Perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant women from Greece

Emerging research themes in maternal hypothyroidism: a bibliometric exploration

Background

Hypothyroidism, a prevalent endocrine disorder, carries significant implications for maternal and infant health, especially in the context of maternal hypothyroidism. Despite a gradual surge in recent research, achieving a comprehensive understanding of the current state, focal points, and developmental trends in this field remains challenging. Clarifying these aspects and advancing research could notably enhance maternal-infant health outcomes. Therefore, this study employs bibliometric methods to systematically scrutinize maternal hypothyroidism research, serving as a reference for further investigations.

Objective

Through bibliometric analysis, this study seeks to unveil key research focus areas, developmental trends, and primary contributors in Maternal Hypothyroidism. The findings offer insights and recommendations to inform future research endeavors in this domain.

Methods

Literature metrics analysis was performed on data retrieved and extracted from the Web of Science Core Collection database. The analysis examined the evolution and thematic trends of literature related to Maternal Hypothyroidism. Data were collected on October 28, 2023, and bibliometric analysis was performed using VOSviewer, CiteSpace, and the Bibliometrix software package, considering specific characteristics such as publication year, country/region, institution, authorship, journals, references, and keywords.

Results

Retrieved from 1,078 journals, 4,184 articles were authored by 18,037 contributors in 4,580 institutions across 113 countries/regions on six continents. Maternal Hypothyroidism research publications surged from 44 to 310 annually, a 604.54% growth from 1991 to 2022. The USA (940 articles, 45,233 citations), China Medical University (82 articles, 2,176 citations), and Teng, Weiping (52 articles, 1,347 citations) emerged as the most productive country, institution, and author, respectively. "Thyroid" topped with 233 publications, followed by "Journal of Clinical Endocrinology & Metabolism" (202) with the most citations (18,513). "Pregnancy" was the most cited keyword, with recent high-frequency keywords such as "outcome," "gestational diabetes," "iodine intake," "preterm birth," "guideline," and "diagnosis" signaling emerging themes in Maternal Hypothyroidism.

Conclusions

This study unveils developmental trends, global collaboration patterns, foundational knowledge, and emerging frontiers in Maternal Hypothyroidism. Over 30 years, research has predominantly focused on aspects like diagnosis, treatment guidelines, thyroid function during pregnancy, and postpartum outcomes, with a central emphasis on the correlation between maternal and fetal health.

Chlorate and perchlorate in tea leaves from major producing regions in China and related human exposure risk

Chlorate and perchlorate are emerging pollutants that may interfere with thyroid function. Since they are highly water soluble, chlorate and perchlorate in tea leaves cause health concerns but have scarcely been studied. In this study, chlorate and perchlorate concentrations in 216 tea samples from different regions of China were determined. Perchlorate was detected in all the samples with a median concentration of 44.1 μg kg-1, while the chlorate detection frequency was 15.7%. We observed regional differences in perchlorate contents in tea leaves, with the highest quantity found in the central region of China. Except for dark tea, the concentration of perchlorate in tea infusions decreased with the increased number of times the tea leaves were brewed. The hazard quotients (HQs) of chlorate and perchlorate in all the samples were less than 1, suggesting negligible health risks caused by these pollutants from tea consumption. To the best of our knowledge, this is the first study to investigate chlorate and perchlorate contamination in tea infusions by simulating brewing behavior.

Associations of Trimester-Specific Exposure to Perchlorate, Thiocyanate, and Nitrate with Childhood Neurodevelopment: A Birth Cohort Study in China

Studies about the impacts of maternal exposure to perchlorate, thiocyanate, and nitrate on offspring neurodevelopment are scarce. Based on a birth cohort in China, 1,028 mothers provided urine samples at three trimesters for determination of the three target analytes, and their offspring neurodevelopment was evaluated at 2 years old. Associations of maternal exposure to the three chemicals with offspring neurodevelopment were estimated using three statistical methods. Trimester-specific analyses using generalized estimating equation models showed that double increment of thiocyanate and nitrate during the first trimester was associated with 1.56 (95% CI: -2.82, -0.30) and 1.22 (-2.40, -0.03) point decreases in the offspring mental development index (MDI), respectively. Weighted quantile sum (WQS) regression analyses showed that the mixture exposure at the first and second trimesters was negatively associated with the offspring MDI (β = -2.39, 95% CI: -3.85, -0.93; β = -1.75, 95% CI: -3.04, -0.47, respectively) and thiocyanate contributed the most to the association (65.0 and 91.6%, respectively). Bayesian kernel machine regression analyses suggested an inverted U-shape relationship of maternal urinary thiocyanate with the offspring MDI. These findings suggested that prenatal exposure to the three chemicals (at current levels), especially thiocyanate and nitrate, may impair neurodevelopment. Early pregnancy seems to be the sensitive window.

Urinary perchlorate, thiocyanate, and nitrate and their associated risk factors among Chinese pregnant women

Perchlorate, nitrate, and thiocyanate are well-known inhibitors of iodide uptake and thyroid-disrupting chemicals. Widespread human exposure to them has been identified, whereas studies on their internal exposure levels among Chinese pregnant women are scarce and factors associated with them are not well recognized. The objective of this study is to determine their levels and identify the associated factors among pregnant women (n = 1120), based on a prospective birth cohort in Wuhan, central China, using repeated urine samples of three trimesters. Urinary perchlorate, thiocyanate, and nitrate were 100% detected in the samples, and specific gravity-adjusted median concentrations of them in all the samples were 12.6 ng/mL, 367 ng/mL, and 63.7 μg/mL, respectively. Their concentrations were weakly-to-moderately correlated with each other, with Spearman correlation coefficients ranging from 0.27 to 0.54. Poor reproducibility were observed for the three analytes over the three trimesters, with intraclass correlation coefficient of 0.07, 0.19, 0.04 for perchlorate, thiocyanate, and nitrate, respectively. The women who were overweight or used tap water as drinking water had significantly higher perchlorate concentrations, while those with excessive gestational weight gain had significantly higher thiocyanate concentrations (p < 0.05). The women with a college degree or above had lower nitrate concentrations (p < 0.05). Meanwhile, the median concentration of perchlorate in urine samples collected in spring, thiocyanate in those collected in winter, and nitrate in those collected in autumn, was significantly higher compared to their median concentrations in the samples collected in other three seasons (p < 0.05), respectively. Urinary perchlorate and nitrate concentrations of pregnant women in this study were higher than the concentrations of pregnant women in other countries, while thiocyanate concentrations were lower than that of most other countries. This study suggested potential covariates for future epidemiological analyses.

