Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis

Jonathan V Lewis¹, Emily A Knapp¹, Shivani Bakre¹, Aisha S Dickerson¹, Theresa M Bastain², Casper Bendixsen³, Deborah H Bennett⁴, Carlos A Camargo⁵, Andrea E Cassidy-Bushrow⁶, Elena Colicino⁷, Viren D'Sa⁸, Dana Dabelea⁹, Sean Deoni¹⁰, Anne L Dunlop¹¹, Amy J Elliott¹², Shohreh F Farzan², Assiamira Ferrara¹³, Rebecca C Fry¹⁴, Tina Hartert¹⁵, Caitlin G Howe¹⁶, Linda G Kahn¹⁷, Margaret R Karagas¹⁶, Teng-Fei Ma¹⁸, Daphne Koinis-Mitchell⁸, Debra MacKenzie¹⁹, Luis E Maldonado², Francheska M Merced-Nieves²⁰, Jenae M Neiderhiser²¹, Anne E Nigra²², Zhongzheng Niu², Sara S Nozadi²³, Zorimar Rivera-Núñez²⁴, Thomas G O'Connor²⁵, Sarah Osmundson²⁶, Amy M Padula²⁷, Alicia K Peterson¹³, Allison R Sherris²⁸, Anne Starling²⁹, Jennifer K Straughen⁶, Rosalind J Wright⁷, Qi Zhao³⁰, Amii M Kress³¹

Affiliations

¹ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
² Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
³ Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA.
⁴ Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA.
⁷ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA.
⁹ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
¹⁰ Bill and Melinda Gates Foundation, Seattle, WA, USA.
¹¹ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
¹² Avera Research Institute, Sioux Falls, SD, USA; Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA.
¹³ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹⁴ Department of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
¹⁵ Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁶ Dartmouth College Geisel School of Medicine, Hanover, NH, USA.
¹⁷ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁸ Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
¹⁹ Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA.
²⁰ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²¹ Department of Psychology, Penn State University, University Park, PA, USA.
²² Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
²³ Community Environmental Health Program, College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA.
²⁴ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA.
²⁵ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
²⁶ Department of OB/GYN, Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁷ Department of Gynecology, Obstetrics and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA.
²⁸ Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
²⁹ Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
³⁰ Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
³¹ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: akress1@jhu.edu.

PMID: 37517496
PMCID: PMC10592196
DOI: 10.1016/j.envres.2023.116772

Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis

Jonathan V Lewis et al. Environ Res. 2023.

. 2023 Nov 1;236(Pt 2):116772.

doi: 10.1016/j.envres.2023.116772. Epub 2023 Jul 28.

Authors

Affiliations

¹ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
² Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
³ Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA.
⁴ Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA.
⁷ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA.
⁹ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
¹⁰ Bill and Melinda Gates Foundation, Seattle, WA, USA.
¹¹ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
¹² Avera Research Institute, Sioux Falls, SD, USA; Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA.
¹³ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹⁴ Department of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
¹⁵ Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁶ Dartmouth College Geisel School of Medicine, Hanover, NH, USA.
¹⁷ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁸ Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
¹⁹ Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA.
²⁰ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²¹ Department of Psychology, Penn State University, University Park, PA, USA.
²² Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
²³ Community Environmental Health Program, College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA.
²⁴ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA.
²⁵ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
²⁶ Department of OB/GYN, Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁷ Department of Gynecology, Obstetrics and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA.
²⁸ Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
²⁹ Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
³⁰ Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
³¹ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: akress1@jhu.edu.

PMID: 37517496
PMCID: PMC10592196
DOI: 10.1016/j.envres.2023.116772

Abstract

Background: Drinking water is a common source of exposure to inorganic arsenic. In the US, the Safe Drinking Water Act (SDWA) was enacted to protect consumers from exposure to contaminants, including arsenic, in public water systems (PWS). The reproductive effects of preconception and prenatal arsenic exposure in regions with low to moderate arsenic concentrations are not well understood.

Objectives: This study examined associations between preconception and prenatal exposure to arsenic violations in water, measured via residence in a county with an arsenic violation in a regulated PWS during pregnancy, and five birth outcomes: birth weight, gestational age at birth, preterm birth, small for gestational age (SGA), and large for gestational age (LGA).

Methods: Data for arsenic violations in PWS, defined as concentrations exceeding 10 parts per billion, were obtained from the Safe Drinking Water Information System. Participants of the Environmental influences on Child Health Outcomes Cohort Study were matched to arsenic violations by time and location based on residential history data. Multivariable, mixed effects regression models were used to assess the relationship between preconception and prenatal exposure to arsenic violations in drinking water and birth outcomes.

Results: Compared to unexposed infants, continuous exposure to arsenic from three months prior to conception through birth was associated with 88.8 g higher mean birth weight (95% CI: 8.2, 169.5), after adjusting for individual-level confounders. No statistically significant associations were observed between any preconception or prenatal violations exposure and gestational age at birth, preterm birth, SGA, or LGA.

Conclusions: Our study did not identify associations between preconception and prenatal arsenic exposure, defined by drinking water exceedances, and adverse birth outcomes. Exposure to arsenic violations in drinking water was associated with higher birth weight. Future studies would benefit from more precise geodata of water system service areas, direct household drinking water measurements, and exposure biomarkers.

Keywords: Arsenic; Contamination; Drinking water; Public water systems; Reproductive health; Water violations.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1:. Number of violating public water systems, serving 500 or more persons, per county, from 2006 to 2022, and ECHO-wide Cohort Study participant’s residential histories.**
Abbreviations: PWS: public water systems.

See this image and copyright information in PMC

References

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1. CDC. (2017, April 7). Arsenic Factsheet. https://www.cdc.gov/biomonitoring/Arsenic_FactSheet.html

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Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis

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Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis

Authors

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Abstract

Conflict of interest statement

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