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Valverde M, Granados A, Milić M, Ceppi M, Sollano L, Bonassi S, Rojas E. Effect of Air Pollution on the Basal DNA Damage of Mother-Newborn Couples of México City. TOXICS 2023; 11:766. [PMID: 37755776 PMCID: PMC10537346 DOI: 10.3390/toxics11090766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
Environmental pollution of megacities can cause early biological damage such as DNA strand breaks and micronuclei formation. Comet assay tail length (TL) reflects exposure in the uterus to high levels of air pollution, primarily ozone and air particles (PM10), including mothers' smoking habits during pregnancy, conditions which can lead to low birth weight. In this biomonitoring study, we evaluated basal DNA damage in the cord blood cells of newborn children from Mexico City. We found a correlation between DNA damage in mothers and their newborns, including various parameters of environmental exposure and complications during pregnancy, particularly respiratory difficulties, malformations, obstetric trauma, neuropathies, and nutritional deficiencies. Mothers living in the southern part of the city showed double DNA damage compared to those living in the northern part (TL 8.64 μm vs. 4.18 μm, p < 0.05). Additionally, mothers' DNA damage correlates with exposure to NOx (range 0.77-1.52 ppm) and PM10 (range 58.32-75.89 μg/m3), as well maternal age >29. These results highlight the sensitivity of the comet assay in identifying differential in utero exposure for newborns whose mothers were exposed during pregnancy. They also suggest the importance of antioxidants during pregnancy and the role of the placental barrier in protecting the newborn from the DNA-damaging effects of oxidative pollution.
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Affiliation(s)
- Mahara Valverde
- Laboratorio de Genotoxicología, Instituto de Investigaciones Biomédicas, U.N.A.M., Mexico City 04510, Mexico; (M.V.); (A.G.)
| | - Adriana Granados
- Laboratorio de Genotoxicología, Instituto de Investigaciones Biomédicas, U.N.A.M., Mexico City 04510, Mexico; (M.V.); (A.G.)
| | - Mirta Milić
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10 001 Zagreb, Croatia;
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Leticia Sollano
- Centro Médico Nacional 20 de Noviembre, I.S.S.S.T.E, Mexico City 03229, Mexico;
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele, 00166 Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy
| | - Emilio Rojas
- Laboratorio de Genotoxicología, Instituto de Investigaciones Biomédicas, U.N.A.M., Mexico City 04510, Mexico; (M.V.); (A.G.)
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Shang L, Yang L, Yang W, Huang L, Qi C, Yang Z, Fu Z, Chung MC. Effects of prenatal exposure to NO 2 on children's neurodevelopment: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:24786-24798. [PMID: 32356052 PMCID: PMC7329770 DOI: 10.1007/s11356-020-08832-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/07/2020] [Indexed: 05/11/2023]
Abstract
The neurotoxicity of NO2 exposure is well-known and potentially causes impaired of neural functions. This review aimed to estimate associations between prenatal NO2 exposure and neurodevelopment for children. Articles published until May 2019 reported prenatal NO2 exposure and children's cognition, psychomotor, language, attention, IQ, and behavior function were searched according to all related terms. The main databases we retrieved included PubMed, Web of Science, Embase, and Cochrane Library. Coefficient was extracted, conversed, and synthesized by random effects meta-analysis. Meanwhile, qualitatively describe would be used for some studies which cannot be synthesized quantitatively for lack of quantity or methods inconsistency. Finally, a total of 3848 citations were searched, and only 10 studies were included. We estimated that per 10 μg/m3 increase of NO2 during pregnancy was associated with a - 0.76 point decrease in global psychomotor (95% CI, - 1.34, - 0.18) and a - 0.62 point decrease in fine psychomotor for children (95% CI, - 1.09, - 0.16). But no significant association found in general cognitive and language. In addition, through the literature review, it seemed that prenatal exposure to NO2 might cause adverse impacts on children's attention, IQ, and different behaviors, but this requires confirmation from further researches. Our study indicated that prenatal exposure to NO2 seems to be associated with impaired neural development for children, especially for fine psychomotor. However, further studies are needed for determining the effects of prenatal air pollution exposure on attention, IQ, and behavior.