Associations of perchlorate, nitrate, and thiocyanate with metabolic syndrome and its components among US adults: A cross-sectional study from NHANES

Perchlorate, nitrate and thiocyanate are common endocrine disruptors. Herein, this study was undertaken to evaluate the associations between perchlorate, nitrate, and thiocyanate exposures (alone or in combination) and risk of metabolic syndrome (MetS) among adults, which has not been explored so far. Analytical data were extracted from different datasets in the National Health and Nutrition Examination Survey (NHANES) database. Multivariate logistic regression models were constructed to investigate the associations between perchlorate, nitrate, and thiocyanate exposures, and the prevalence of MetS. Subsequently, odds ratios (OR) and their corresponding 95 % confidence intervals (CIs) were adopted to represent the magnitude of the effect size. We performed a series of subgroup analyses and sensitivity analyses as well. Moreover, three commonly used mixture modeling strategies [Weighted quantile sum (WQS) regression, quantile-based g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR)] were utilized to evaluate the joint mixture effect on MetS. This study included 12,007 participants in the subsequent analyses. After adjustment for confounding factors, higher levels of perchlorate, and thiocyanate concentrations were significantly associated with the risk of MetS (OR = 1.15, 95%CI:1.00, 1.32; OR = 1.21, 95%CI:1.04, 1.41, respectively). Analyses of WQS and Qgcomp showed that a quartile increase in chemical mixture was correlated with the occurrence of MetS with ORs of 1.07 (95%CI: 0.99, 1.16) and 1.07 (95%CI: 1.00, 1.14), respectively. This positive association was mainly driven by perchlorate and thiocyanate. Analysis of BKMR revealed that perchlorate, nitrate, and thiocyanate mixture was positively associated with the risk of MetS while perchlorate, and thiocyanate were major predictors in the mixture. In summary, our study reveals positive relationships between perchlorate, thiocyanate and MetS. Co-exposure to perchlorate, nitrate and thiocyanate is positively associated with the risk of MetS, with perchlorate and thiocyanate contributing the most to the overall mixture effect.

Environmental exposure to perchlorate, nitrate and thiocyanate, and thyroid function in Chinese adults: A community-based cross-sectional study

BACKGROUND

Evidence on environmental exposure to perchlorate, nitrate, and thiocyanate, three thyroidal sodium iodine symporter (NIS) inhibitors, and thyroid function in the Chinese population remains limited.

OBJECTIVE

To investigate the associations of environmental exposure to perchlorate, nitrate, and thiocyanate with markers of thyroid function in Chinese adults.

METHODS

A total of 2441 non-pregnant adults (mean age 50.4 years and 39.1% male) with a median urinary iodine of 180.1 μg/L from four communities in Shenzhen were included in this cross-sectional study. Urinary perchlorate, nitrate, thiocyanate, and thyroid profiles, including serum free thyroxine (FT4), total thyroxine (TT4), free triiodothyronine (FT3), total triiodothyronine (TT3), and thyroid stimulating hormone (TSH), were measured. Generalized linear model was applied to investigate the single-analyte associations. Weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models were used to examine the association between the co-occurrence of three anions and thyroid profile.

RESULTS

The median levels of urinary perchlorate, nitrate, and thiocyanate were 5.8 μg/g, 76.4 mg/g, and 274.1 μg/g, respectively. After adjusting for confounders, higher urinary perchlorate was associated with lower serum FT4, TT4, and TT3, and higher serum FT3 and TSH (all P < 0.05). Comparing extreme tertiles, subjects in the highest nitrate tertile had marginally elevated TT3 (β: 0.02, 95% CI: 0.00-0.04). Each 1-unit increase in log-transformed urinary thiocyanate was associated with a 0.04 (95% CI: 0.02-0.06) pmol/L decrease in serum FT3. The WQS indices were inversely associated with serum FT4, TT4, and FT3 (all P < 0.05). In the BKMR model, the mixture of three anions was inversely associated with serum FT4, TT4, and FT3.

CONCLUSIONS

Our study provides evidence that individual and combined environmental exposure to perchlorate, nitrate, and thiocyanate are associated with significant changes in thyroid function markers in the Chinese population with adequate iodine intake.

Perchlorate removal by a combined heterotrophic and bio-electrochemical hydrogen autotrophic system

Here, a novel combined heterotrophic and bio-electrochemical hydrogen autotrophic (CHBHA) system was developed to remove perchlorate under low chemical dosages and energy consumption. The perchlorate removal performance at various hydraulic retention times (HRTs) and acetate dosages was investigated. For influent containing 10 ± 0.10 mg/L perchlorate, the optimal removal efficiency by the CHBHA system was 98.96 ± 1.62 %, 92.99 ± 2.99 %, 97.85 ± 0.41 %, and 98.24 ± 1.56 % at different operating stages. Perchlorate was mainly removed in the heterotrophic part (H-part) at a sufficient HRT (6 h) and acetate dosage (14.75 mg/L). At other stages, perchlorate was synergistically removed by the H-part and electrochemical hydrogen autotrophic part (E-part). Since the H-part removed some perchlorate, the E-part's applied current decreased, thus reducing energy costs. The maximum current efficiency of CHBHA system was 22.09 %. Compared with the single E-part system, the combined system used 65 % less energy. Perchlorate was converted into active chlorine in the E-part, which improved the effluent quality. The bacterial community structures of the two parts were significantly different. Comamonas, Dechloromonas, Acinetobacter, and Chryseobacterium were enriched in the H-part, and the dominant genera in the E-part were Thauera, Azonexus, Hydrogenophaga, and Tissierella.

