Arsenicosis status and urinary malondialdehyde (MDA) in people exposed to arsenic contaminated-coal in China

Arsenic exposure and oxidative damage to lipid, DNA, and protein among general Chinese adults: A repeated-measures cross-sectional and longitudinal study

Arsenic-related oxidative stress and resultant diseases have attracted global concern, while longitudinal studies are scarce. To assess the relationship between arsenic exposure and systemic oxidative damage, we performed two repeated measures among 5236 observations (4067 participants) in the Wuhan-Zhuhai cohort at the baseline and follow-up after 3 years. Urinary total arsenic, biomarkers of DNA oxidative damage (8-hydroxy-2'-deoxyguanosine (8-OHdG)), lipid peroxidation (8-isoprostaglandin F2alpha (8-isoPGF2α)), and protein oxidative damage (protein carbonyls (PCO)) were detected for all observations. Here we used linear mixed models to estimate the cross-sectional and longitudinal associations between arsenic exposure and oxidative damage. Exposure-response curves were constructed by utilizing the generalized additive mixed models with thin plate regressions. After adjusting for potential confounders, arsenic level was significantly and positively related to the levels of global oxidative damage and their annual increased rates in dose-response manners. In cross-sectional analyses, each 1% increase in arsenic level was associated with a 0.406% (95% confidence interval (CI): 0.379% to 0.433%), 0.360% (0.301% to 0.420%), and 0.079% (0.055% to 0.103%) increase in 8-isoPGF2α, 8-OHdG, and PCO, respectively. More importantly, arsenic was further found to be associated with increased annual change rates of 8-isoPGF2α (β: 0.147; 95% CI: 0.130 to 0.164), 8-OHdG (0.155; 0.118 to 0.192), and PCO (0.050; 0.035 to 0.064) in the longitudinal analyses. Our study suggested that arsenic exposure was not only positively related with global oxidative damage to lipid, DNA, and protein in cross-sectional analyses, but also associated with annual increased rates of these biomarkers in dose-dependent manners.

Assessment of per- and poly-fluoroalkyl substances and physiological biomarkers in aquarium-based bottlenose dolphins and killer whales

Environmental concerns about per- and polyfluoroalkyl substances (PFAS) are considerably increasing due to their extensive use in commercial and consumer products. PFAS bioaccumulate and biomagnify throughout the food chain, and their toxicity and potential adverse health effects can potentially represent a threat to living organisms. In this study, we described PFAS profiles in the serum of two species of zoo-based bottlenose dolphins (Tursiops truncatus, n = 14 individuals) and killer whales (Orcinus orca, n = 14 individuals) from three locations (California, Florida, and Texas, USA), from 1994 to 2020. Potential physiological effects of PFAS were also explored by measuring different biomarkers (cortisol, corticosterone, aldosterone, TBARS, and hydrogen peroxide) while accounting for individual age, sex, and reproductive stage. All PFAS were detected in at least one of the individuals, considering both species. ΣPFAS reached 496 ng mL-1 in bottlenose dolphins and 230 ng mL-1 in killer whales. In both species, the PFAS with higher mean concentrations were PFOS (108.0-183.0 ng ml-1) and PFNA (14.40-85.50 ng ml-1), which are long-chain compounds. Newborn individuals of both species were also exposed to PFAS, indicating transference via placenta and lactation. Linear mixed model analyses indicated significant correlations between aldosterone, month, year, location, and status; and between hydrogen peroxide, month, year, age, status, ΣPFAS, and Σ short-chain PFAS in killer whales suggesting seasonal variations related to the animal's physiological state (e.g., reproductive cycles, stress responses, weaning events) and increased reactive oxygen species formation due to PFAS exposure. Given our results, other contaminant classes should be investigated in cetaceans as they might have additive and synergistic detrimental effects on these individuals. This study lays the foundation to guide future researchers and highlights the importance of such assessments for animal welfare, and species conservation. Our results may inform management decisions regarding regulations of contaminant thresholds in delphinids.

