Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study.

Anisma R Gokoel,Maureen Y Lichtveld,Emily W Harville,Firoz Abdoel Wahid,M Sigrid Macdonald-Ottevanger,Ashna D Hindori-Mohangoo,Jeffrey K Wickliffe,Arti Shankar,Hannah H Covert,Wilco C W R Zijlmans

doi:10.3390/ijerph17124444

Abstract

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen’s Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05–5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03–46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

Highlights

Maternal exposure to chemical and non-chemical stressors may result in adverse health effects for mother and child
Perceived stress was not significantly associated with low birthweight or preterm birth, but it was associated with a low Apgar score; women with high perceived stress levels had a twofold higher risk of having a baby with a low Apgar score
We found perceived stress to be significantly associated with a low 5-min Apgar score

Summary

Introduction

Maternal exposure to chemical and non-chemical stressors may result in adverse health effects for mother and child. Stress, or depression that may result in adverse birth outcomes and long-term neurodevelopmental effects in children are of particular concern. Women prenatally exposed to mercury are more likely to deliver infants who have a low birthweight or who are small-for-gestational age [1], as well as infants with a smaller head circumference, lower Apgar score at 5 min, and shorter umbilical cord length [2]. High perceived stress during pregnancy and prenatal depression has been associated with low birthweight (LBW) [4,5], preterm birth (PTB) [4,5,6], and a low Apgar score [7]. Noteworthy is that women with high perceived stress levels have a greater risk of developing prenatal and postnatal depression [8,9]

Objectives

Methods

Results

Discussion

Conclusion