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. 2017 Oct 6;12(10):e0185645.
doi: 10.1371/journal.pone.0185645. eCollection 2017.

Heavy metals exposure levels and their correlation with different clinical forms of fetal growth restriction

Sally Sabra  1 , Ebba Malmqvist  2 , Alicia Saborit  1 , Eduard Gratacós  1   3 , Maria Dolores Gomez Roig  1   4   5
Affiliations

Heavy metals exposure levels and their correlation with different clinical forms of fetal growth restriction

Sally Sabra et al. PLoS One. .

Abstract

Background: Prenatal heavy metals exposure has shown a negative impact on birth weight. However, their influence on different clinical forms of fetal smallness was never assessed.

Objectives: To investigate whether there is a differential association between heavy metals exposure and fetal smallness subclassification into intrauterine growth restriction (IUGR) and small-for-gestational age (SGA).

Method: In this prospective case-control study, we included 178 mother-infant pairs; 96 of appropriate for gestational age (AGA) and 82 of small fetuses diagnosed in third trimester. The small ones were further subclassified into IUGR, n = 49 and SGA, n = 33. Cadmium (Cd), mercury (Hg), lead (Pb), arsenic (As) and zinc (Zn) levels were measured in the maternal and cord serum, and in the placentas of the three groups.

Results: Maternal serum level of Cd (p<0.001) was higher in the small fetuses compared to AGA. Fetal serum level of Cd (p<0.001) was increased in the small fetuses compared to AGA. Fetal serum level of Hg (p<0.05) showed an increase in SGA compared to both IUGR and AGA. Fetal serum level of Zn was increased in the AGA (p < 0.001) compared to each of the small fetuses groups. Only differences in the levels between the small fetuses' subgroups were detected in the fetal serum levels of Cd and Hg. Fetal birth weight was negatively correlated with the fetal serum level of Cd (p < 0.001). No differences in the placental heavy metal levels were observed among the groups.

Conclusion: Fetal serum levels of Cd showed differential correlation between small fetuses' clinical subclassification, which together with the increased Cd levels in both maternal and fetal serum of the small fetuses reinforce the negative influence of heavy metals on birth weight. These findings provide more opportunities to verify the role of heavy metals exposure in relation to small fetuses' subclassification.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the total number of recruited patients, number of excluded cases and our cohort three subgroups.
AGA: Appropriate for gestational age; IUGR: intrauterine growth restriction; SGA: small for gestational age.
Fig 2
Fig 2. Neonatal birth weights of the three groups.
Mean birth weights of the AGA (white), IUGR (grey) and SGA (dashed) groups are presented, significant differences in the birth weight of the AGA compared to the IUGR and SGA (p<0.001). Increased mean birth weight of the SGA compared to the IUGR group (p<0.001). AGA: appropriate for gestational age; IUGR: intrauterine growth restriction; SGA: small for gestational age; Analysis of variance (ANOVA) and posthoc test, *** p <0.001.
Fig 3
Fig 3
Comparison between the detected maternal serum levels of Cd (A), Hg (B) and As (C) in the three groups of our cohort. AGA: appropriate for gestational age; IUGR: intrauterine growth restriction; SGA: small for gestational age. Cd: cadmium; Hg: mercury; As: arsenic Kruskal-Wallis and Mann Whitney tests were used. * p<0.05, **p<0.01, ***p<0.001.
Fig 4
Fig 4
Comparison between the detected fetal serum levels of Cd (A) and Hg (B) in the three groups of our cohort. AGA: appropriate for gestational age; IUGR: intrauterine growth restriction; SGA: small for gestational age; Cd: cadmium; Hg: mercury. Kruskal-Wallis and Mann Whitney tests were used. * p<0.05, ***p<0.001.
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