Assessment of Phthalate Esters and Physiological Biomarkers in Bottlenose Dolphins (Tursiops truncatus) and Killer Whales (Orcinus orca)

There is growing concern about the potential adverse health effects of phthalates (PAEs) on human health and the environment due to their extensive use as plasticizers and additives in commercial and consumer products. In this study, we assessed PAE concentrations in serum samples from aquarium-based delphinids (Tursiops truncatus, n = 36; Orcinus orca, n = 42) from California, Florida, and Texas, USA. To better understand the physiological effects of phthalates on delphinids, we also explored potential correlations between phthalates and the biomarkers aldosterone, cortisol, corticosterone, hydrogen peroxide, and malondialdehyde while accounting for sex, age, and reproductive stage. All PAEs were detected in at least one of the individuals. ΣPAE ranges were 5.995-2743 ng·mL-1 in bottlenose dolphins and 5.372-88,675 ng·mL-1 in killer whales. Both species displayed higher mean concentrations of DEP and DEHP. PAEs were detected in newborn delphinids, indicating transference via placenta and/or lactation. Linear mixed model results indicated significant correlations between aldosterone, month, location, status, and ΣPAEs in killer whales, suggesting that aldosterone concentrations are likely affected by the cumulative effects of these variables. This study expands on the knowledge of delphinid physiological responses to PAEs and may influence management and conservation decisions on contamination discharge regulations near these species.

Arsenic exposure incurs hyperglycemia mediated by oxidative damage in urban adult population: A prospective cohort study with three repeated measures

The associations and potential mechanisms of low to moderate arsenic exposure with fasting plasma glucose (FPG) and type 2 diabetes mellitus (T2DM) are still unclear. To assess the effects of short-term and long-term arsenic exposure on hyperglycemia and the mediating effect of oxidative damage on such association, three repeated-measures studies with 9938 observations were conducted in the Wuhan-Zhuhai cohort. The levels of urinary total arsenic, FPG, urinary 8-iso-prostaglandin F2alpha (8-iso-PGF2α), urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), and plasma protein carbonyls (PCO) were measured. Generalized linear mixed models were used to evaluate the exposure-response relationships of urinary total arsenic with FPG and the prevalent risks of impaired fasting glucose (IFG), T2DM, and abnormal glucose regulation (AGR). Cox regression models were applied to assess the associations of arsenic exposure with incident risks of IFG, T2DM, and AGR. Mediation analyses were performed to assess the mediating effects of 8-iso-PGF2α, 8-OHdG, and PCO. In cross-sectional analyses, each one-unit increase in natural log-transformed urinary total arsenic was associated with a 0.082 (95% CI: 0.047 to 0.118) mmol/L increase in FPG, as well as a 10.3% (95% CI: 1.4%-20.0%), 4.4% (95% CI: 5.3%-15.2%), and 8.7% (95% CI: 1.2%-16.6%) increase in prevalent risks of IFG, T2DM, and AGR, respectively. In longitudinal analyses, arsenic exposure was further associated with the annual increased rate of FPG with a β (95% CI) of 0.021 (95% CI: 0.010 to 0.033). The incident risks of IFG, T2DM, and AGR were increased without statistical significance when arsenic levels increased. Mediation analyses showed that 8-iso-PGF2α and PCO mediated 30.04% and 10.02% of the urinary total arsenic-associated FPG elevation, respectively. Our study indicated that arsenic exposure was associated with elevated level and progression rate of FPG among general Chinese adults, where lipid peroxidation and oxidative protein damage might be the potential mechanisms.

Urinary Malondialdehyde (MDA) Concentrations in the General Population—A Systematic Literature Review and Meta-Analysis

Oxidative stress has been associated with various inflammation-related human diseases. It is defined as an imbalance between the production and elimination of reactive oxygen species (ROS). ROS can oxidize proteins, lipids, and DNA, and some of these oxidized products are excreted in urine, such as malondialdehyde (MDA), which is considered a biomarker for oxidative damage of lipids. To interpret changes of this biomarker as a measure of oxidative species overproduction in humans, a background range for urinary MDA concentration in the general population is needed. We sought to establish urinary MDA concentration ranges for healthy adult populations based on reported values in the available scientific literature. We conducted a systematic review and meta-analysis using the standardized protocol registered in PROSPERO (CRD42020146623). EMBASE, PubMed, Web of Science, and Cochrane library databases were searched from journal inception up to October 2020. We included 35 studies (divided into 47 subgroups for the quantitative analysis). Only studies that measured creatinine-corrected urinary MDA with high-performance liquid chromatography (HPLC) with mass spectrometry (MS), fluorescence detection, or UV photometry were included. The geometric mean (GM) of urinary MDA concentration was 0.10 mg/g creatinine and 95% percentile confidence interval (CI) 0.07–0.12. Age, geographical location but not sex, and smoking status had a significant effect on urinary MDA concentrations. There was a significant increasing trend of urinary MDA concentrations with age. These urinary MDA values should be considered preliminary, as they are based on mostly moderate to some low-quality evidence studies. Although urinary MDA can reliably reflect excessive oxidative stress in a population, the influence of physiological parameters that affect its meaning needs to be addressed as well as harmonizing the chemical analytical methods.