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Affiliation(s)
- Li Shang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road., Xi'an, 710061, Shaanxi Province, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Liren Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road., Xi'an, 710061, Shaanxi Province, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Wenfang Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road., Xi'an, 710061, Shaanxi Province, People's Republic of China.
| | - Liyan Huang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road., Xi'an, 710061, Shaanxi Province, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Cuifang Qi
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road., Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Zixuan Yang
- Antai College, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhuxuan Fu
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mei Chun Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Wallace MAG, Pleil JD, Whitaker DA, Oliver KD. Recovery and reactivity of polycyclic aromatic hydrocarbons collected on selected sorbent tubes and analyzed by thermal desorption-gas chromatography/mass spectrometry. J Chromatogr A 2019; 1602:19-29. [PMID: 31128883 DOI: 10.1016/j.chroma.2019.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022]
Abstract
This article describes the optimization of methodology for extending the measurement of volatile organic compounds (VOCs) to increasingly heavier polycyclic aromatic hydrocarbons (PAHs) with a detailed focus on recent sorbent tube technology. Although PAHs have lower volatility than compounds such as benzene, toluene, ethylbenzene and xylenes, these semi-volatile compounds can be detected in air and breath samples. For this work, PAHs were captured on sorbent tubes and subsequently analyzed using automated thermal desorption gas chromatography - mass spectrometry (ATD-GC/MS). While many different sorbent tubes are commercially available, optimization for airborne PAH sampling using sorbent tubes has not been previously considered. Herein, several commercially available sorbent tubes, including Carbograph 2 TD/1TD, Tenax TA, XRO-440, and inert-coated PAH tubes are compared to determine the relative recovery for eight PAHs commonly found in the environment. Certain types of sorbent materials were found to be better suited for PAH recovery during thermal desorption, and PAH reaction products were observed on several types of sorbent tubes, including graphitized carbon black sorbents with stainless steel tube materials. As such, selection of sorbent tube media should be carefully considered prior to embarking on a PAH study.
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Affiliation(s)
- M Ariel Geer Wallace
- National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Joachim D Pleil
- National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Donald A Whitaker
- National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Karen D Oliver
- National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
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Williams AL, Bates CA, Pace ND, Leonhard MJ, Chang ET, DeSesso JM. Impact of chloroform exposures on reproductive and developmental outcomes: A systematic review of the scientific literature. Birth Defects Res 2018; 110:1267-1313. [PMID: 30350414 DOI: 10.1002/bdr2.1382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
AIMS We assessed the animal and epidemiological data to determine if chloroform exposure causes developmental and/or reproductive toxicity. RESULTS AND DISCUSSION Initial scoping identified developmental toxicity as the primary area of concern. At levels producing maternal toxicity in rats and mice, chloroform caused decrements in fetal weights and associated delays in ossification. In a single mouse inhalation study, exposure to a high concentration of chloroform was associated with small fetuses and increased cleft palate. However, oral exposure of mice to chloroform at a dose 4 times higher was negative for cleft palate; multiple inhalation studies in rats were also negative. Epidemiologic data on low birth weight and small for gestational age were generally equivocal, preventing conclusions from being drawn for humans. The animal data also show evidence of very early (peri-implantation) total litter losses at very high exposure levels. This effect is likely maternally mediated rather than a direct effect on the offspring. Finally, the epidemiologic data indicate a possible association of higher chloroform exposure with lower risk of preterm birth (<37 weeks gestation). CONCLUSIONS The available animal data suggest that exposures lower than those causing maternal toxicity should be without developmental effects in the offspring. Also, most studies in humans rely on group-level geographic exposure data, providing only weak epidemiologic evidence for an association with development outcomes and fail to establish a causal role for chloroform in the induction of adverse developmental outcomes at environmentally relevant concentrations.
