Prenatal exposure to methylmercury and child development: influence of social factors

Sex difference of pre- and post-natal exposure to six developmental neurotoxicants on intellectual abilities: a systematic review and meta-analysis of human studies

BACKGROUND

Early life exposure to lead, mercury, polychlorinated biphenyls (PCBs), polybromide diphenyl ethers (PBDEs), organophosphate pesticides (OPPs), and phthalates have been associated with lowered IQ in children. In some studies, these neurotoxicants impact males and females differently. We aimed to examine the sex-specific effects of exposure to developmental neurotoxicants on intelligence (IQ) in a systematic review and meta-analysis.

METHOD

We screened abstracts published in PsychINFO and PubMed before December 31st, 2021, for empirical studies of six neurotoxicants (lead, mercury, PCBs, PBDEs, OPPs, and phthalates) that (1) used an individualized biomarker; (2) measured exposure during the prenatal period or before age six; and (3) provided effect estimates on general, nonverbal, and/or verbal IQ by sex. We assessed each study for risk of bias and evaluated the certainty of the evidence using Navigation Guide. We performed separate random effect meta-analyses by sex and timing of exposure with subgroup analyses by neurotoxicant.

RESULTS

Fifty-one studies were included in the systematic review and 20 in the meta-analysis. Prenatal exposure to developmental neurotoxicants was associated with decreased general and nonverbal IQ in males, especially for lead. No significant effects were found for verbal IQ, or postnatal lead exposure and general IQ. Due to the limited number of studies, we were unable to analyze postnatal effects of any of the other neurotoxicants.

CONCLUSION

During fetal development, males may be more vulnerable than females to general and nonverbal intellectual deficits from neurotoxic exposures, especially from lead. More research is needed to examine the nuanced sex-specific effects found for postnatal exposure to toxic chemicals.

Sex-specific neurotoxic effects of heavy metal pollutants: Epidemiological, experimental evidence and candidate mechanisms

The heavy metals lead (Pb), mercury (Hg), and cadmium (Cd) are ubiquitous environmental pollutants and are known to exert severe adverse impacts on the nervous system even at low concentrations. In contrast, the heavy metal manganese (Mn) is first and foremost an essential nutrient, but it becomes neurotoxic at high levels. Neurotoxic metals also include the less prevalent metalloid arsenic (As) which is found in excessive concentrations in drinking water and food sources in many regions of the world. Males and females often differ in how they respond to environmental exposures and adverse effects on their nervous systems are no exception. Here, we review the different types of sex-specific neurotoxic effects, such as cognitive and motor impairments, that have been attributed to Pb, Hg, Mn, Cd, and As exposure throughout the life course in epidemiological as well as in experimental toxicological studies. We also discuss differential vulnerability to these metals such as distinctions in behaviors and occupations across the sexes. Finally, we explore the different mechanisms hypothesized to account for sex-based differential susceptibility including hormonal, genetic, metabolic, anatomical, neurochemical, and epigenetic perturbations. An understanding of the sex-specific effects of environmental heavy metal neurotoxicity can aid in the development of more efficient systematic approaches in risk assessment and better exposure mitigation strategies with regard to sex-linked susceptibilities and vulnerabilities.

Global burden of intellectual disability resulting from prenatal exposure to methylmercury, 2015

We describe analyses to estimate the global burden of disease associated with methylmercury (MeHg). An intelligence quotient < 70, indicating intellectual disability (ID), was selected as the critical disease, maternal hair Hg concentration during pregnancy selected as the critical exposure biomarker, and a dose-effect relationship of an 0.18 point IQ reduction per µg/g increase in maternal hair Hg was assumed, based on a meta-analysis. A systematic review was conducted to obtain country-specific data on the distribution of maternal hair Hg concentrations. The country-specific incidence of MeHg-associated ID was calculated, and a random effects model was used to impute the incidence for countries for which no exposure data could be found. The global burden of MeHg-associated ID was quantified in terms of Disability-Adjusted Life Years (DALYs) using the World Health Organization (WHO) Global Health Estimates methodology, and presented by 14 subregions. In 2015, the global total for MeHg-associated cases of ID was 226,655; 210,074 of these cases (93%) were mild cases of ID. The highest rate of ID (6 cases per 100,000 population) was found in the Americas D subregion. The global DALY estimate was 1,963,869. The Western Pacific B subregion contributed the most to this total (696,417), although the Americas D subregion had the greatest rate (54 DALYs per 100,000 population). The burden of disease associated with MeHg is therefore highly subregion-dependent even in areas that are geographically related. The priority given to reducing this burden can therefore be expected to vary considerably by subregion depending on other health needs.