Resveratrol Attenuates Learning, Memory, and Social Interaction Impairments in Rats Exposed to Arsenic

Arsenic (As) toxicity has deleterious effects on human health causing disorder in the brain. The aim of this study was to investigate the possible neuroprotective effect of resveratrol (RSV) on arsenic-induced neurotoxicity in rats. Neurotoxicity in rats was developed by treating As 10 mg/kg/day for 21 days orally. Animals were put into seven groups: control, vehicle, As, As+RSV10, As+RSV20 mg/kg, RSV10, and RSV20 mg/kg. Behavioral assessments such as the social interaction test, novel object recognition test, elevated plus maze, open field, the Morris water maze, in addition to assessment of biomarkers such as ferric reducing ability of plasma assay, glutathione assay, and malondialdehyde assay, were used to evaluate the effects of RSV on cognitive impairment and molecular changes induced by As. The results showed that cognitive performance impaired in As rats. RSV20 mg/kg significantly could ameliorate behavioral changes like spatial learning in days 3 and 4 (p < 0.05), recognition learning and memory (p < 0.01), disabilities in motor coordination and stress (p < 0.05), increased anxiety (p < 0.05), and social interaction deficit (sociability (p < 0.001) and social memory (p < 0.05)). RSV20 mg/kg also attenuated molecular modifications like decreased antioxidant power (p < 0.001), reduced glutathione content (p < 0.05), and increased malondialdehyde level (p < 0.05) induced by As. In addition to oxidative stress assessments, RSV10 mg/kg could significantly increase FRAP (p < 0.01) and GSH (p < 0.05); however, MDA was not significantly increased. Our current behavioral findings suggest that RSV has neuroprotective effects against AS toxicity.

Association of low blood arsenic exposure with level of malondialdehyde among Chinese adults aged 65 and older

High environmental arsenic exposure can increase chronic oxidative stress in experimental studies and in occupational epidemiology studies. Many regulatory agencies have put forth arsenic exposure limits, it is still unclear that whether low environmental arsenic exposure was associated with adverse health outcome in general population. This study aimed to explore the association of low blood arsenic with malondialdehyde in community-dwelling older adults. We used a cross-sectional study of 2384 older adult individuals aged ≥65 years (mean age: 85 years) from the Healthy Aging and Biomarkers Cohort Study in 2017. The median blood arsenic level was 1.41 μg/L. High oxidative stress was categorized according to the 95th percentile of MDA levels (7.47 nmol/mL). Restricted cubic spline models showed that blood arsenic levels were positively associated with malondialdehyde levels (P < 0.01); and the risk of high oxidative stress was no longer significantly increased when blood arsenic level up to 8.74 μg/L. After adjusting for potential confounders, the odds ratios of high oxidative stress for the second, third, and fourth quartiles of blood arsenic were 2.35 (1.11-4.96), 3.87 (1.90-7.91), and 4.18 (2.00-8.72) (P_trend < 0.01), compared with the first quartile. We concluded that even low arsenic exposure was associated with higher risk of oxidative stress, in a nonlinear dose-response.

Ginkgo biloba extract attenuates the disruption of pro-and anti-inflammatory T-cell balance in peripheral blood of arsenicosis patients