Exploring the destiny and distribution of thiocyanate in the water-soil-plant system and the potential impacts on human health

Endocrine disruptors like thiocyanate are some of the principal causes of chronic disorders worldwide. Prenatal and postnatal exposure to thiocyanate can interfere with normal neurological development in both fetuses and newborns. Currently, little information regarding thiocyanate levels and potential sources of exposure is available. In this study, we evaluated thiocyanate uptake and accumulation in chard and spinach grown under greenhouse conditions. Both chard and spinach are commonly used to produce baby foods. Three thiocyanate concentrations were compared: Control, T1 (30 ng mL^-1), and T2 (70 ng mL^-1). Thiocyanate accumulation depended on the concentration and exposure time. Chard was found to accumulate more thiocyanate than spinach, with leaf accumulation > stem accumulation (p < 0.0194) and maximum concentrations of 76 ng g^-1 (control), 112 ng g^-1, (T1), and 134 ng g^-1 (T2). The estimated daily intake (EDI) of thiocyanate for chard and spinach (fresh) exceeded the subchronic reference dose of 200 ng^-1 kg^-1 day^-1 and the chronic reference dose of 600 ng^-1 kg^-1 day^-1. In addition, the EDI of thiocyanate for spinach in baby food exceeded twice the chronic reference dose in the vulnerable newborn-1 year age group. However, all EDIs were lower than the lowest observed adverse effect level (LOAEL) of 1.9 × 10⁵ ng kg^-1 day^-1. Further studies are needed that increase our knowledge of thiocyanate levels and potential environmental sources to reduce opportunities for exposure, especially in vulnerable groups.

Exploration of the optimal range of urinary iodine concentration in Chinese pregnant women in mildly iodine-deficient and -sufficient areas

PURPOSE

There is some uncertainty about the optimal ranges for urinary iodine concentration (UIC) during pregnancy. This study aimed to explore associations between maternal UIC and thyroid function in iodine sufficient and mildly iodine deficient areas.

METHODS

It was a cross-sectional study in which 1461 healthy pregnant women were enrolled to collect their blood and urine samples during their routine antenatal care in Tianjin and Wuqiang, China. Wuqiang was a mildly iodine-deficient region, while Tianjin was iodine sufficient. UIC, free triiodothyronine (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), serum iodine concentration (SIC) including total serum iodine concentration (tSIC) and non-protein bound serum iodine concentration (nbSIC) were assessed during the routine antenatal care visits.

RESULTS

The median UIC in pregnant women was 174 (113, 249) μg/L in Tianjin and 111 (63, 167) μg/L in Wuqiang, respectively. Compared with Tianjin, UIC, FT3 and TSH were lower, and FT4, tSIC, nbSIC, rates of TPOAb and TgAb positivity and the thyroid dysfunction rate (TDR) were higher in Wuqiang (P < 0.001). FT3, FT4, tSIC and nbSIC increased during pregnancy in Tianjin with increasing UIC, while only FT3 and nbSIC increased in Wuqiang (P < 0.05). In Tianjin, the TDR increased with UIC and peaked at UIC ≥ 500 μg/L (P = 0.002), while in Wuqiang, the TDR showed a weak "U-shaped" relationship with UIC and the rate was lowest with UIC 100-149 μg/L.

CONCLUSIONS

In iodine-deficient areas, there was a lower TDR in pregnant women with UIC 100-149 μg/L. We suspected that the optimal UIC criteria recommended by WHO may be a little high for pregnant women in mild-to-moderate iodine-deficient countries.

Perchlorate - properties, toxicity and human health effects: an updated review

Interest in perchlorate as environmental pollutant has increased since 1997, when high concentrations have been found in the waters of the Colorado River, USA. Perchlorate is very persistent in nature and it is slowly degraded. Although harmful effects of large doses of perchlorate on thyroid function have been proven, the environmental effects are still unclear. The primary objective of the present review is to collect prevailing data of perchlorate exposure and to discuss its impact on human health. The results show that more than 50% of reviewed works found significant associations of perchlorate exposure and human health. This review consists of the following sections: general information of perchlorate sources, its properties and determination methods, role and sources in human body including food and water intake, overview of the scientific literature on the research on the effect of perchlorate on human health from 2010 to 2020. Finally, conclusions and recommendations on future perchlorate studies concerning human exposure are presented.

The small silver nanoparticle-assisted homogeneous sensing of thiocyanate ions with an ultra-wide window based on surface-enhanced Raman-extinction spectroscopy

For the first time, we present an original sensing strategy with an ultra-wide detection window from 17 nM to 20 mM to detect SCN- ions. Initially, we investigated the clustering and optical properties of noble metal sol nanoparticles (NPs) due to the competitive interaction of thiocyanate ions (SCN-) and cetyltrimethylammonium bromide (CTAB) under weak acidic conditions, and found that different dimensions and scales of nanoclusters containing the alkyne-embedded Au@Ag NPs and relatively small Ag NPs could be achieved by the mediation of CTAB through electrostatic forces and hydrophobic interaction, in which SCN- could be covalently bonded with the silver surface of NPs to form a compact molecular layer (-Ag-S-C[triple bond, length as m-dash]N), and CTAB could only occupy remaining sites. In this process, we found that SCN- always runs counter to CTAB and tends to dissolve nanoclusters, so that they occupy the exposed surface of NPs in nanoclusters rather than the binding sites of one another. Remarkably, when the concentration of SCN- initially increased, two highly recognizable SERS emissions, which were assigned to alkyne reporter molecules (2208 cm-1) and C[triple bond, length as m-dash]N of SCN- (2110 cm-1), respectively, were rapidly detected, and their ratios (I2110/I2208) increased linearly proportional to the concentration of SCN- over a range of 17 nM to 172 μM, with a limit of detection (LOD) of 10 nM. With the further increase of SCN-, small Ag NPs started to desorb from the surface of individual Au@Ag NPs and dissociated in the solution but did not contribute to SERS signals. Instead, the surface plasmon resonance (SPR) peak of pure silver NPs at 385 nm increased gradually in the range from 0.5 to 20 mM with an LOD of 0.2 mM. Of particular significance, this simple sensor in conjunction with surface-enhanced Raman-extinction spectroscopy can be used for the rapid detection of extensive samples with an ultra-wide detection window, such as body fluids (saliva, urine, and serum) and food (milk powder and brassica vegetables), which is far superior to that of ion chromatography (IC).

