

Int. J. Environ. Res. Public Health 2012, 9(2), 579-595; https://doi.org/10.3390/ijerph9020579 - 16 Feb 2012

Cited by 10 | Viewed by 8463

Abstract

It is generally surmised that community stressors have an incubating effect for a variety of diagnoses on maternal and child health. This is of public health significance, as children of mothers facing long-term distress were found to have a 60% higher risk for asthma diagnosis at age 7 in Manitoba, Canada. Our objective was to determine the association of community stressors with childhood asthma prevalence in Winnipeg, Canada from participants who completed the Study of Asthma, Genes and the Environment (SAGE) survey administered in 2002–2003 to a birth cohort from 1995. Measures of community socioeconomic makeup and community disorder with rank ordinalized by quintile at the census tract level were obtained from the 1996 Canada Census. Crime data (annual incidence per 10,000 persons) by neighbourhood profile for 2001 was provided by the Winnipeg Police Service. Dichotomous caregiver report of child asthma along with other indicators from the geocoded SAGE survey allowed linkage to 23 neighbourhood profiles. Multilevel logistic regression analyses were performed to estimate the effect of community stressors on childhood asthma prevalence for birth and non-birth home children (N = 1472) and children resident of birth homes at age 7 or 8 (N = 698). After adjusting for individual risk factors, children resident of birth homes in a high thefts over $5,000 neighbourhood profile were twice as likely (Adjusted OR, 2.05; 95% CI, 1.11–3.81) to have report of asthma compared to children in a lower thefts over $5,000 profile, with community thefts over $5,000 explaining over half of the observed neighbourhood variation in asthma. Full article

(This article belongs to the Special Issue Maternal and Child Health)

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174 KiB

Open AccessArticle

The Role of Maternal Smoking in Effect of Fetal Growth Restriction on Poor Scholastic Achievement in Elementary School

by Igor Burstyn, Stefan Kuhle, Alexander C. Allen and Paul Veugelers

Int. J. Environ. Res. Public Health 2012, 9(2), 408-420; https://doi.org/10.3390/ijerph9020408 - 27 Jan 2012

Cited by 7 | Viewed by 7739

Abstract

Fetal growth restriction and maternal smoking during pregnancy are independently implicated in lowering intellectual attainment in children. We hypothesized that only reduction of fetal growth that is attributable to extrinsic causes (e.g., maternal smoking) affects intellectual development of a child. Cross-sectional survey of 3,739 students in Nova Scotia (Canada) in 2003 was linked with the perinatal database, parental interviews on socio-demographic factors and the performance on standardized tests when primarily 11–12 years of age, thereby forming a retrospective cohort. Data was analyzed using hierarchical logistic regression with correction for clustering of children within schools. The risk of poor test result among children born small-for-gestational-age (SGA) to mothers who smoked was 29.4%, higher than in any other strata of maternal smoking and fetal growth. The adjusted odds ratio among SGA children born to mothers who smoked was the only one elevated compared to children who were not growth restricted and born to mothers who did not smoke (17.0%, OR = 1.46, 95% CI 1.02, 2.09). Other perinatal, maternal and socio-demographic factors did not alter this pattern of effect modification. Heterogeneity of etiology of fetal growth restriction should be consider in studies that address examine its impact on health over life course. Full article

(This article belongs to the Special Issue Maternal and Child Health)

323 KiB

Open AccessArticle

Temporal Variation in Air Pollution Concentrations and Preterm Birth—A Population Based Epidemiological Study

by David Olsson, Magnus Ekström and Bertil Forsberg

Int. J. Environ. Res. Public Health 2012, 9(1), 272-285; https://doi.org/10.3390/ijerph9010272 - 18 Jan 2012

Cited by 32 | Viewed by 9494

Abstract

There is growing evidence of adverse birth outcomes due to exposure to air pollution during gestation. However, recent negative studies are also reported. The aim of this study was to assess the effect of ozone and vehicle exhaust exposure (NO₂) on the length of the gestational period and risk of preterm delivery. We used data from the Swedish Medical Birth Registry on all vaginally delivered singleton births in the Greater Stockholm area who were conceived during 1987–1995 (n = 115,588). Daily average levels of NO₂ (from three measuring stations) and ozone (two stations) were used to estimate trimester and last week of gestation average exposures. Linear regression models were used to assess the association between the two air pollutants and three exposure windows, while logistic regression models were used when analyzing associations with preterm delivery ( < 37 weeks gestation). Five percent were born preterm. The median gestational period was 40 weeks. Higher levels of ozone during the first trimester were associated with shorter gestation as well as with an elevated risk of preterm delivery, the odds ratio from the most complex model was 1.06 (95% CI: 1.00–1.13) per 10 μg/m³ increase in the mean daily 8-h maximum concentration. Higher levels of ozone during the second trimester were associated with shorter gestation but the elevated risk of preterm delivery was not statistically significant. Higher levels of ozone and NO₂ during the last week of gestation were associated with a shorter duration of gestation and NO₂ also with preterm delivery. There were no significant associations between first and second trimester NO₂ exposure estimates and studied outcomes. The effect of first trimester ozone exposure, known to cause oxidative stress, was smallest among women who conceived during autumn when vitamin D status, important for fetal health, in Scandinavian women is the highest. Full article