Neurotoxicants, Micronutrients, and Social Environments

SUMMARY—Systematic research evaluating the separate and interacting impacts of neurotoxicants, micronutrients, and social environments on children's cognition and behavior has only recently been initiated. Years of extensive human epidemiologic and animal experimental research document the deleterious impact of lead and other metals on the nervous system. However, discrepancies among human studies and between animal and human studies underscore the importance of variations in child nutrition as well as social and behavioral aspects of children's environments that mitigate or exacerbate the effects of neurotoxicants.

In this monograph, we review existing research on the impact of neurotoxic metals, nutrients, and social environments and interactions across the three domains. We examine the literature on lead, mercury, manganese, and cadmium in terms of dispersal, epidemiology, experimental animal studies, effects of social environments, and effects of nutrition.

Research documenting the negative impact of lead on cognition and behavior influenced reductions by the Center for Disease Control in child lead-screening guidelines from 30 micrograms per deciliter (μg/dL) in 1975 to 25 μg/dL in 1985 and to 10 μg/dL in 1991. A further reduction is currently being considered. Experimental animal research documents lead's alteration of glutamate-neurotransmitter (particularly N-methyl-D-aspartate) activity vital to learning and memory. In addition, lead induces changes in cholinergic and dopaminergic activity. Elevated lead concentrations in the blood are more common among children living in poverty and there is some evidence that socioeconomic status influences associations between lead and child outcomes. Micronutrients that influence the effects of lead include iron and zinc.

Research documenting the negative impact of mercury on children (as well as adults) has resulted in a reference dose (RfD) of 0.1 microgram per kilogram of body weight per day (μg/kg/day). In animal studies, mercury interferes with glutamatergic, cholinergic, and dopaminergic activity. Although evidence for interactions of mercury with children's social contexts is minimal, researchers are examining interactions of mercury with several nutrients.

Research on the effects of cadmium and manganese on child cognition and behavior is just beginning. Experimental animal research links cadmium to learning deficits, manganese to behaviors characteristic of Parkinson's disease, and both to altered dopaminergic functioning.

We close our review with a discussion of policy implications, and we recommend interdisciplinary research that will enable us to bridge gaps within and across domains.

Country-specific estimates of the incidence of intellectual disability associated with prenatal exposure to methylmercury

This paper describes country-specific estimates of the incidence of intellectual disability in children associated with prenatal exposure to methylmercury. A systematic review was undertaken to identify country-specific data on hair mercury concentrations in women of reproductive age. A variety of approaches were used to estimate biomarker concentrations for countries lacking such data. A dose-effect relationship derived on the basis of the data from three large prospective studies relating prenatal methylmercury exposure to IQ in children was used to estimate the country-specific incidences of mild, moderate, severe, and profound intellectual disability in children as a result of prenatal methylmercury exposure. The incidence of methylmercury-associated mild intellectual disability (IQ scores 50-70) varied nearly 40-fold across countries, with the greatest incidences generally in countries that are islands or that are coastal. Countries with high birth rates and greater consumption of foods that contribute most to methylmercury intake in humans (seafood, rice) can be expected to make the largest contributions to the worldwide burden of disease associated with methylmercury. The assumptions and limitations of the estimates are discussed.

Constructing and Adapting Causal and Formative Measures of Family Settings: The HOME Inventory as Illustration

Measures of the home environment are frequently used in studies of children's development. This review provides information on indices composed of causal and formative indicators (the kind of indicators often used to capture salient aspects of family environments) and to suggest approaches that may be useful in constructing such measures for diverse populations. The HOME Inventory is used to illustrate challenges scholars face in determining what to include in useful measures of family settings. To that end, a cross-cultural review of research on relations among HOME, family context, and child outcomes is presented. The end of the review offers a plan for how best to further research on relations between the home environment and child development for diverse populations.