Is There Such a Thing as "Anti-Nutrients"? A Narrative Review of Perceived Problematic Plant Compounds

Plant-based diets are associated with reduced risk of lifestyle-induced chronic diseases. The thousands of phytochemicals they contain are implicated in cellular-based mechanisms to promote antioxidant defense and reduce inflammation. While recommendations encourage the intake of fruits and vegetables, most people fall short of their target daily intake. Despite the need to increase plant-food consumption, there have been some concerns raised about whether they are beneficial because of the various ‘anti-nutrient’ compounds they contain. Some of these anti-nutrients that have been called into question included lectins, oxalates, goitrogens, phytoestrogens, phytates, and tannins. As a result, there may be select individuals with specific health conditions who elect to decrease their plant food intake despite potential benefits. The purpose of this narrative review is to examine the science of these ‘anti-nutrients’ and weigh the evidence of whether these compounds pose an actual health threat.

Interference on Iodine Uptake and Human Thyroid Function by Perchlorate-Contaminated Water and Food

Background: Perchlorate-induced natrium-iodide symporter (NIS) interference is a well-recognized thyroid disrupting mechanism. It is unclear, however, whether a chronic low-dose exposure to perchlorate delivered by food and drinks may cause thyroid dysfunction in the long term. Thus, the aim of this review was to overview and summarize literature results in order to clarify this issue. Methods: Authors searched PubMed/MEDLINE, Scopus, Web of Science, institutional websites and Google until April 2020 for relevant information about the fundamental mechanism of the thyroid NIS interference induced by orally consumed perchlorate compounds and its clinical consequences. Results: Food and drinking water should be considered relevant sources of perchlorate. Despite some controversies, cross-sectional studies demonstrated that perchlorate exposure affects thyroid hormone synthesis in infants, adolescents and adults, particularly in the case of underlying thyroid diseases and iodine insufficiency. An exaggerated exposure to perchlorate during pregnancy leads to a worse neurocognitive and behavioral development outcome in infants, regardless of maternal thyroid hormone levels. Discussion and conclusion: The effects of a chronic low-dose perchlorate exposure on thyroid homeostasis remain still unclear, leading to concerns especially for highly sensitive patients. Specific studies are needed to clarify this issue, aiming to better define strategies of detection and prevention.

One-step sample processing method for the determination of perchlorate in human urine, whole blood and breast milk using liquid chromatography tandem mass spectrometry

A one-step sample processing was developed to determine the levels of perchlorate in human urine, whole blood and breast milk by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Athena C18-WP column was used to separate and analyze perchlorate. Perchlorate and isotope-labeled perchlorate (Cl¹⁸O₄^-) internal standards were spiked in the sample matrix through vortex mixing, centrifugation, and filtration. The filtrate was collected and subjected to LC analysis. The developed method was validated for its reproducibility, linearity, trueness, and recovery. Satisfactory recovery of perchlorate ranged from 81% to 117% with intraday relative standard deviations (RSDs) (n = 3) and inter-day RSDs (n = 9) of 5-18% and of 5-16%, respectively. Good linearity (R² ≥ 0.99) was observed. Limits of detection and quantification for perchlorate ranged from 0.06 µg/L to 0.3 µg/L and from 0.2 µg/L to 1 µg/L, respectively. Perchlorate concentrations were found in human urine (n = 38) and whole blood (n = 8) samples with the range of 6.5-288.6 µg/L and 0.3-2.8 µg/L, respectively. These results indicate the applicability of our developed method in determining perchlorate level in real samples. Moreover, this method is also highly reliable, sensitive and selective in detecting perchlorate in human urine, whole blood and breast milk samples and may be applicable to other matrixes i.e. saliva, serum, plasma, milk powder and dairy milk.

Surface Enhanced Raman Spectroscopy Detection of Sodium Thiocyanate in Milk Based on the Aggregation of Ag Nanoparticles

A method is developed for detecting the concentration of sodium thiocyanate (NaSCN) in milk based on surface-enhanced Raman scattering (SERS) technology. A trichloroacetic acid solution can be used to enhance the SERS signal because of its function in promoting the aggregation of Ag nanoparticles (Ag NPs). Meanwhile, the protein in milk would be precipitated as trichloroacetic acid added and the interference from protein could be reduced during the detection. In this work, the enhancement factor (EF) is 7. 56 × 10⁵ for sodium thiocyanate in water and the limit of detection (LOD) is 0.002 mg/L. Meanwhile, this method can be used to detect the concentration of sodium thiocyanate in milk. Results show that SERS intensity increased as the concentration of sodium thiocyanate increase from 10 to 100 mg/L. The linear correlation coefficient is R² = 0.998 and the detection limit is 0.04 mg/L. It is observed that the concentration of sodium thiocyanate does not exceed the standard in the three kinds of milk. The confirmed credibility of SERS detection is compared with conventional methods.

Iodine intake and chronic autoimmune thyroiditis: a comparative study between coastal and mainland regions in Greece

INTRODUCTION

The purpose of this study was to evaluate the relationship between iodine intake and autoimmune thyroiditis in Chios, an island located in the North East Aegean Sea, in comparison to mainland regions in South Western Greece (SWG).

MATERIALS AND METHODS

Urine iodine concentration (UIC), thyroid function (serum TSH, thyroid autoantibodies: anti-TPO and anti-Tg), and thyroid U/S were assessed in 200 subjects (150 females and 50 males) from Chios and 322 subjects (255 females and 67 males) from several mainland regions in SWG. All participants were recruited from outpatient clinics and were diagnosed as euthyroid.

RESULTS

Median UIC in Chios was significantly higher compared to SWG (136.1 vs. 104.5 μg/L, p < 0.001), indicating that both regions are iodine sufficient according to World Health Organization (WHO) criteria. The prevalence of thyroid autoimmunity was 66.5% in Chios and 27% in SWG, significantly higher in females (46.7%) than in males (26.5%). Furthermore, individuals with increased levels of thyroid autoantibodies either anti-TPO or anti-Tg (TAbs) showed increased median UIC levels compared to those / subjects / patients with normal levels (126.7 vs. 108.95 μg/L, p < 0.001). Serum TSH mean values (mIU/L) were greater in females (mean = 2.1 ± 1.41) compared to males (mean = 1.82 ± 1.26) (p = 0.04) and decreased with age.

CONCLUSIONS

In conclusion, in the present study, we clearly indicate that increased thyroid autoimmunity is positively associated with increased iodine intake, as well as with the female gender. Moreover, iodine intake and thyroid autoimmunity appear to be significantly higher in a coastal region (Chios) than in mainland Greece (SWG). Additional environmental factors, apart from iodine, should be investigated in future studies. Mean TSH values were increased in females and decreased with age. The latter is probably due to the presence of autonomous goiter in older Greek populations, as a result of long-term status of iodine deficiency in the past.

