Hospital centered surveillance of births in Gaza, Palestine, 2011-2017 and heavy metal contamination of the mothers reveals long-term impact of wars

Pregnancy in Times of War: What Are the Fallouts? A Review

BACKGROUND

The beginning of the conflict in Ukraine has reminded Europeans of the many and diverse consequences of armed conflicts. Indeed, the ever more sophisticated conflicts have led to the diffusion of numerous chemicals whose consequences spread even after the end of the war. We present through this paper a review of the consequences of pregnancies from the major conflicts that took place since the end of World War II.

SUMMARY

MEDLINE, Web of Science, and Embase were screened for articles linking perinatal death (PD) or birth defects (BD) to wartime. A total of 50 papers treating 8 countries and 4 major and medically documented conflicts were included in the final analysis. An increase in BD and PD during and after the end of the conflicts was reported through all the conflicts analyzed.

KEY MESSAGE

While more data are needed to conclude, maternal-fetal medicine specialists ought to be wary when dealing with exposed populations.

Mercury Dynamics in the Sea of Azov: Insights from a Mass Balance Model

The Sea of Azov, an inland shelf sea bounding Ukraine and Russia, experiences the effects of ongoing and legacy pollution. One of the main contaminants of concern is the heavy metal mercury (Hg), which is emitted from the regional coal industry, former Hg refineries, and the historic use of mercury-containing pesticides. The aquatic biome acts both as a major sink and source in this cycle, thus meriting an examination of its environmental fate. This study collated existing Hg data for the SoA and the adjacent region to estimate current Hg influxes and cycling in the ecosystem. The mercury-specific model "Hg Environmental Ratios Multimedia Ecosystem Sources" (HERMES), originally developed for Canadian freshwater lakes, was used to estimate anthropogenic emissions to the sea and regional atmospheric Hg concentrations. The computed water and sediment concentrations (6.8 ng/L and 55.7 ng/g dw, respectively) approximate the reported literature values. The ongoing military conflict will increase environmental pollution in the region, thus further intensifying the existing (legacy) anthropogenic pressures. The results of this study provide a first insight into the environmental Hg cycle of the Sea of Azov ecosystem and underline the need for further emission control and remediation efforts to safeguard environmental quality.

Health effects of exposure to urban ambient particulate matter: A spatial-statistical study on 3rd-trimester pregnant women

Pregnant women are highly vulnerable to environmental stressors such as ambient particulate matter (PM). Particularly during their 3rd trimester, their bodies undergo significant oxidative stresses. To further consolidate this dialogue into practice, the current study evaluated healthy pregnant women (n = 150 housewives; 18-40 years old; gestation age >36 weeks) from the highly polluted city of Yazd, Iran, from September to November 2021. The aerosol optical depth (AOD) data retrieved from the Moderate Resolution Imaging Spectroradiometer (MODIS) were employed as influencing variables and validated using field-collected PM10 data (r = 0.62, p-value <0.01). The links between blood platelet count, enzymes (SGOT, SGPT, LDH, bilirubin), metabolic products (urea and acid uric) and different combinations of AOD data were assessed using the Generalized Additive Model. The results showed a high temporal variability in AOD (0.94 ± 0.51) but a spatially stable distribution pattern. The mean AOD during the 3rd trimester, followed by that of the three-month peak, were identified as the most significant non-linear predictors, while the mean AOD during the 1st trimester and throughout the entire pregnancy showed no significant associations with any of the biomarkers. Considering the associations found between AOD variables and maternal oxidative stresses, urgent planning is required to improve the urban air quality for sensitive subpopulations.

Heavy metals and trace elements in maternal blood and prevalence of congenital limb abnormalities among newborns: the Japan Environment and Children's Study

BACKGROUND

Heavy metals such as lead (Pb) and cadmium (Cd) have been associated with adverse pregnancy and developmental outcomes, including congenital abnormalities. This study investigated the association between exposure to heavy metals and trace elements during fetal life and congenital limb abnormalities in infants.

METHODS

This study is based on a prospective ongoing nationwide birth cohort from the Japan Environment and Children's Study (JECS). The concentrations of Cd, Pb, mercury (Hg), selenium (Se), and manganese (Mn) were measured in maternal blood collected during the mid-late trimesters. Inclusion criteria were available from questionnaires filled in during pregnancy, including information about congenital limb abnormalities at birth or at one month. To examine the associations with limb anomalies and individual chemicals, logistic regression models were applied following log-transformation or division into quartiles of Cd, Pb, Hg, Se, and Mn concentrations. To assess the associations with the heavy metals and trace elements mixture, quantile g-computation was employed. All models were adjusted for age, maternal smoking history, maternal alcohol intake, history of smoking, and infant sex.