Effect of low-level prenatal mercury exposure on neonate neurobehavioral development in China

BACKGROUND

This study aimed to assess the effects of low-level prenatal mercury exposure on neonate neurobehavioral development in China.

METHODS

In total, 418 mother-neonate pairs were included in the study. Maternal urine, hair, and blood samples and cord blood samples were used to document prenatal exposure to mercury. The Neonatal Behavioral Neurological Assessment was used to estimate neurobehavioral development in the neonates at 3 days of age.

RESULTS

Total mercury level was significantly higher in cord blood than that in maternal blood. A strong correlation was found between total mercury levels in maternal blood and those in cord blood (r = 0.7431; P < 0.0001). Trend analysis revealed that mothers who consumed more fish had higher blood and cord blood mercury levels (all P < 0.0001). Significant differences were also found between male and female cord blood mercury levels among groups with different fish consumption frequencies (all P < 0.0001). Cord blood mercury level was significantly associated with total Neonatal Behavioral Neurological Assessment scores (β = 0.03; standard error = 0.01; P = 0.0409), passive muscle tone (odds ratio = 1.07; 95% confidence interval = 1.12-1.13; P = 0.0071), and active muscle tone (odds ratio = 1.06; 95% confidence interval = 1.01-1.11; P = 0.0170) scores after adjustment, respectively.

CONCLUSIONS

Neonatal neurodevelopment was associated with prenatal exposure to mercury. Women with high mercury levels should avoid intake seafood excessively during pregnancy. Long-term effects of exposure to mercury on childhood development need to be further explored.

Prenatal exposure to mercury and infant neurodevelopment in a multicenter cohort in Spain: study of potential modifiers

Vulnerability of the central nervous system to mercury is increased during early development. This study aimed to evaluate whether cord blood total mercury levels may have a negative effect on both mental and psychomotor development in a maternal-birth cohort from moderate-high fish consumption areas. Study subjects were 1,683 child participants in the INMA (Environment and Childhood) Project from 4 areas of Spain between 2003 and 2010. Cord blood total mercury levels were analyzed by atomic absorption spectrometry. Infant neurodevelopment was assessed around age 14 months by the Bayley Scales of Infant Development. Sociodemographic, lifestyle, and dietary information was obtained by questionnaire during pregnancy. The geometric mean of total mercury levels was 8.4 μg/L (95% confidence interval (CI): 8.1, 8.7). In multivariate analysis, a doubling in total mercury levels did not show an association with mental (β = 0.1, 95% CI: -0.68, 0.88) or psychomotor (β = -0.05, 95% CI: -0.79, 0.68) developmental delay; however, stratified findings by sex suggest a negative association between prenatal exposure to total mercury and psychomotor development among female infants (β = -1.09, 95% CI: -2.21, 0.03), although follow-up is required to confirm these results.

Postnatal exposure to methyl mercury from fish consumption: a review and new data from the Seychelles Child Development Study

BACKGROUND

Fish is an important source of nutrition worldwide. Fish contain both the neurotoxin methyl mercury (MeHg) and nutrients important for brain development. The developing brain appears to be most sensitive to MeHg toxicity and mothers who consume fish during pregnancy expose their fetus prenatally. Although brain development is most dramatic during fetal life, it continues for years postnatally and additional exposure can occur when a mother breast feeds or the child consumes fish. This raises the possibility that MeHg might influence brain development after birth and thus adversely affect children's developmental outcomes. We reviewed postnatal MeHg exposure and the associations that have been published to determine the issues associated with it and then carried out a series of analyses involving alternative metrics of postnatal MeHg exposure in the Seychelles Child Development Study (SCDS) Main Cohort.

METHODS

The SCDS is a prospective longitudinal evaluation of prenatal MeHg exposure from fish consumption. The Main Cohort includes 779 subjects on whom recent postnatal exposure data were collected at the 6-, 19-, 29-, 66-, and 107-month evaluations. We examined the association of recent postnatal MeHg exposure with multiple 66- and 107-month outcomes and then used three types of alternative postnatal exposure metrics to examine their association with the children's intelligence quotient (IQ) at 107 months of age.