Environmental exposure to perchlorate: A review of toxicology and human health

Perchlorate pharmacology and toxicology studies date back at least 65 years in the peer-reviewed literature. Repeated studies in animals and humans have demonstrated perchlorate's mechanism of action, dose-response, and adverse effects over a range of doses. The first measurable effect of perchlorate is inhibition of iodine uptake to the thyroid gland. Adequate levels of thyroid hormones are critical for the development of the fetal nervous system. With sufficient dose and exposure duration, perchlorate can reduce thyroid hormones in the pregnant or non-pregnant woman via this mechanism. The developing fetus is the most sensitive life stage for chemical agents that affect iodide uptake to the thyroid. Perchlorate has a half-life of eight hours, is not metabolized, does not bioaccumulate, is not a mutagen or carcinogen, and is not reprotoxic or immunotoxic. More recently, epidemiological and biomonitoring studies have been published in the peer-reviewed literature characterizing the thyroidal effects of perchlorate and other goitrogens. While the results from most populations report no consistent association, a few studies report thyroidal effects at environmentally relevant levels of perchlorate. We reviewed the literature on health effects of perchlorate at environmental exposure levels, with a focus on exposures during pregnancy and neurodevelopmental effects. Based on the studies we reviewed, health effects are expected to only occur at doses substantially higher than environmental levels.

Effect of perchlorate and thiocyanate exposure on thyroid function of pregnant women from South-West England: a cohort study

Background

Iodine is important for thyroid hormone synthesis, and iodine deficiency in pregnancy may impair fetal neurological development. As perchlorate and thiocyanate inhibit sodium-iodide symporter reducing the transport of iodine from circulation into the thyroid follicular cells, environmental exposure to these substances in pregnancy may impair maternal thyroid hormone synthesis. We aimed to explore the impact of perchlorate and thiocyanate exposure on thyroid status in a cohort of pregnant mothers from South West England.

Methods

Urine samples were obtained from 308 women participating in a study of breech presentation in late pregnancy. They had no known thyroid disease and a singleton pregnancy at 36–38 weeks gestation. Samples were analysed for urinary concentrations of iodine (UIC), perchlorate (UPC) and thiocyanate (UTC). Blood samples were taken for free T4 (FT4), thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab). Baseline data included age, parity, smoking status, ethnicity and BMI at booking. Following delivery, data on offspring’s sex, gestational age at birth and birthweight were collected.

Results

Participants had a mean (SD) age 31 (5) years, median (IQR) BMI 24.4 (22.0, 28.3) kg/m², 42% were primiparous, 10% were smokers, and 96% were Caucasian. Median UIC was 88 μg/l, and 174/308 (57%) women had UIC < 100 μg/l. Log transformed UPC negatively correlated with FT4, but not with TSH, in the whole cohort (r = − 0.12, p = 0.03) and in the subgroup of women with UIC < 100 μg/l (r = − 0.15, p = 0.04). Regression analysis with the potential confounders (TPO-Ab status, UIC and UTC) identified UPC to be negatively associated with FT4 (p = 0.01). There was no correlation between UTC and FT4 or TSH. Maternal UPC or UTC was not associated with offspring birthweight.

Conclusion

Environmental perchlorate exposure is negatively associated with circulating FT4 levels in third trimester pregnant women. This may have an adverse impact on neurocognitive development of the fetus.

Pregnant Greek Women May Have a Higher Prevalence of Iodine Deficiency than the General Greek Population

BACKGROUND

Adequate dietary iodine consumption, predicted via the urinary iodine concentration (UIC), is necessary for normal thyroid function and for the neurodevelopment of fetuses and neonates. The general population of Greece is considered to be iodine sufficient, but our preliminary findings suggest that Greek pregnant women are at risk of iodine deficiency.

OBJECTIVE

Our aim was to estimate the thyroid function and UIC in a representative population of pregnant Greek women.

METHODS

UIC and thyroid function were assessed in 1,118 women from 19 representative areas of the country.

RESULTS

The median UIC was found to be 127.1 µg/l (range 7.8-2,296), which is indicative of insufficient iodine intake according to the standard of the World Health Organization (WHO) for pregnant women. The median UIC was below the minimal recommended value of 150 µg/l in 61% of the women, and below 100 or 50 µg/l in 32 and 7%, respectively. An optimal iodine intake (150-250 µg/l) was observed in 26%, and was over the cut-off of 500 µg/l in 2% of the subjects. Serum thyrotropin significantly increased between trimesters, from 1.57 ± 1.2, to 1.68 ± 1.0 and to 2.02 ± 1.2 mU/l (p < 0.001). Serum-free thyroxine decreased significantly between trimesters, from 1.22 ± 0.34, to 1.01 ± 0.21 and 0.96 ± 0.2 ng/ml (p < 0.05). Serum thyroglobulin levels remained unchanged over the trimesters and were not correlated with UIC.

CONCLUSIONS

While the general population of Greece is iodine sufficient, these findings suggest that, according to the WHO, the majority of pregnant Greek women are iodine deficient. These data strongly suggest that a proactive policy should be developed to lower iodine deficiency risk in this population of women.

Thyroid antagonists and thyroid indicators in U.S. pregnant women in the Vanguard Study of the National Children's Study

