Abstract
Inorganic arsenic exposure has been related to the risk of increased blood pressure. However, available data are based largely on cross-sectional studies conducted in highly exposed populations. Pregnancy is a period of particular vulnerability to environmental insults and little is known about the cardiovascular impacts of arsenic exposure during pregnancy. We conducted a prospective longitudinal study to evaluate the association between prenatal arsenic exposure and blood pressure changes over pregnancy in 514 women enrolled in the New Hampshire Birth Cohort Study, an ongoing study located in New Hampshire, US, where over 10% of participant household wells exceed the arsenic maximum contaminant level of 10 µg/L established by the US EPA. We considered urinary arsenic as our measure of exposure, as drinking water and diet may contribute to overall arsenic burden in US pregnant women. Using linear mixed effects models adjusted for potential confounders, we found that each 10 µg/L increase in total urinary arsenic was associated with a 0.31 mmHg (95% CI: 0.04 to 0.57, p = 0.02) greater increase in systolic blood pressure per month and a 0.28 mmHg (95% CI: 0.05 to 0.52, p = 0.02) greater increase in pulse pressure per month over the course of pregnancy. Our observation that increased arsenic exposure was related to more rapid increases in blood pressure over the course of pregnancy may have important implications as even modest increases in blood pressure impact CVD risk. To our knowledge, our study is among the first longitudinal study of arsenic exposure and blood pressure, and the first to examine cardiovascular effects of arsenic exposure during pregnancy. As cardiovascular morbidity and mortality rise worldwide, the potential risk of later life cardiovascular diseases in mothers and children who are exposed to arsenic during pregnancy makes this a critical area of investigation.
Highlights
Millions of individuals are chronically exposed to inorganic arsenic via contaminated water sources and through diet (National Research Council 2014; Navas-Acien and Nachman 2013)
Because blood pressure (BP) increases over the latter part of pregnancy (Cunningham et al 2010; Miller et al 2007; Thompson et al 2007), we further examined whether women with higher urinary arsenic had higher BP at the end of pregnancy, using linear regression models with the outcome, respectively defined as the average of the last three BP measurements (SBP, diastolic blood pressure (DBP), pulse pressure (PP)), adjusting for the same covariate variables
As an a priori selection requirement, we required women to have at least two BP measurements taken during pregnancy; all 527 women in this sample had a minimum of four measurements
Summary
Millions of individuals are chronically exposed to inorganic arsenic via contaminated water sources and through diet (National Research Council 2014; Navas-Acien and Nachman 2013). In the United States, an estimated 17 million people have been exposed to drinking water sources containing arsenic levels exceeding the maximum contaminant limit of 10 μg/L [U.S Environmental Protection Agency (EPA) 2000]. Available evidence on cardiovascular disease risk factors is based on cross-sectional studies, and prospective studies that characterize the magnitudes of longitudinal changes in risk factors related to arsenic exposure are lacking Certain populations, such as pregnant women, may be especially susceptible to these adverse effects, but little is known about the cardio vascular effects of arsenic exposure during this time period. Little is known about the cardiovascular impacts of arsenic exposure during pregnancy
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