RESULTS

Recent postnatal exposure at 107 months of age was adversely associated with four endpoints, three in females only. One alternative postnatal metric was beneficially associated with 9-year IQ in males only.

CONCLUSIONS

We found several associations between postnatal MeHg biomarkers and children's developmental endpoints. However, as has been the case with prenatal MeHg exposure in the SCDS Main Cohort study, no consistent pattern of associations emerged to support a causal relationship.

Overview of modifiers of methylmercury neurotoxicity: chemicals, nutrients, and the social environment

It has been known for decades that methylmercury is a potent neurotoxicant, and that the developing brain is more susceptible to impairment as a result of methylmercury exposure than is the adult. Exposure to methylmercury is exclusively through consumption of fish and marine mammals. In recent years, the potential for protection against methylmercury toxicity by nutrients present in fish, particularly omega-3 fatty acids and selenium, has been explored in both epidemiological and experimental studies. There is evidence from several studies that fish consumption per se and methylmercury body burden act in opposition with regard to neuropsychological outcomes, whereas the evidence for a protective effect of specific nutrients is contradictory in both epidemiological and experimental studies published to date. The potential for methylmercury to interact with other chemicals present in marine food, particularly PCBs, has been explored in both animal models and human studies. Results may be both exposure- and endpoint-dependent. The Seychelles Islands study has explored the potential for the social environment to modify the effects of developmental methylmercury exposure. An understanding of the interactions of the multiple factors that determine the final behavioral outcome of exposure to methylmercury is crucial to risk assessment and risk management decisions.

Prenatal exposure to mercury and neurobehavioral development of neonates in Zhoushan City, China

Exposure to hazardous Hg can adversely affect children's neurodevelopment. However, few data are available on either Hg levels in neonates and their mothers or the impact of prenatal exposure to Hg on neonates' neurobehavioral development in the Chinese population. Therefore, this study examined Hg levels in neonates and their mothers and the relationship between prenatal exposure to Hg and neonates' neurobehavioral development in Zhoushan City, Zhejiang Province, China. Between August and October 2004, 417 women who delivered their babies at Zhoushan Women's and Children's Health Hospital, an island city in east China were invited to take part in this study. A total of 408 complete questionnaires, 405 maternal hair samples, and 406 umbilical cord samples were collected. Neonatal behavioral neurological assessments (NBNA) were conducted for 384 neonates. The geometric mean (GM) of Hg level in cord blood was 5.58 microg/L (interquartile range: 3.96-7.82 microg/L), and the GM of maternal hair Hg level was 1246.56 microg/kg (interquartile range: 927.34-1684.67 microg/kg), a level much lower than other reported fish-eating populations, indicating Hg exposure in Zhoushan city is generally below those considered hazardous. However, according to the reference dose of Hg levels (RfD 5.8 microg/L) derived by EPA, 69.9% of newborns had levels at or above the RfD, an estimated level assumed to be without appreciable harm. There was a strong correlation between maternal hair and cord blood Hg levels (r = 0.82, P < 0.01). Frequency of fish consumption was associated with hair Hg (r = 0.48, P < 0.01) and cord blood Hg levels (r = 0.54, P < 0.01). Increased prenatal Hg exposure was associated with decreased behavioral ability for males (OR = 1.235, 95%CI of OR = 1.078-1.414, P < 0.001), but not for females. Our results provide some support for the hypothesis that there is neurodevelopmental risk for males from prenatal MeHg exposure resulting from fish consumption. But the findings of this study may be due to chance, and long-term follow-up research is needed to evaluate cumulative effects of exposure to mercury.