The sodium iodide-symporter (NIS) mediates uptake of iodide into thyroid follicular cells. This key step in thyroid hormone synthesis is inhibited by perchlorate, thiocyanate (SCN) and nitrate (NO3) anions. When these exposures occur during pregnancy the resulting decreases in thyroid hormones may adversely affect neurodevelopment of the human fetus. Our objectives were to describe and examine the relationship of these anions to the serum thyroid indicators, thyroid stimulating hormone (TSH) and free thyroxine (FT4), in third trimester women from the initial Vanguard Study of the National Children's Study (NCS); and to compare urine perchlorate results with those in pregnant women from the National Health and Nutritional Examination Survey (NHANES). Urinary perchlorate, SCN, NO3, and iodine, serum TSH, FT4, and cotinine were measured and a food frequency questionnaire (FFQ) was administered to pregnant women enrolled in the initial Vanguard Study. We used multiple regression models of FT4 and TSH that included perchlorate equivalent concentration (PEC, which estimates combined inhibitory effects of the anions perchlorate, SCN, and NO3 on the NIS). We used multiple regression to model predictors of each urinary anion, using FFQ results, drinking water source, season of year, smoking status, and demographic characteristics. Descriptive statistics were calculated for pregnant women in NHANES 2001-2012. The geometric mean (GM) for urinary perchlorate was 4.04µg/L, for TSH 1.46mIU/L, and the arithmetic mean for FT4 1.11ng/dL in 359 NCS women. In 330 women with completed FFQs, consumption of leafy greens, winter season, and Hispanic ethnicity were significant predictors of higher urinary perchlorate, which differed significantly by study site and primary drinking water source, and bottled water was associated with higher urinary perchlorate compared to filtered tap water. Leafy greens consumption was associated with higher urinary NO3 and higher urinary SCN. There was no association between urinary perchlorate or PEC and TSH or FT4, even for women with urinary iodine <100µg/L. GM urinary perchlorate concentrations in the full sample (n=494) of third trimester NCS women (4.03µg/L) were similar to pregnant women in NHANES (3.58µg/L).

Serum Thyroglobulin Concentration Is a Weak Marker of Iodine Status in a Pregnant Population with Iodine Deficiency

OBJECTIVE

To assess the reliability of thyroglobulin (Tg) as a marker of iodine status during pregnancy.

DESIGN

299 women aged 30.5 ± 4.8 years (mean ± SD) were studied.

METHODS

In every subject, we measured urinary iodine concentration (UIC), serum thyrotropin (TSH), Tg, free thyroxine (fT4), Tg autoantibodies (TgAbs) and human chorionic gonadotropin (hCG) levels. We excluded samples with increased TgAbs from the analysis.

RESULTS

According to WHO criteria, the study population was iodine deficient in every trimester. Serum Tg levels did not differ during the three trimesters of pregnancy. Serum hCG levels fell significantly as pregnancies advanced. A weak, significantly negative correlation (limited to the 3rd trimester) was found between Tg and UIC (ρ = -0.187, p = 0.039). Serum fT4 decreased as pregnancies advanced and TSH increased. Serum fT4 was negatively correlated with TSH (ρ = -0.161, p = 0.006) and positively with hCG (ρ = +0.165, p = 0.005). The multiple regression equation of Tg based on hCG, TSH, UIC and trimester of pregnancy was significant but weak (F = 4.057, p = 0.003; R(2) = 0.055), with hCG as a significant predictor Tg (p for log hCG = 0.041).

CONCLUSIONS

Tg cannot be considered as a valid marker of iodine deficiency in pregnancy, at least in a mildly iodine-deficient environment. Further studies in a larger patient cohort with differences in iodine status, as well as studies on Tg changes after improving iodine status in pregnant women, are needed in order to corroborate these results.

Supplementation during pregnancy: beliefs and science

Pregnancy represents a challenge from a nutritional perspective, because micronutrient intake during the periconceptional period and in pregnancy affects fetal organ development and the mother's health. Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia. This article reviews the risks associated with nutrient deficiencies in pregnant women and presents an overview of recommendations for dietary supplementation in pregnancy, focusing on oral iron supplementation. Risk factor detection, including dietary patterns and comorbidities, is paramount in optimal pregnancy management. Dietary habits, which can lead to deficiencies (e.g., iron, folate, vitamin D, and calcium) and result in negative health consequences for the mother and fetus/newborn, need to be investigated. Prenatal care should be personalized, accounting for ethnicity, culture, education, information level about pregnancy, and dietary and physical habits. Clinicians should make a plan for appropriate supplementation and prophylaxis/treatment of nutritional and other needs, and consider adequate intake of calcium, iodine, vitamin D, folate, and iron. Among the available oral iron supplements, prolonged-released ferrous sulfate (ferrous sulfate-polymeric complex) presents the lowest incidence of overall and gastrointestinal adverse events, with positive implications for compliance.

Perchlorate in Water Supplies: Sources, Exposures, and Health Effects

Perchlorate exposure occurs from ingestion of natural or man-made perchlorate in food or water. Perchlorate is used in a variety of industrial products including missile fuel, fireworks, and fertilizers, and industrial contamination of drinking water supplies has occurred in a number of areas. Perchlorate blocks iodide uptake into the thyroid and decreases the production of thyroid hormone, a critical hormone for metabolism, neurodevelopment, and other physiologic functions. Occupational and clinical dosing studies have not identified clear adverse effects, but may be limited by small sample sizes, short study durations, and the inclusion of mostly healthy adults. Expanding evidence suggests that young children, pregnant women, fetuses, and people co-exposed to similarly acting agents may be especially susceptible to perchlorate. Given the ubiquitous nature of perchlorate exposure, and the importance of thyroid hormone for brain development, studying the impact of perchlorate on human health could have far-reaching public health implications.

Thyroid Hormones and Moderate Exposure to Perchlorate during Pregnancy in Women in Southern California

BACKGROUND

Findings from national surveys suggest that everyone in the United States is exposed to perchlorate. At high doses, perchlorate, thiocyanate, and nitrate inhibit iodide uptake into the thyroid and decrease thyroid hormone production. Small changes in thyroid hormones during pregnancy, including changes within normal reference ranges, have been linked to cognitive function declines in the offspring.

OBJECTIVES

We evaluated the potential effects of low environmental exposures to perchlorate on thyroid function.

METHODS

Serum thyroid hormones and anti-thyroid antibodies and urinary perchlorate, thiocyanate, nitrate, and iodide concentrations were measured in 1,880 pregnant women from San Diego County, California, during 2000-2003, a period when much of the area's water supply was contaminated from an industrial plant with perchlorate at levels near the 2007 California regulatory standard of 6 μg/L. Linear regression was used to evaluate associations between urinary perchlorate and serum thyroid hormone concentrations in models adjusted for urinary creatinine and thiocyanate, maternal age and education, ethnicity, and gestational age at serum collection.

RESULTS

The median urinary perchlorate concentration was 6.5 μg/L, about two times higher than in the general U.S.

POPULATION

Adjusted associations were identified between increasing log10 perchlorate and decreasing total thyroxine (T4) [regression coefficient (β) = -0.70; 95% CI: -1.06, -0.34], decreasing free thyroxine (fT4) (β = -0.053; 95% CI: -0.092, -0.013), and increasing log10 thyroid-stimulating hormone (β = 0.071; 95% CI: 0.008, 0.133).