RESULTS

Data from 90,163 participants were included in the analysis, of whom 369 had congenital limb abnormalities in any of the collected information, and 89,794 had none. Among the 369 cases of congenital limb abnormalities, there were 185 and 142 cases of polydactyly and syndactyly, respectively. The median concentrations of Pb, Cd, Hg, Se, and Mn were 5.85, 0.66, 3.64, 168, and 15.3 ng/g, respectively. There were no associations between maternal blood concentrations of Pb [adjusted odd ratio = 0.83; 95% confidence interval = 0.61, 1.11], Cd [0.87; 0.68, 1.10], Hg [0.88; 0.73, 1.07], Se [1.07; 0.44, 2.59], and Mn [0.91; 0.64, 1.30] with congenital limb abnormalities. No significant association was observed between the mixture of heavy metals and trace elements [0.85; 0.72, 1.02] and any congenital limb abnormalities. Moreover, there was no association with all polydactylies and all syndactylies, or any type of abnormality as a subdivision.

CONCLUSION

At the maternal exposure levels of Cd, Pb, Hg, Se, and Mn assessed in the present study, no association was identified with the risk of developing congenital limb abnormalities in children.

Analysis of the nutritional status in the Palestinian territory: a review study

Background

Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023.

Method

Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency.

Results

Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children.

Conclusion

This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.

Emerging disposal technologies of harmful phytoextraction biomass (HPB) containing heavy metals: A review

Phytoextraction is an effective approach for remediation of heavy metal (HM) contaminated soil. After the enhancement of phytoextraction efficiency has been systematically investigated and illustrated, the harmless disposal and value-added use of harmful phytoextraction biomass (HPB) become the major issue to be addressed. Therefore, in recent years, a large number of studies have focused on the disposal technologies for HPB, such as composting, enzyme hydrolysis, hydrothermal conversion, phyto-mining, and pyrolysis. The present review introduces their operation process, reaction parameters, economic/ecological advantages, and especially the migration and transformation behavior of HMs/biomass. Since plenty of plants possess comparable extraction abilities for HMs but with discrepancy constitution of biomass, the phytoextraction process should be combined with the disposal of HPB after harvested in the future, and thus a grading handling strategy for HPB is also presented. Hence, this review is significative for disposing of HPB and popularizing phytoextraction technologies.

Environmental and health hazards of military metal pollution

An increasing body of literature has demonstrated that armed conflicts and military activity may contribute to environmental pollution with metals, although the existing data are inconsistent. Therefore, in this paper, we discuss potential sources of military-related metal emissions, environmental metal contamination, as well as routes of metal exposure and their health hazards in relation to military activities. Emission of metals into the environment upon military activity occurs from weapon residues containing high levels of particles containing lead (Pb; leaded ammunition), copper (Cu; unleaded), and depleted uranium (DU). As a consequence, military activity results in soil contamination with Pb and Cu, as well as other metals including Cd, Sb, Cr, Ni, Zn, with subsequent metal translocation to water, thus increasing the risk of human exposure. Biomonitoring studies have demonstrated increased accumulation of metals in plants, invertebrates, and vertebrate species (fish, birds, mammals). Correspondingly, military activity is associated with human metal exposure that results from inhalation or ingestion of released particles, as well as injuries with subsequent metal release from embedded fragments. It is also notable that local metal accumulation following military injury may occur even without detectable fragments. Nonetheless, data on health effects of military-related metal exposures have yet to be systematized. The existing data demonstrate adverse neurological, cardiovascular, and reproductive outcomes in exposed military personnel. Moreover, military-related metal exposures also result in adverse neurodevelopmental outcome in children living within adulterated territories. Experimental in vivo and in vitro studies also demonstrated toxic effects of specific metals as well as widely used metal alloys, although laboratory data report much wider spectrum of adverse effects as compared to epidemiological studies. Therefore, further epidemiological, biomonitoring and laboratory studies are required to better characterize military-related metal exposures and their underlying mechanisms of their adverse toxic effects.

(Ascorb)ing Pb Neurotoxicity in the Developing Brain

Lead (Pb) neurotoxicity is a major concern, particularly in children. Developmental exposure to Pb can alter neurodevelopmental trajectory and has permanent neuropathological consequences, including an increased vulnerability to further stressors. Ascorbic acid is among most researched antioxidant nutrients and has a special role in maintaining redox homeostasis in physiological and physio-pathological brain states. Furthermore, because of its capacity to chelate metal ions, ascorbic acid may particularly serve as a potent therapeutic agent in Pb poisoning. The present review first discusses the major consequences of Pb exposure in children and then proceeds to present evidence from human and animal studies for ascorbic acid as an efficient ameliorative supplemental nutrient in Pb poisoning, with a particular focus on developmental Pb neurotoxicity. In doing so, it is hoped that there is a revitalization for further research on understanding the brain functions of this essential, safe, and readily available vitamin in physiological states, as well to justify and establish it as an effective neuroprotective and modulatory factor in the pathologies of the nervous system, including developmental neuropathologies.

It Takes Time to Unravel the Ecology of War in Gaza, Palestine: Long-Term Changes in Maternal, Newborn and Toddlers' Heavy Metal Loads, and Infant and Toddler Developmental Milestones in the Aftermath of the 2014 Military Attacks

Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers’ and infants’ heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants’ and toddlers’ growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018–2019. In the 2015 cohort, mothers’ hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk.