Endemic arsenicosis is a public health problem that affects thousands of people worldwide. However, the biological mechanism involved is not well characterized, and there is no specific treatment. Exposure to arsenic may be associated with immune-related problems. In the present work, we performed an investigation to determine whether the Th17/Treg balance was abnormal in peripheral blood mononuclear cells (PBMCs) of patients with arsenicosis caused by burning coal. Furthermore, we investigated the effect of Ginkgo biloba extract (GBE) on the Th17/Treg imbalance in patients with arsenicosis. In this trial, 81 arsenicosis patients and 37 controls were enrolled. The numbers of Th17 and Treg cells, as well as related transcription factors and serum cytokines, were determined at the beginning and end of the study. Patients with arsenicosis exhibited higher levels of Th17 cells, Th17-related cytokines (IL-17A and IL-6), and the transcription factor RORγt. There were lower levels of Treg cells, a Treg-related cytokine (IL-10), and the transcription factor Foxp3 as compared with controls. There was a positive correlation between the levels of Th17 cells and IL-17A and the levels of arsenic in hair. Arsenicosis patients were randomly assigned to a GBE treatment group or a placebo group. After 3 months of follow-up, 74 patients completed the study (39 cases in the GBE group and 35 in the placebo group). Administration of GBE to patient upregulated the numbers of Treg cells and the level of IL-10 and downregulated the numbers of Th17 cells and the levels of cytokines associated with Th17 cells. The mRNA levels of Foxp3 and RORγt were increased and decreased, respectively. These results indicated that exposure to arsenic is associated with immune-related problems. The present investigation describes a previously unknown mechanism showing that an imbalance of pro- and anti-inflammatory T cells is involved in the pathogenesis of arsenicosis and that a GBE exerts effects on arsenicosis through regulation of the pro- and anti-inflammatory T cell balance.

Effect of a Supplementation with Two Quelites on Urinary Excretion of Arsenic in Adolescents Exposed to Water Contaminated with the Metalloid in a Community in the State of Guanajuato, Mexico

Quelites are Mexican wild plants, reported as excellent sources of nutritional compounds such as amino acids (serine, glycine, and cysteine), minerals (Mg, Fe, and Zn), and phytochemicals, as phenolic acids (chlorogenic acid) and flavonoids (phloridzin and naringenin); on the other hand, high biological activity has been shown in these compounds. This work aimed to evaluate the effect of a supplementation with two endemic quelites of Mexico (Chenopodium berlandieri L. and Portulaca Oleracea L.); in addition to supplementation, a nutritional intervention was performed; the biomarkers of hemoglobin (Hb), urinary malondialdehyde (UMDA), and urinary arsenic (UAs) were measured in adolescents exposed to arsenic. A clinical intervention study was conducted in 27 adolescents ages 11 to 12 years for 4 weeks. Weekly anthropometric and dietary evaluations were carried out, as well as the concentration of Hb; the UMDA and UAs were performed by plate-based colorimetric measurement and atomic absorption spectrophotometry with the hydrides generation system, respectively. The results showed that UMDA concentrations had a significant improvement in the supplemented group (SG) vs. control group (CG) (SG = 1.59 ± 0.89 µM/g creatinine vs. CG = 2.90 ± 0.56 µM/g creatinine) in the second week of intervention; on the other hand, the supplemented group showed an increase in Hb levels (15.12 ± 0.99 g/dL) in the same week; finally after the second week, an increase in UAs levels was observed significantly compared to the baseline value (Baseline: 56.85; Week 2: 2.02 µg/g creatinine). Therefore, the results show that the mixture of quelites (a rich source of phytochemicals and nutrients) improved hemoglobin and UMDA levels, and urinary arsenic excretion from the second week in the exposed population.

Alterations of arsenic levels in arsenicosis residents and awareness of its risk factors: A population-based 20-year follow-up study in a unique coal-borne arsenicosis County in Guizhou, China

BACKGROUND

Currently, most arsenic (As) studies in populations are concerned with water-borne arsenicosis. However, residents in Xingren County of Guizhou Province, Southwest of China, represent a unique case of arsenicosis which is related to indoor combustion of high As-containing coal. This study aimed to assess the alterations of As levels and its risk factors in coal-borne arsenicosis residents during the past 20 years.

METHODS

Four follow-up investigations in Xingren County were selected from the year 1998 to 2017, a total of 245, 272, 584, and 309 residents were involved in the four investigations, respectively. Local external environmental medium (coal, soil, water, air, rice, corn and chili peppers) and biological samples (urine, hair) were collected at each time of investigation for total As analysis. Sociodemographics and lifestyles variables were extracted from the questionnaire investigation. Both univariate and multivariate unconditional logistic regression models were performed to analyze the variation of risk factors for coal-borne arsenicosis.

RESULTS

A substantial reduction of total As levels was observed both in external environmental medium and biological samples in the unique coal-borne arsenicosis region, especially since the year 2006. In addition, age, duration of consuming high As-containing coal and smoking status were found to be the most significant risk factors for coal-borne arsenicosis during the past 20 years by both two different logistic regression models. Room ventilation and grain drying modes were no longer to be risk factors since 1998 survey. Annual household income had always been an important protective factor for coal-borne arsenicosis in recent 20 years by both two different logistic regression models. Grain storage modes had become significant protective factor in 2014 and 2017 survey. A certain correlation between sex, education and coal-borne arsenicosis was observed by univariate logistic regression model but no clear links were found by multivariate logistic regression model.

