Prenatal Lead Exposures in Pakistan: A Prelude to Prevention

描述（由申请人提供）：铅毒性仍然是世界各地的主要环境健康风险。巴基斯坦和南亚国家认为逐步淘汰含铅汽油是控制铅的适当措施。然而，铅沉积在环境介质和母亲的骨头继续暴露胎儿和儿童。我们在卡拉奇的初步研究表明，巴基斯坦城市地区约50%的新生儿脐带血铅含量（BLL）高于10 <g/dL。我们使用问卷评估铅暴露的来源；然而，我们无法测量环境介质中的铅含量。拟议的研究是一项关于南亚铅暴露的先驱研究，它将招募在巴基斯坦卡拉奇三所三级保健医院之一接生婴儿的妇女，并将测量她们家中环境介质中的铅。具体目的是：(1)估计平均脐带血铅水平和新生儿脐带血铅水平高（bbb10 </dl）的比例；(2)确定儿童家庭和周围环境中铅暴露的来源和水平；(3)并确定脐带血铅水平（BLL）的主要决定因素，包括环境来源和母体决定因素。我们将招募在研究医院准备分娩的母亲，对她们进行访谈，采集她们的血液，检测白蛋白、血清铁蛋白和血红蛋白，并采集脐带检测铅含量。开展家庭及周边环境环境源测量。疾病控制和预防中心（CDC）将提供技术援助，以便为国家决策者和公共卫生专业人员解释和传播研究结果。这项研究将有助于了解环境中铅的来源，为巴基斯坦减少铅和减少环境风险的问题提供信息基础，并作为该区域其他国家的干预模式。公共卫生相关性：铅毒性在全世界仍然是一个主要的环境健康风险。先前的研究表明，大约50%的巴基斯坦儿童血铅水平(BLL) < 10克/分升。越来越多的证据表明，儿童暴露于铅含量和认知功能下降之间存在关联，并且在成年早期有不良行为。这些调查结果引起了人们对儿童健康的关注，以及他们未来成为本国和世界社会中有贡献的成员的潜力。这项研究是一项关于发展中国家铅接触评估的先驱研究，将有助于了解巴基斯坦各种铅接触来源的作用。这些数据将为在巴基斯坦进行国家一级的干预提供基础，从而减少儿童的bll。这项研究的结果也与南亚其他国家的铅预防/控制项目直接相关。

DESCRIPTION (provided by applicant): Lead toxicity remains a major environmental health risk throughout the world. Pakistan and South Asian countries consider phasing-out of leaded gasoline as an adequate measure for control of lead. However, lead deposited in environmental media and maternal bone continues to expose fetuses and children. Our preliminary study in Karachi has shown that approximately 50% of neonates in an urban area of Pakistan had cord blood lead levels (BLL) above10 <g/dL. We assessed sources of lead exposures using questionnaires; however, we were not able to measure lead levels in environmental media. The proposed study, a pioneer study on lead exposure in South Asia, will recruit women delivering infants at one of three tertiary care hospitals in Karachi, Pakistan and will measure lead in environmental media in their homes. The specific aims are: (1) to estimate the mean umbilical cord blood lead level and the proportion of newborns with high cord blood lead levels (>10</dl); (2) to determine sources and levels of environmental lead exposure in children's homes and surroundings; (3) and to identify the major determinants of umbilical cord blood lead level (BLL) including environmental sources and maternal determinants. We will recruit mothers presenting for delivery at the study hospitals, interview them, will collect their blood for BLLs, serum ferritin and hemoglobin, and will collect umbilical cord for lead levels. We will conduct environmental source measurements in homes and surrounding environment. The Centers for Disease Control and Prevention (CDC) will provide technical assistance to interpret and disseminate research findings for national policy makers and public health professionals. This study will contribute to understanding the sources of lead in environment that will provide a basis for which to inform issues of lead abatement and environmental risk reduction in Pakistan and serve as a model intervention for other countries in the region. PUBLIC HEALTH RELEVANCE: Narrative Lead toxicity continues to remain a major environmental health risk throughout the world. Previous research has shown that about 50% of Pakistani children have blood lead levels (BLL) >10 <g/dL. There is growing evidence of an association between children exposed to lead levels and lowered cognitive function, and delinquent behavior in young adulthood. These findings raise concerns about the health of children and of their future potential to be productive members of society in their country and in the world. This study, a pioneer study on lead exposure assessment in a developing country, will contribute to understanding the role of various sources of lead exposure in Pakistan. These data will provide a basis for intervention in Pakistan at the national level that will result in reduction of BLLs in children. The findings of this study also are directly relevant to lead prevention/control programs in other countries in South Asia.