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Affiliation(s)
| | | | | | | | | | - John M DeSesso
- Exponent, Inc., Alexandria, Virginia.,Georgetown University School of Medicine, Washington, District of Columbia
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Kadawathagedara M, Botton J, de Lauzon-Guillain B, Meltzer HM, Alexander J, Brantsaeter AL, Haugen M, Papadopoulou E. Dietary acrylamide intake during pregnancy and postnatal growth and obesity: Results from the Norwegian Mother and Child Cohort Study (MoBa). ENVIRONMENT INTERNATIONAL 2018; 113:325-334. [PMID: 29398013 DOI: 10.1016/j.envint.2018.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prenatal acrylamide exposure has been negatively associated with fetal growth but the association with child growth is unknown. OBJECTIVES We studied the association between prenatal acrylamide exposure and child postnatal growth up to 8 years in the Norwegian Mother and Child Cohort Study (MoBa). METHODS In 51,952 mother-child pairs from MoBa, acrylamide intake during pregnancy was estimated by combining maternal food intake with food concentrations of acrylamide. Mothers reported their child's weight and length/height up to 11 times between 6 weeks and 8 years. Weight and height growth trajectories were modelled using Jenss-Bayley's growth model. Logistic regression models were used to study the association with overweight/obese status at 3, 5 and 8 years, as identified using the International Obesity Task Force cut-offs. Linear mixed-effect models were used to explore associations with overall growth. RESULTS At 3 years, the adjusted odds ratios (95% Confidence Intervals (CI)) of being overweight/obese were 1.10 (1.02, 1.20), 1.12 (1.04, 1.22) and 1.21 (1.11, 1.31) by increasing prenatal acrylamide exposure quartile. Similar dose-response associations were found at 5 and 8 years. Acrylamide intake during pregnancy was associated with higher weight growth velocity in childhood. Children exposed at the highest level had 22 g (95% CI: 8, 37), 57 g (95% CI: 32, 81), and 194 g (95% CI: 110, 278) higher weight at 0.5, 2, and 8 years, respectively, compared to their low exposed peers. CONCLUSIONS Children prenatally exposed to acrylamide in the highest quartile experienced a moderate increase in weight growth velocity during early childhood that resulted in a moderately increased prevalence of overweight/obesity compared to peers in the lowest quartile. Our study is the first to link prenatal acrylamide exposure and postnatal growth.
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Affiliation(s)
- Manik Kadawathagedara
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Paris Descartes University, Paris, France.
| | - Jérémie Botton
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Univ. Paris-Sud, Université Paris-Saclay, F-92296 Châtenay-Malabry, France
| | - Blandine de Lauzon-Guillain
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Paris Descartes University, Paris, France
| | | | | | - Anne Lise Brantsaeter
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Margaretha Haugen
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Pedersen M, Garne E, Hansen-Nord N, Hjortebjerg D, Ketzel M, Raaschou-Nielsen O, Nybo Andersen AM, Sørensen M. Exposure to air pollution and noise from road traffic and risk of congenital anomalies in the Danish National Birth Cohort. ENVIRONMENTAL RESEARCH 2017; 159:39-45. [PMID: 28763732 DOI: 10.1016/j.envres.2017.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ambient air pollution has been associated with certain congenital anomalies, but few studies rely on assessment of fine-scale variation in air quality and associations with noise from road traffic are unexplored. METHODS Among 84,218 liveborn singletons (1997-2002) from the Danish National Birth Cohort with complete covariate data and residential address history from conception until birth, we identified major congenital anomalies in 4018 children. Nitrogen dioxide (NO2) and noise from road traffic (Lden) burden during fetal life was modeled. Outcome and covariate data were derived from registries, hospital records and questionnaires. Odds ratios (ORs) for eleven major anomaly groups associated with road traffic pollution during first trimester were estimated using logistic regression with generalized estimating equation (GEE) approach. RESULTS Most of the associations tested did not suggest increased risks. A 10-µg/m3 increase in NO2 exposure during first trimester was associated with an adjusted ORs of 1.22 (95% confidence interval: 0.98-1.52) for ear, face and neck anomalies; 1.14 0.98-1.33) for urinary anomalies. A 10-dB increase in road traffic noise was also associated with these subgroups of anomalies as well as with an increased OR for orofacial cleft anomalies (1.17, 0.94-1.47). Inverse associations for several both air pollution and noise were observed for atrial septal defects (0.85, 0.68-1.04 and 0.81, 0.65-0.99, respectively). CONCLUSIONS Residential road traffic exposure to noise or air pollution during pregnancy did not seem to pose a risk for development of congenital anomalies.
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Affiliation(s)
- Marie Pedersen
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1014 Copenhagen K, Denmark; Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
| | - Ester Garne
- Pediatric Department, Hospital Lillebaelt, Skovvangen 2-8, 6000 Kolding, Denmark.
| | - Nete Hansen-Nord
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
| | - Dorrit Hjortebjerg
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000 Roskilde, Denmark.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000 Roskilde, Denmark.