Long Term Risks to Neonatal Health from Exposure to War-9 Years Long Survey of Reproductive Health and Contamination by Weapon-Delivered Heavy Metals in Gaza, Palestine

Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars and are the suspected long term effects of contamination by stable war remnants. Although potentially affecting millions of people, this is still an understudied issue of public health. Background: Gaza, Palestine since 2006 has been an object of repeated severe military attacks that left heavy metals remnants in the environment, in wound tissues and that were assumed by the population. Retrospective studies showed a progressive increase in birth defects since the 2006 attacks. In 2011 we started surveillance at birth alongside analysis of the heavy metals load carried by pregnant women and their babies. Methods: We used protocols for birth registration which also document the extent of exposures to attacks, war remnants and to other environmental risks that allow comparison of 3 data sets-2011, 2016 and 2018-2019 (4000-6000 women in each set). By ICP/MS analysis we determined the content of 23 metals in mothers' hair. Appropriate statistical analysis was performed. Results: Comparison of data in birth registers showed a major increase in the prevalence in birth defects and preterm babies between 2011 and 2016, respectively from 1.1 to 1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to 2019 were associated with exposure of the mothers to the attacks in 2014 and/or to hot spots of heavy metals contamination. Metal loads since the attacks in 2014 were consistently high until 2018-2019 for barium, arsenic, cobalt, cadmium, chrome, vanadium and uranium, pointing to these metals as potential inducers for the increased prevalence of negative health outcomes at birth since 2016. Conclusions: Bodily accumulation of metals following exposure whilst residing in attacked buildings predispose women to negative birth outcomes. We do not know if the metals act in synergy. Trial for mitigation of the documented negative effects of high metal load on reproductive health, and ensuing perinatal deaths, could now be done in Gaza, based on this documentary record. High load of heavy metals may explain recent increases in non-communicable diseases and cancers at all ages in Gaza. Modern war's legacy of diseases and deaths extends in time to populations and demands monitoring.

External interference from ambient air pollution on using hair metal(loid)s for biomarker-based exposure assessment

Hair metal(loid)s are often measured as biomarkers to evaluate population internal exposure, however, hair samples could be easily contaminated by ambient particulate matter (PM) pollution. Here, we evaluated the potential external interference from ambient PM pollution on using hair metal(loid)s for population biomarker-based exposure assessment. The raw hair samples were strictly washed and placed under various indoor and outdoor scenarios for ~6 months at sites with high PM pollution. The contaminated hair was then washed using the same method. A total of 33 hair elements were quantified by inductively coupled plasma-mass spectrometry. The surface residual PM on hair after washing was observed by scanning electron microscopy. In addition, we chose a practical exposure scenario including 77 housewives in Shanxi Province, China for validation. The results for the hair exposure experiment revealed that external contamination of some elements that had relatively high concentrations in hair was generally mild in both indoor and outdoor exposure scenarios (i.e., Zn, Mg, Se, Fe, Sr, Ti, Mn, Sn, Ge, U, Co, Mo, and As). A relatively higher external contamination of other elements (e.g., Al, Cr, Pb, Cd, Li, and most rare earth elements (REEs)) was observed, especially for those elements with relatively low hair concentrations (e.g., Cd, and REEs) in the outdoor environment. This finding was due mainly to some small ambient PM not being fully removed by the current washing strategy when the hair sample was heavily contaminated. However, results from practical exposure scenario of the housewives showed that there were overall no significant differences of hair metal(loid)s between the housewives using coal and clean energy for cooking. We concluded that the external interference on hair internal metal(loid) analysis could be negligible when hair was efficiently washed, especially for population with relatively longer indoor activities. It is therefore promising to use hair analysis for their population exposure assessment.

Meconium identifies high levels of metals in newborns from a mining community in the U.S

BACKGROUND

This pilot study was conducted to determine if we could identify intrauterine exposure to metals in meconium, as a measure of exposure for mother-child pairs living in proximity to a mining operation.

OBJECTIVES

We used meconium as a means to measure metal exposure in utero. We set out to quantify the exposure to selected metals that are currently being mined and also are found in the Superfund site in Butte, Montana, and to compare it to that of Columbia, South Carolina, US, where mining is not occurring.

METHODS

This cross-sectional study was conducted between May and November 2018. We received Institutional Review Board approval and we consented women following the birth of their newborns, and collected meconium within 24 h of birth, without any identifiers. Each laboratory used the same protocol for collection, transport, and storage; and the same laboratory protocol was used for the analysis of all samples. Samples were digested using standard acid/peroxide digestion methods and measured by inductively coupled plasma mass spectroscopy.

RESULTS

We collected meconium specimens from 17 infants in Columbia, South Carolina and 15 infants in Butte, Montana. The concentrations found in Columbia were in the low μg kg^-1 range (or less) and were similar to the low levels that have been identified in other studies of meconium. The magnitude of the differences in concentrations found in Butte compared to Columbia was 1792 times higher for Cu, 1650 times higher for Mn, and 1883 times higher for Zn.

CONCLUSION

Using meconium to measure exposure of newborns has implications for risk assessment in a mining-exposed population. This approach was inexpensive and thorough. The magnitude of the differences in the metal levels identified from the two study sites suggests there is an urgent need for further research to learn if there are health consequences to these highly exposed infants.