CONCLUSIONS

Considerable efforts to blocking As exposure from burning coal and As contaminated foods in this region are observed over the study period. Further practical health education programs may need to target individuals with long-term of As exposure, lower socioeconomic status and smoking in order to better prevent and control the occurrence and development of coal-borne arsenicosis.

Assessing the bioavailability and bioaccessibility of metals and metalloids

Bioavailability (BA) determines the potential harm of a contaminant that exerts on the receptor. However, environmental guidelines for site contamination assessment are often set assuming the contaminant is 100 % bioavailable. This conservative approach to assessing site risk may result in the unnecessary and expensive remediation of a contaminated site. The National Environmental Protection Measures in Australia has undergone a statutory 5-year review that recommended that contaminant bioavailability and bioaccessibility (BAC) measures be adopted as part of the contaminated site risk assessment process by the National Environment Protection Council. We undertook a critical review of the current bioavailability and bioaccessibility approaches, methods and their respective limitations. The 'gold' standard to estimate the portion of a contaminant that reaches the system circulatory system (BA) of its receptor is to determine BA in an in vivo system. Various animal models have been utilised for this purpose. Because of animal ethics issues, and the expenses associated with performing in vivo studies, several in vitro methods have been developed to determine BAC as a surrogate model for the estimation of BA. However, few in vitro BAC studies have been calibrated against a reliable animal model, such as immature swine. In this review, we have identified suitable methods for assessing arsenic and lead BAC and proposed a decision tree for the determination of contaminant bioavailability and bioaccessibility for health risk assessment.

Biomarkers for the evaluation of population health status 16 years after the intervention of arsenic-contaminated groundwater in Xinjiang, China

The arsenicosis endemic area in the region of Kuitun and Chepaizi, Dzungaria district, Xinjiang, People Republic of China was the first identified arsenic endemic area in China where arsenic concentration of up to 850 μg/L in the groundwater was reported. An intervention was put in place in 1985 by government to provide an alternative water source at a centralized community level. Sixteen years on since the intervention, we evaluated the health status of 178 villagers from endemic and 179 villagers from control sites. Biomarkers in their urine, included arsenic, porphyrins and malondialdehyde (MDA) were measured and the prevalence of skin lesions was also assessed. The average urinary arsenic (117 ± 8.3 μg/g of creatinine) from the endemic-villages was significantly higher (p<0.001) than that of the controls (73.6 ± 3.2 μg/g of creatinine) while no significant difference was found in urinary porphyrins and malondialdehyde concentrations in the overall studies subjects from these two areas. However when the urinary arsenic was higher than 150 μg/g of creatinine, MDA and porphyrins were higher in the endemic-villagers compared to the controls. Fifty-one out of 178 people from the arsenic endemic area showed skin lesions related to arsenicosis but these were absent among villagers from the control site. Of particular concern, skin lesions related to arsenicosis were observed in 4 out of 9 subjects 16 years of age or younger who were from different villages and born after the completion of water intervention. Although sporadic exposure and/or voluntary drinking contaminated water were thought to be a contributor of arsenicosis after the water intervention, the contribution from other dietary arsenic intakes remain unclear.

Arsenic exposure and oral cavity lesions in Bangladesh

OBJECTIVE

To evaluate the relationship between arsenic exposure and oral cavity lesions among an arsenic-exposed population in Bangladesh.

METHODS

We carried out an analysis utilizing the baseline data of the Health Effects of Arsenic Exposure Longitudinal Study, which is an ongoing population-based cohort study to investigate health outcomes associated with arsenic exposure via drinking water in Araihazar, Bangladesh. We used multinomial regression models to estimate the risk of oral cavity lesions.

RESULTS

Participants with high urinary arsenic levels (286.1 to 5000.0 μg/g) were more likely to develop arsenical lesions of the gums (multinomial odds ratio = 2.90; 95% confidence interval, 1.11 to 7.54), and tongue (multinomial odds ratio = 2.79; 95% confidence interval, 1.51 to 5.15), compared with those with urinary arsenic levels of 7.0 to 134.0 μg/g.

CONCLUSIONS

Higher level of arsenic exposure was positively associated with increased arsenical lesions of the gums and tongue.