CONCLUSIONS

These results suggest that environmental perchlorate exposures may affect thyroid hormone production during pregnancy. This could have implications for public health given widespread perchlorate exposure and the importance of thyroid hormone in fetal neurodevelopment.

CITATION

Steinmaus C, Pearl M, Kharrazi M, Blount BC, Miller MD, Pearce EN, Valentin-Blasini L, DeLorenze G, Hoofnagle AN, Liaw J. 2016. Thyroid hormones and moderate exposure to perchlorate during pregnancy in women in Southern California. Environ Health Perspect 124:861-867; http://dx.doi.org/10.1289/ehp.1409614.

CO-occurring exposure to perchlorate, nitrate and thiocyanate alters thyroid function in healthy pregnant women

BACKGROUND

Adequate maternal thyroid function during pregnancy is necessary for normal fetal brain development, making pregnancy a critical window of vulnerability to thyroid disrupting insults. Sodium/iodide symporter (NIS) inhibitors, namely perchlorate, nitrate, and thiocyanate, have been shown individually to competitively inhibit uptake of iodine by the thyroid. Several epidemiologic studies examined the association between these individual exposures and thyroid function. Few studies have examined the effect of this chemical mixture on thyroid function during pregnancy

OBJECTIVES

We examined the cross sectional association between urinary perchlorate, thiocyanate and nitrate concentrations and thyroid function among healthy pregnant women living in New York City using weighted quantile sum (WQS) regression.

METHODS

We measured thyroid stimulating hormone (TSH) and free thyroxine (FreeT4) in blood samples; perchlorate, thiocyanate, nitrate and iodide in urine samples collected from 284 pregnant women at 12 (±2.8) weeks gestation. We examined associations between urinary analyte concentrations and TSH or FreeT4 using linear regression or WQS adjusting for gestational age, urinary iodide and creatinine.

RESULTS

Individual analyte concentrations in urine were significantly correlated (Spearman's r 0.4-0.5, p<0.001). Linear regression analyses did not suggest associations between individual concentrations and thyroid function. The WQS revealed a significant positive association between the weighted sum of urinary concentrations of the three analytes and increased TSH. Perchlorate had the largest weight in the index, indicating the largest contribution to the WQS.

CONCLUSIONS

Co-exposure to perchlorate, nitrate and thiocyanate may alter maternal thyroid function, specifically TSH, during pregnancy.

The Relationship between Perchlorate in Drinking Water and Cord Blood Thyroid Hormones: First Experience from Iran

Background:

Considering the controversial information regarding the effects of perchlorate on thyroid function of high risk population as neonates, and given the high prevalence rate of thyroid disorders specially congenital hypothyroidism in our region, this study aims to investigate for the first time in Iran, the relationship between drinking groundwater perchlorate and cord blood thyroid hormones level in an industrial region.

Methods:

In this cross-sectional study, drinking groundwater perchlorate level of rural areas of Zarinshahr, Isfahan was measured. Simultaneously, cord blood level of thyroid hormones of neonates born in the studied region was measured. Thyroid function test of neonates in regions with low and high perchlorate level were compared.

Results:

In this study, 25 tap water samples were obtained for perchlorate measurement. Level of cord blood thyroid stimulating hormone (TSH), T4 and T3 of 25 neonates were measured. Mean (standard deviation) of perchlorate, TSH, T4 and T3 was 3.59 (5.10) μg/l, 7.81 (4.14) mIU/m, 6.06 (0.85) mg/dl, and 63.46 (17.53) mg/dl, respectively. Mean levels of thyroid function tests were not different in low (<5 μg/l) and high level of drinking ground water perchlorate (P > 0.05).

Conclusions:

Perchlorate did not appear to be related to thyroid function of neonates in the studied industrial region. It seems that iodine status of the regions, as well as other environmental contaminants and genetic background, could impact on its relation with thyroid function of neonates.

Perchlorate in indoor dust and human urine in China: contribution of indoor dust to total daily intake

Perchlorate is used in fireworks and China is the largest fireworks producer and consumer in the world. Information regarding human exposure to perchlorate is scarce in China, and exposure via indoor dust ingestion (EDI indoor dust) has rarely been evaluated. In this study, perchlorate was found in indoor dust (detection rate: 100%, median: 47.4 μg/g), human urine (99%, 26.2 ng/mL), drinking water (100%, 3.99 ng/mL), and dairy milk (100%, 12.3 ng/mL) collected from cities that have fireworks manufacturing areas (Yueyang and Nanchang) and in cities that do not have fireworks manufacturing industries (Tianjin, Shijiazhuang, Yuxi and Guilin) in China. In comparison with perchlorate levels reported for other countries, perchlorate levels in urine samples from fireworks sites and nonfireworks sites in China were higher. Median indoor dust perchlorate concentrations were positively correlated (r = 0.964, p < 0.001) with outdoor dust perchlorate levels reported previously. The total daily intake (EDI total) of perchlorate, estimated based on urinary levels, ranged from 0.090 to 27.72 μg/kg body weight (bw)/day for all studied participants; the percentage of donors who had EDI total exceeding the reference dose (RfD) recommended by the United States Environmental Protection Agency (US EPA) was 79%, 48%, and 25% for toddlers (median: 1.829 μg/kg bw/day), adults (0.669 μg/kg bw/day), and children (median: 0.373 μg/kg bw/day), respectively. Toddlers (0.258 μg/kg bw/day) had the highest median EDI indoor dust, which was 2 to 5 times greater than the EDI indoor dust calculated for other age groups (the range of median values: 0.044 to 0.127 μg/kg bw/day). Contribution of indoor dust to EDItotal was 26%, 28%, and 7% for toddlers, children, and adults, respectively. Indoor dust contributed higher percentage to EDI total than that by dairy milk (0.5-5%).

Environmental perchlorate exposure: potential adverse thyroid effects

PURPOSE OF REVIEW

This review will present a general overview of the sources, human studies, and proposed regulatory action regarding environmental perchlorate exposure.

RECENT FINDINGS

Some recent studies have reported significant associations between urinary perchlorate concentrations, thyroid dysfunction, and decreased infant intelligence quotient in groups who would be particularly susceptible to perchlorate effects. An update regarding the recently proposed regulatory actions and potential costs surrounding amelioration of perchlorate contamination is provided.

