Associations between Prenatal Lead Exposure and Birth Outcomes in Shanghai Newborns: Potentially Affected by Infant Sex and Maternal Dietary Intakes

Abstract

Background/Aim: Studies on the associations between prenatal lead exposure and birth outcomes have been inconsistent, and few data are available on the impacts of infant sex and maternal dietary intakes on these associations. The aims of this study were to probe the effects of prenatal lead exposure on neonatal birth outcomes and to assess the sex differences in these associations after adjusting for potential confounders. Methods: The study was a cross-sectional multicenter survey of mother-infant pairs in Shanghai, the most economically developed city in eastern China. We measured the cord blood lead levels and used a series of multivariable linear regression models to determine their associations with birth outcomes, which included birth weight, birth length, head circumference, and the ponderal index, in the total sample and within sex subgroups. Results: A total of 1,009 mother-infant pairs were enrolled from 10 hospitals in Shanghai between September 2008 and October 2009. The geometric mean of the cord blood lead concentrations was 4.07μg/dl (95% CI: 3.98 to 4.17μg/dl). A significant inverse association was found between cord blood lead levels and head circumference only in the male subgroup without adjustment for maternal dietary intakes, and increasing cord blood lead levels were related to significant decreases in the ponderal index only in females. The birth weights of the male infants were positively associated with cord blood lead levels; after adjusting for the maternal intake frequency of preserved eggs, the estimated mean differences in birth weights decreased by 11.7% for each 1-unit increase in the log10-transformed cord blood lead concentration. Conclusions: Our findings suggest that prenatal lead exposure may have sex-specific effects on birth outcomes and that maternal dietary intake may be a potential confounder in these relationships. Further studies on this topic are highly warranted.