Medical geology of arsenic, selenium and thallium in China

Arsenic (As), selenium (Se) and thallium (Tl) are three trace metals (metalloids) of high concern in China because deficiency or excess expose can cause a range of endemic diseases, such as endemic arsenism, selenosis, Keshan disease (KD), Kashin-Beck disease (KBD) and thallotoxicosis. These specific endemic diseases were attributable for overabundance or deficiency (mainly referring to selenium) of these three elements in the local environment as a result of natural geochemical processes and/or anthropologic activities. The geochemistry and human health impacts of these three trace elements have been intensively studied since the 1970s in China, in terms of geochemical sources, distribution, transportation, health impact pathways, and prevention/remediation measures. Endemic arsenism in China are induced from the exposures of high As in either drinking water or domestic combustion of As-rich coals. Both endemic selenium deficiency and selenosis occurred in China. The KD and KBD were related to the deficiency of Se in the low-Se geological belt with Se contents in soil less than 0.125mg/kg stretching from northeast to southwest of China. Endemic selenosis occurred in areas with high Se concentrations in soils derived from the Se-enriched black carbonaceous siliceous rocks, carbonaceous shale and slate. Endemic Tl poisoning occurred in southwestern China due to Tl contamination in local drinking water and vegetables surrounding the Tl-rich sulfide mineralized areas. Some measures have been taken to control and remedy the endemic diseases with significant effects in reducing health risk and damage of As, Se and Tl. However, the states of the endemic diseases of As, Se and Tl in China are still serious in some areas, and substantial research efforts regarding the health impacts of these elements are further required. This paper reviews the progress of medical geology of As, Se and Tl in China, and provides with some outlooks for future research directions.

Effects of repeated seafood consumption on urinary excretion of arsenic species by volunteers

Arsenic (As) is a known human carcinogen and widely distributed in the environment. The main route of As exposure in the general population is through food and drinking water. Seafood harvested in Korea contains high-level organoarsenics such as arsenobetaine, arsenocholine, and arsenosugars, which are much less harmful than inorganic arsenics. However, for those who eat large amounts of seafood it is important to understand whether seafood consumption affects urinary levels of inorganic As metabolites such as arsenite, arsenate, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA). In this study we investigated urinary As metabolites (inorganic As, MMA[V], DMA[V]) and some biological indexes such as AST, GSH, GPX, lipid peroxidation, and uric acid in volunteer study subjects (seven males and nine females). Total urinary As metabolites were analyzed by the hydride generation method, followed by arsenic speciation using HPLC with ICP-mass spectrometry. Study subjects refrained from eating seafood for 3 days prior to the first urine collection and then ingested seafood daily for 6 consecutive days. The first voided urine of the morning was collected from each subject the first day of the consecutive 6 days of seafood ingestion but prior to the first seafood meal. The first voided urine of the morning was also collected on days 1, 2, 3, 4, 5, 6, 7, 10, and 14 after seafood ingestion. The daily mean intake of total As was 6.98 mg, comprised of 4.71 mg of seaweed (67%), 1.74 mg of flat fish (25%), and 0.53 mg of conch (8%). We observed a substantial increase in total urinary As metabolites for subjects consuming seafood from day 1, which recovered to control level at day 10. The increase in total urinary As metabolites was attributed to the increase in DMA, which is a more harmful metabolite than organoarsenics. However, no significant changes in response biological indexes were observed. These results suggest that it is necessary to evaluate As metabolism when assessing the exposure to inorganic As and potential chronic health effects of seafood consumption in Korea.

Effects of arsenic on maternal and fetal health

Arsenic, which is commonly found in drinking water, is a potent toxicant, but little is known about its effects on maternal health. Arsenic's modes of action include enzyme inhibition and oxidative stress as well as immune, endocrine, and epigenetic effects. A couple of studies reported increased blood pressure and anemia during pregnancy. Susceptibility to arsenic is dependent on the biomethylation, which occurs via one-carbon metabolism. Methylarsonic acid and dimethylarsinic acid are main metabolites in urine, and elevated methylarsonic acid is considered a general risk factor. Arsenic easily passes the placenta, and a few human studies indicate a moderately increased risk of impaired fetal growth and increased fetal and infant mortality. The fetus and infant are probably partly protected by the increased methylation of arsenic during pregnancy and lactation; the infant is also protected by low arsenic excretion in breast milk. Early-life exposure may induce changes that will become apparent much later in life.