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, 1123 Copenhagen K, Denmark.
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
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Chatzi L, Leventakou V, Vafeiadi M, Koutra K, Roumeliotaki T, Chalkiadaki G, Karachaliou M, Daraki V, Kyriklaki A, Kampouri M, Fthenou E, Sarri K, Vassilaki M, Fasoulaki M, Bitsios P, Koutis A, Stephanou EG, Kogevinas M. Cohort Profile: The Mother-Child Cohort in Crete, Greece (Rhea Study). Int J Epidemiol 2017; 46:1392-1393k. [DOI: 10.1093/ije/dyx084] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
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9
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Dass Singh M, Thomas P, Hor M, Almond T, Owens J, Hague W, Fenech M. Infant birth outcomes are associated with DNA damage biomarkers as measured by the cytokinesis block micronucleus cytome assay: the DADHI study. Mutagenesis 2017; 32:355-370. [DOI: 10.1093/mutage/gex001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Dodd-Butera T, Quintana PJE, Ramirez-Zetina M, Batista-Castro AC, Sierra MM, Shaputnic C, Garcia-Castillo M, Ingmanson S, Hull S. Placental biomarkers of PAH exposure and glutathione-S-transferase biotransformation enzymes in an obstetric population from Tijuana, Baja California, Mexico. ENVIRONMENTAL RESEARCH 2017; 152:360-368. [PMID: 27567517 DOI: 10.1016/j.envres.2016.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 03/19/2016] [Accepted: 04/16/2016] [Indexed: 06/06/2023]
Abstract
Environmental exposures along the US-Mexico border have the potential to adversely affect the maternal-fetal environment. The purpose of this study was to assess placental biomarkers of environmental exposures in an obstetric population at the California-Baja California border in relation to detoxifying enzymes in the placenta and nutritional status. This study was conducted on consenting, full-term, obstetric patients (n=54), delivering in a hospital in Tijuana, Baja California (BC), Mexico. Placental polyaromatic hydrocarbon (PAH)-DNA adducts were measured in addition to placental glutathione-S-transferase (GST) activity and genotype, maternal serum folate, and maternal and umbilical cord blood lead and cadmium levels. A questionnaire was administered to the mothers to determine maternal occupation in a maquiladora, other exposures, and obstetric indicators. In univariate analysis, maternal serum folate levels were inversely correlated with total PAH-DNA adducts (rho=-0.375, p=0.007); adduct #1 (rho=-0.388, p=0.005); and adduct #3 (rho =-0.430, p=0.002). Maternal lead levels were significantly positively correlated with cord blood lead levels (rho=0.512, p<0.001). Cadmium levels were generally very low but significantly higher in mothers exposed to environmental tobacco smoke (ETS) (either at work or at home, n=10). In multivariate analysis, only maternal serum folate levels remained as a significant negative predictor of total DNA-PAH adducts levels in placenta. These findings affirm that placental tissue is a valuable and readily available source of human tissue for biomonitoring; and indicate that further study of the role of nutrition in detoxification and mitigation of environmental exposures in pregnant women is warranted.
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Affiliation(s)
- Teresa Dodd-Butera
- California State University San Bernardino, Department of Nursing, 5500 University Parkway, San Bernardino, CA 92407, USA; San Diego State University, Graduate School of Public Health, San Diego, CA, USA; Union Institute & University, Cincinnati, OH, USA.
| | | | | | - Ana C Batista-Castro
- Instituto Mexicano del Seguro Social Tijuana, BC, Mexico; Hospital General de Tijuana, Tijuana, Mexico.
| | - Maria M Sierra
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA.
| | - Carolyn Shaputnic
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA; University of California, San Diego, Western FASD Practice and Implementation Center, Department of Pediatrics, Division of Dysmorphology-Teratology, San Diego, CA, USA.
| | - Maura Garcia-Castillo
- Xochicalco Universidad Escuela de Medicina, BC, Mexico; Institute for Public Health, San Diego State University, San Diego, CA, USA.
| | - Sonja Ingmanson
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA.
| | - Stacy Hull
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA.
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