SUMMARY

The potential adverse thyroidal effects of environmental perchlorate exposure remain controversial, and further research is needed to further define its relationship to human health among pregnant and lactating women and their infants.

Genetic and non-iodine-related factors in the aetiology of nodular goitre

Genetic and a large number of environmental non-iodine-related factors play a role in the cause of nodular goitre. Most evidence for the influence of genetic and environmental factors in the cause of goitre is from cross-sectional, population-based studies. Only a few studies have included prospective data on risk factors for nodular goitre, although few prospective data are available on the effect of iodine and tobacco smoking on goitre development. Goitre is not one single phenotype. Many epidemiological studies do not distinguish diffuse from nodular goitre, as the investigated parameter is often thyroid volume or frequency with increased thyroid volume. Moreover, information on the presence and effect of gene-environment, gene-gene, and environment-environment effect modifications is limited. Thus, firm conclusions about the relative contributions and causality of the investigated risk factors should be made with caution. Smoking seems to be an established risk factor for nodular goitre, possibly with effect modification from iodine intake, as the risk associated with smoking is smaller or absent in areas with sufficient iodine intake. The use of oral contraceptives might have protective effects against goitre, and childbirth is an increased risk factor for goitre in areas with non-optimal iodine intake. Insulin resistance is a recently investigated risk factor, and the risk of goitre may be reversible with metformin treatment. Iodine remains the major environmental risk factor for nodular goitre.

The association between perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant Thai women

CONTEXT

Thyroid hormone is critical for fetal neurodevelopment. Perchlorate and thiocyanate decrease thyroidal iodine uptake by competitively inhibiting the sodium/iodide symporter. It is clear that perchlorate and thiocyanate anions can influence thyroid function. However, as pollutants in the environment, their impact is conflicting.

OBJECTIVE

The objective was to determine the effects of environmental perchlorate and/or thiocyanate exposure on thyroid function in first-trimester pregnant women.

DESIGN AND PATIENTS

A cross-sectional study was conducted in 200 pregnant Thai women with a gestational age of 14 weeks or less.

MEASURES

Urinary iodide, perchlorate, thiocyanate, and serum thyroid function tests were measured.

RESULTS

The women were aged 28.6 ± 6.1 years and the mean gestational age was 9.6 ± 2.7 weeks. Median urinary iodide, perchlorate, and thiocyanate concentrations were 153.5 μg/L, 1.9 μg/L, and 510.5 μg/L, respectively. Using Spearman's rank correlation analyses, there were positive correlations between serum TSH and urine perchlorate to creatinine (r = 0.20, P = .005) and TSH and thiocyanate to creatinine ratios (r = 0.22, P = .001). There were negative correlations between free T4 and the perchlorate to creatinine ratio (r = -0.18, P = .01) and free T4 and the thiocyanate to creatinine ratio (r = -0.19, P = .008). In multivariate analyses adjusting for log thiocyanate to creatinine ratio, log iodide to creatinine ratio, and gestational age, log perchlorate to creatinine ratio was positively associated with log TSH (P = .002) and inversely associated with log free T4 (P = .002). Log thiocyanate to creatinine ratio was a significant positive predictor of log TSH (P = .02) in women with a urine iodide level of less than 100 μg/L.

CONCLUSIONS

Low-level environmental exposure to perchlorate and thiocyanate is common in Thailand. Low-level exposure to perchlorate is positively associated with TSH and negatively associated with free T4 in first-trimester pregnant women using multivariate analyses. In multivariate analyses, thiocyanate exposure is also positively associated with TSH in a subgroup of pregnant women with low iodine excretion.

Urine selenium changes during pregnancy do not correlate with thyroid autoantibodies in a mildly iodine deficient population

Selenium (Se) is a key component of iodinases; higher Se levels are associated with lower titers of antithyroid peroxidase antibodies (anti-TPO). Pregnancy exerts profound effects on thyroid function and autoimmunity. To assess the relationship of urine Se levels with thyroid function and autoimmunity in pregnant women residing in Athens, Greece, we studied prospectively 47 euthyroid women in uncomplicated singleton pregnancies (mean age + SD: 30 + 5 years) in each trimester, measuring urine Se levels, urine iodine, plasma thyrotropin (TSH), free thyroxine and triiodothyronine (FT4 and FT3), as well as levels of anti-TPO antibodies. Changes of the measured parameters were assessed over each trimester; thyroid parameters were assessed with relation to Se levels. Urine Se dropped by the third trimester, whereas urine iodine did not change appreciably during pregnancy. TSH and anti-TPO did not show appreciable changes; FT4 and FT3 gradually decreased as the pregnancy advanced. No relationship between urine Se levels and anti-TPO was found. During pregnancy, changes in urine Se levels accompany mild changes in thyroid function. However, we did not find some association between these changes and thyroid autoimmune activity over this period, probably because the effect of Se on thyroid autoimmunity may only become apparent in case of excess Se fortification.

Impact of pregnancy and other factors on the levels of urinary perchlorate, thiocyanate, and nitrate among females aged 15-44 years: data from National Health and Nutrition Examination Survey: 2003-2008

Impact of pregnancy on levels of urinary perchlorate, thiocyanate, and nitrate has not been studied using large scale data. Data from National Health and Nutrition Examination Survey for the years 2003-2008 were used to evaluate risk factors that impact levels of these contaminants among females of child bearing age. In addition to pregnancy, other risk factors evaluated were: age, race/ethnicity, smoking status, serum triglyceride levels, and iodine deficiency status. Pregnancy did not affect the levels of perchlorate and nitrate but, new to this study, it was found that thiocyanate levels were statistically significantly lower among pregnant females as compared to non-pregnant females (p<0.01). Iodine deficient females had statistically significantly lower levels of these contaminates than iodine replete females (p<0.01). Levels of thiocyanate among smokers were about five times higher than among non-smokers. Non-Hispanic Blacks had the lowest and Mexican Americans had the highest levels of perchlorate and nitrate. The reverse was true for thiocyanate levels. There was an inverse association between nitrate and education levels. There was a positive association between serum triglyceride levels and the levels of these contaminants. Also, new to this study, of concern, was the fact that levels of these contaminants increased among females over the period 2005-2008. Levels of perchlorate, thiocyanate, and nitrate did not vary across pregnancy trimesters.