Maternal bone lead as an independent risk factor for fetal neurotoxicity: A prospective study
Maternal bone lead as an independent risk factor for fetal neurotoxicity: A prospective study
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DOI：
10.1542/peds.110.1.110
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发表时间：
2002-07-01
期刊：
影响因子：
8
通讯作者：
Hernandez-Avila, M
中科院分区：
文献类型：
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作者：
Gomaa, A;Hu, H;Hernandez-Avila, M
客观的。许多前瞻性研究检查了出生时脐带血中的铅水平，作为婴儿智力发育的预测因子。尽管有一些发现了显着的反向关联，但其他一些却没有。母体骨骼中铅水平的测量现在被认为是胎儿大量暴露的来源，有可能作为铅对胎儿影响的更好或补充预测指标。我们的目标是使用前瞻性设计来比较脐带血和母体骨骼中的铅水平作为婴儿智力发育的独立预测因子。方法。我们招募了在墨西哥城 3 家妇产医院分娩的女性，这些医院为同质的中产阶级社区提供服务。通过石墨炉原子吸收光谱法测量脐带血铅水平，并在分娩后 4 周内使用 109-Cd K-x 射线荧光仪器测量母体皮质（胫骨）和小梁（髌骨）骨中的铅水平。在 24 个月大时，使用贝利婴儿发育量表 II（西班牙语版）对每个婴儿进行评估。结果。共有 197 对母婴完成了这部分研究，并获得了所有感兴趣变量的数据。调整婴儿神经发育的其他众所周知的决定因素后，包括母亲年龄、智商和教育程度；父亲的教育；婚姻状况;母乳喂养持续时间；婴儿性别；和婴儿疾病、脐带血和骨小梁中的铅水平与贝利量表的智力发展指数 (MDI) 分数显着、独立且呈负相关。相对于骨小梁铅的最低四分位数，第二、第三和第四四分位数与调整后的 MDI 评分减少 5.4、7.2 和 6.5 分相关。脐带血铅水平增加 2 倍（例如，从 5 至 10 微克/分升）与 MDI 评分下降 3.1 分相关，这与之前研究中观察到的影响程度相当。结论。母亲骨小梁铅水平较高是 24 个月婴儿智力发育受损的独立危险因素。这种效应可能归因于母体骨铅储存的动员，鉴于铅在骨骼中的停留时间较长，这一现象可能构成重大的公共健康问题。
Objective. A number of prospective studies have examined lead levels in umbilical cord blood at birth as predictors of infant mental development. Although several have found significant inverse associations, others have not. Measurement of lead levels in maternal bone, now recognized as the source of much fetal exposure, has the potential to serve as a better or complementary predictor of lead's effect on the fetus. Our objective was to compare lead levels in umbilical cord blood and maternal bone as independent predictors of infant mental development using a prospective design.Methods. We recruited women who were giving birth at 3 maternity hospitals in Mexico City that serve a homogeneous middle-class community. Umbilical cord blood lead levels were measured by graphite furnace atomic absorption spectroscopy, and maternal lead levels in cortical (tibial) and trabecular (patellar) bone were measured within 4 weeks of giving birth using a 109-Cd K-x-ray fluorescence instrument. At 24 months of age, each infant was assessed using the Bayley Scales of Infant Development-II (Spanish Version).Results. A total of 197 mother-infant pairs completed this portion of the study and had data on all variables of interest. After adjustment for other well-known determinants of infant neurodevelopment, including maternal age, IQ, and education; paternal education; marital status; breastfeeding duration; infant gender; and infant illness, lead levels in umbilical cord blood and trabecular bone were significantly, independently, and inversely associated with the Mental Development Index (MDI) scores of the Bayley Scale. In relation to the lowest quartile of trabecular bone lead, the second, third, and fourth quartiles were associated with 5.4-, 7.2-, and 6.5-point decrements in adjusted MDI scores. A 2-fold increase in cord blood lead level (eg, from 5 to 10 mug/dL) was associated with a 3.1-point decrement in MDI score, which is comparable to the magnitude of effect seen in previous studies.Conclusion. Higher maternal trabecular bone lead levels constitute an independent risk factor for impaired mental development in infants at 24 months of age. This effect is probably attributable to mobilization of maternal bone lead stores, a phenomenon that may constitute a significant public health problem in view of the long residence time of lead in bone.