Consequences of prenatal toxin exposure for mental health in children and adolescents: a systematic review

Drug use during pregnancy is common and the developing foetus may be exposed to a range of environmental toxins that have long-term consequences for neurodevelopment. We conducted a systematic review of the literature to explore the results of longitudinal cohort studies that have examined this question. Out of 2,977 abstracts identified, 7 previous systematic reviews and 95 original articles met further selection criteria. These mostly addressed the neurodevelopmental effects of exposure to lead, polychlorinated biphenyls, mercury, cocaine, alcohol, marijuana, cigarettes and antidepressants. Radiation, opiates, steroids, amphetamines and caffeine have received much less attention. Findings are difficult to interpret because risk factors tend to cluster together and interact. However, some findings are consistent. Lead and PCB's have a general effect on brain development, whilst marijuana and alcohol appear to have long-term effects specifically on attentional skills. The effects of alcohol increase with maternal age and binge drinking is more important than average intake. The effects of cocaine diminish with age and are largely mediated through psychosocial factors, whilst the relation between smoking and later delinquency is largely mediated by genetically inherited factors. Exposure to toxins during pregnancy may constitute an important but relatively unacknowledged cause of child psychiatric morbidity.

Hershey Medical Center Technical Workshop Report: optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure

Neurodevelopmental disabilities affect 3-8% of the 4 million babies born each year in the U.S. alone, with known etiology for less than 25% of those disabilities. Numerous investigations have sought to determine the role of environmental exposures in the etiology of a variety of human neurodevelopmental disorders (e.g., learning disabilities, attention deficit-hyperactivity disorder, intellectual disabilities) that are manifested in childhood, adolescence, and young adulthood. A comprehensive critical examination and discussion of the various methodologies commonly used in investigations is needed. The Hershey Medical Center Technical Workshop: Optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure provided such a forum for examining these methodologies. The objective of the Workshop was to develop scientific consensus on the key principles and considerations for optimizing the design and interpretation of epidemiologic studies of in utero exposure to environmental chemicals and subsequent neurodevelopmental effects. (The Panel recognized that the nervous system develops post-natally and that critical periods of exposure can span several developmental life stages.) Discussions from the Workshop Panel generated 17 summary points representing key tenets of work in this field. These points stressed the importance of: a well-defined, biologically plausible hypothesis as the foundation of in utero studies for assessing neurodevelopmental outcomes; understanding of the exposure to the environmental chemical(s) of interest, underlying mechanisms of toxicity, and anticipated outcomes; the use of a prospective, longitudinal cohort design that, when possible, runs for periods of 2-5 years, and possibly even longer, in an effort to assess functions at key developmental epochs; measuring potentially confounding variables at regular, fixed time intervals; including measures of specific cognitive and social-emotional domains along with non-cognitive competence in young children, as well as comprehensive measures of health; consistency of research design protocols across studies (i.e., tests, covariates, and analysis styles) in an effort to improve interstudy comparisons; emphasis on design features that minimize introduction of systematic error at all stages of investigation: participant selection, data collection and analysis, and interpretation of results; these would include (but not be limited to) reducing selection bias, using double-blind designs, and avoiding post hoc formulation of hypotheses; a priori data analysis strategies tied to hypotheses and the overall research design, particularly for methods used to characterize and address confounders in any neurodevelopmental study; actual quantitative measurements of exposure, even if indirect, rather than methods based on subject recall; careful examination of standard test batteries to ensure that the battery is tailored to the age group as well as what is known about the specific neurotoxic effects on the developing nervous system; establishment of a system for neurodevelopmental surveillance for tracking the outcomes from in utero exposure across early developmental time periods to determine whether central nervous system injuries may be lying silent until developmentally challenged; ongoing exploration of computerized measures that are culturally and linguistically sensitive, and span the age range from birth into the adolescent years; routine incorporation of narrative in manuscripts concerning the possibility of spurious (i.e., false positive and false negative) test results in all research reportage (this can be facilitated by detailed, transparent reporting of design, covariates, and analyses so that others can attempt to replicate the study); forthright, disciplined, and intellectually honest treatment of the extent to which results of any study are conclusive--that is, how generalizable the results of the study are in terms of the implications for the individual study participants, the community studied, and human health overall; confinement of reporting to the actual research questions, how they were tested, and what the study found, and avoiding, or at least keeping to a minimum, any opinions or speculation concerning public health implications; education of clinicians and policymakers to critically read scientific reports, and to interpret study findings and conclusions appropriately; and recognition by investigators of their ethical duty to report negative as well as positive findings, and the importance of neither minimizing nor exaggerating these findings.