Abstract
The first pediatric lead screening typically occurs at 1-year well-child care visits. However, data on the extent of maternal lead exposure and its long-term consequences for child health are lacking. To investigate the associations between maternal red blood cell (RBC) lead levels and intergenerational risk of overweight or obesity (OWO) and whether adequate maternal folate status is associated with a reduction in OWO risk. Prospective birth cohort study. The analysis was conducted from July 14, 2018, to August 2, 2019, at Johns Hopkins Bloomberg School of Public Health. This study included 1442 mother-child pairs recruited at birth from October 27, 2002, to October 10, 2013, and followed up prospectively at Boston Medical Center. Child body mass index (BMI) z score, calculated according to US national reference data, and OWO, defined as BMI at or exceeding the 85th percentile for age and sex. Maternal RBC lead levels and plasma folate levels were measured in samples obtained 24 to 72 hours after delivery; child whole-blood lead level was obtained from the first pediatric lead screening. The mean (SD) age of mothers and children was 28.6 (6.5) years and 8.1 (3.1) years, respectively; 50.1% of children were boys. The median maternal RBC lead level and plasma folate level were 2.5 (interquartile range [IQR], 1.7-3.8) μg/dL and 32.2 (IQR, 22.1-44.4) nmol/L, respectively. The median child whole-blood lead level and child BMI z score were 1.4 (IQR, 1.4-2.0) μg/dL and 0.78 (IQR, -0.08 to 1.71), respectively. Maternal RBC lead level was associated with child OWO risk in a dose-response fashion, with an odds ratio (OR) of 1.65 (95% CI, 1.18-2.32) for high maternal RBC lead level (≥5.0 μg/dL) compared with low maternal RBC lead level (<2.0 μg/dL). Child OWO was highest among children of OWO mothers with high RBC lead levels (adjusted OR, 4.24; 95% CI, 2.64-6.82) compared with children of non-OWO mothers with low RBC lead levels. Children of OWO mothers with high RBC lead levels had 41% lower OWO risk (OR, 0.59; 95% CI, 0.36-0.95; P = .03) if their mothers had adequate plasma folate levels (≥20.4 nmol/L) compared with their counterparts. In this sample of a US urban population, findings suggest that maternal elevated lead exposure was associated with increased risk of intergenerational OWO independent of postnatal blood lead levels. Adequate maternal folate status appeared to be associated with lower OWO risk. If confirmed by additional studies, these findings have implications for prenatal lead screening and management to minimize adverse health consequences on children.
Highlights
Despite concerted efforts to decrease maternal and child obesity rates, obesity prevalence in the United States remains high, and low-income urban minority populations are disproportionately represented.[1]
Maternal red blood cell (RBC) lead level was associated with child overweight or obesity (OWO) risk in a dose-response fashion, with an odds ratio (OR) of 1.65 for high maternal RBC lead level (Ն5.0 μg/dL) compared with low maternal RBC lead level (
Child OWO was highest among children of OWO mothers with high RBC lead levels compared with children of non-OWO mothers with low RBC lead levels
Summary
Despite concerted efforts to decrease maternal and child obesity rates, obesity prevalence in the United States remains high, and low-income urban minority populations are disproportionately represented.[1]. Because of its fetal toxic effects and multiorgan detrimental associations across a wide range of exposures without a clear threshold, lead is among the top 10 chemicals of major global public health concern.[9] blood lead levels for the average population have decreased significantly with improvements in environmental policies,[10] exposure to lead is still ubiquitous in the United States[11] and remains a social ecodisadvantage.[12] More alarming is that bone lead, which accounts for 90% of the total body burden, is mobilized during pregnancy and lactation, resulting in a source of in utero lead exposure.[13] Because bone lead stores persist for decades,[14] women and their infants may be at risk for continued exposure long after exposure to external environmental sources
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