(This article belongs to the Special Issue Maternal and Child Health)

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235 KiB

Open AccessArticle

Zinc in Well Water and Infant Mortality in Bangladesh: A Report from Gonoshasthaya Kendra

by Nicola Cherry, Corbett McDonald and Zafrullah Chowdhury

Int. J. Environ. Res. Public Health 2012, 9(1), 171-177; https://doi.org/10.3390/ijerph9010171 - 10 Jan 2012

Cited by 3 | Viewed by 7956

Abstract

Zinc supplementation reduces the duration, severity and recurrence of diarrhoea in young children. This study examines whether zinc, found naturally in drinking water, reduced infant deaths from diarrhoea in rural Bangladesh. Information was compiled for births over two calendar years with follow-up for deaths within one year of birth. The study included 29,744 live births and 934 deaths in some 600 villages under the care of Gonoshasthaya Kendra (GK), grouped into 15 health centre regions within 12 upazillas. Individual matching of death to birth data was not possible, but information on exposures through well water and on potential confounders was available for each upazilla. Average concentration of zinc in well water, reported by the British Geological Survey, was grouped into high (>0.07 mg/L), moderate (0.020–0.070 mg/L) and low (< 0.020 mg/L) concentrations. Odds ratios (OR) were calculated for zinc by age and cause of death. Zinc concentration was unrelated to all-cause mortality but a decrease in deaths from diarrhoea (N = 50) was seen in areas with high zinc (OR = 0.30; 95% CI 0.13–0.69). No relation to diarrhoeal deaths was found with other well contaminants (arsenic, manganese) having accounted for zinc. Upazillas with a high proportion of women without education had higher rates of death from diarrhea, but the decrease in risk with high zinc remained (OR adjusted = 0.41; 95% CI 0.20–0.84). It is concluded that exposure to zinc through drinking water may reduce risk of diarrhoeal deaths. Full article

(This article belongs to the Special Issue Maternal and Child Health)

Review

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221 KiB

Open AccessReview

Mitochondrial Toxicity in Human Pregnancy: An Update on Clinical and Experimental Approaches in the Last 10 Years

by Constanza Morén, Sandra Hernández, Mariona Guitart-Mampel and Glòria Garrabou

Int. J. Environ. Res. Public Health 2014, 11(9), 9897-9918; https://doi.org/10.3390/ijerph110909897 - 22 Sep 2014

Cited by 21 | Viewed by 7829

Abstract

Mitochondrial toxicity can be one of the most dreadful consequences of exposure to a wide range of external agents including pathogens, therapeutic agents, abuse drugs, toxic gases and other harmful chemical substances. However, little is known about the effects of mitochondrial toxicity on pregnant women exposed to these agents that may exert transplacental activity and condition fetal remodeling. It has been hypothesized that mitochondrial toxicity may be involved in some adverse obstetric outcomes. In the present study, we investigated the association between exposure to mitochondrial toxic agents and pathologic conditions ranging from fertility defects, detrimental fetal development and impaired newborn health due to intra-uterine exposure. We have reviewed data from studies in human subjects to propose mechanisms of mitochondrial toxicity that could be associated with the symptoms present in both exposed pregnant and fetal patients. Since some therapeutic interventions or accidental exposure cannot be avoided, further research is needed to gain insight into the molecular pathways leading to mitochondrial toxicity during pregnancy. The ultimate objective of these studies should be to reduce the mitochondrial toxicity of these agents and establish biomarkers for gestational monitoring of harmful effects. Full article

(This article belongs to the Special Issue Maternal and Child Health)

1939 KiB

Open AccessReview

Effects of Air Pollution on the Risk of Congenital Anomalies: A Systematic Review and Meta-Analysis

by Esther Kai-Chieh Chen, Denis Zmirou-Navier, Cindy Padilla and Séverine Deguen

Int. J. Environ. Res. Public Health 2014, 11(8), 7642-7668; https://doi.org/10.3390/ijerph110807642 - 31 Jul 2014

Cited by 111 | Viewed by 9459

Abstract

Congenital anomalies are the main causes of preterm and neonatal mortality and morbidity. We investigated the association between congenital anomalies and mothers’ exposure to air pollution during pregnancy by combining risk estimates for a variety of air pollutants (SO₂, NO₂, PM₁₀, PM_2.5, CO and O₃) and anomaly defect outcomes. Seventeen articles were included in the systematic review and thirteen studies were taken into account in the meta-analysis. Combined estimated were calculated separately according to whether the exposure metric was continuous or categorical. Only one significant combination was; NO₂ concentrations were significantly associated with coarctation of the aorta (OR = 1.20 per 10 ppb, 95% CI, (1.02, 1.41)). This finding could stem from strong heterogeneity in study designs. Improved exposure assessment methods, in particular more accurate spatial measurements or modeling, standardized definition of cases and of better control of confounders are highly recommended for future congenital anomalies research in this area. Full article

(This article belongs to the Special Issue Maternal and Child Health)

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