Abstract
BackgroundMillions of individuals worldwide, particularly in Bangladesh, are exposed to arsenic, mainly through drinking water from tube wells. Arsenic is a reproductive toxicant, but there is limited knowledge of whether it influences pubertal development. ObjectivesWe evaluated the association between prenatal arsenic exposure and age at menarche. MethodsThis prospective study was based on data from two studies conducted in Matlab, Bangladesh—the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial and the Health Consequences of Arsenic in Matlab (AsMat) study. We included 809 MINIMat girls who participated in assessing age at menarche from July 2016 to June 2017 and had prenatal arsenic exposure data through the AsMat study via measurements in tube well water used by the mothers during pregnancy. The exposure was categorized into <10, 10–49, 50–99, 100–199, and ≥200 µg/L. We used Kaplan-Meier and Cox proportional hazards analyses with adjustment for potential confounders to evaluate the association between arsenic exposure and age at menarche. The results were presented by adjusted hazards ratio (aHR) with a 95% confidence interval (CI). ResultsThe median arsenic concentration in tube well water consumed by pregnant women was 80 µg/L (interquartile range 2–262 µg/L), and 55% drank water with concentrations above Bangladesh’s acceptable value of 50 µg/L. The median age at menarche was 13.0 years. The unadjusted analysis revealed 3.2 months delay in menarche for girls exposed to arsenic concentrations ≥200 µg/L compared with the girl exposed to arsenic concentrations <10 µg/L. Girls exposed to the same higher arsenic concentrations were 23% (aHR 0.77, 95% CI: 0.63–0.95) less likely to have reached menarche than girls exposed to low arsenic concentrations. ConclusionsIncreased levels of prenatal arsenic exposure were associated with older age at menarche. This delay may indicate endocrine disruptions that could potentially result in adverse health consequences in later life. This finding, along with other severe adverse health reinforces the need for arsenic mitigation at the population level.
Highlights
Puberty is the transition from childhood to the attainment of mature reproductive functions
Exposure above Bangladesh’s acceptable level of arsenic (≥50 μg/L) implied 2.8 months delay in the timing of menarche, and the adjusted hazards ratio (aHR) of 0.84 compared with the girls who had exposure to arsenic below the accepted level (
When we included stunting of adolescent girls at first follow up visit as a covariate, the aHRs were 0.77, 0.81, 0.78, and 0.74 in the 10–49, 50–99, 100–199 and ≥200 μg/L arsenic concentration groups in drinking water, respectively, compared with the group in < 10 μg/L
Summary
Puberty is the transition from childhood to the attainment of mature reproductive functions. The timing of onset of puberty, including age at menarche, is of public health interest due to its association with a wide range of adverse health out comes in later life. We included 809 MINIMat girls who participated in assessing age at menarche from July 2016 to June 2017 and had prenatal arsenic exposure data through the AsMat study via measurements in tube well water used by the mothers during pregnancy. Conclusions: Increased levels of prenatal arsenic exposure were associated with older age at menarche This delay may indicate endocrine disruptions that could potentially result in adverse health consequences in later life. This finding, along with other severe adverse health reinforces the need for arsenic mitigation at the population level
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