American Journal of Epidemiology Advance Access published online on March 10, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm025
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ORIGINAL CONTRIBUTIONS |
Association of Arsenic Exposure during Pregnancy with Fetal Loss and Infant Death: A Cohort Study in Bangladesh
1 International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
2 International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, Uppsala, Sweden
3 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Correspondence to Dr. Lars-Åke Persson, International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, SE-75185 Uppsala, Sweden (e-mail: lars-ake.persson{at}kbh.uu.se).
Received for publication May 9, 2006. Accepted for publication December 4, 2006.
The authors evaluated the effect of arsenic exposure on fetal and infant survival in a cohort of 29,134 pregnancies identified by the health and demographic surveillance system in Matlab, Bangladesh, in 1991–2000. Arsenic exposure, reflected by drinking water history and analysis of arsenic concentrations in tube-well water used by women during pregnancy, was assessed in a separate survey conducted in 2002–2003. Data on vital events, including pregnancy outcome and infant mortality, were collected by monthly surveillance at the household level. The risk of fetal loss and infant death in relation to arsenic exposure was estimated by a Cox proportional hazards model. Drinking tube-well water with more than 50 µg of arsenic per liter during pregnancy significantly increased the risks of fetal loss (relative risk = 1.14, 95% confidence interval: 1.04, 1.25) and infant death (relative risk = 1.17, 95% confidence interval: 1.03, 1.32). There was a significant dose response of arsenic exposure to risk of infant death (p = 0.02). Women of reproductive age should urgently be prioritized for mitigation activities where drinking water is contaminated by arsenic.
arsenic; Bangladesh; fetal death; infant; mortality; pregnancy outcome; water
Abbreviations: AsMat, health consequences of arsenic exposure in Matlab; CI, confidence interval; HDSS, health and demographic surveillance system; ICDDR,B, International Centre for Diarrhoeal Disease Research, Bangladesh; RR, relative risk
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