Abstract
BackgroundPreeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season. We tested whether preeclampsia was associated with exposure to environmental metals.MethodsUsing a case-control design, 88 women hospitalized with preeclampsia (cases) and 88 healthy pregnant women from the antenatal clinic (controls) were included in the study; 67 and 109 women were enrolled during the rainy and dry season, respectively. The concentrations of 24 elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) in 24-h urine collections. Differences in the urinary excretion of metals were investigated between cases and controls, and the interaction with season was assessed.ResultsCases and controls were well matched regarding age, parity and duration of pregnancy. In controls, the urinary concentrations of most elements were substantially higher than reference values for adults from industrially developed countries, e.g. for lead: geometric mean (GM) 8.0 μg/L [25th-75th percentile 3.1–13.8]. The daily urinary excretions of 14 metals were significantly higher in women with preeclampsia than in control women, e.g. for lead: GM 61 μg/day (25th–75th percentile 8–345) in women with preeclampsia vs 9 μg/day (25th–75th percentile 3–21) in controls (p < 0 · 001). A significant interaction was found between season and preeclampsia for several elements, with higher urinary excretions in preeclamptic women than controls during the dry season, but not during the rainy season.ConclusionsThis study revealed not only that women with preeclampsia excrete higher amounts of several toxic metals, especially lead, than control women, but also that this excretion exhibits seasonal variation, thus possibly explaining the high incidence and seasonal variation of preeclampsia in Kinshasa. Although the exact sources of this exposure are unknown, these findings underscore the need for preventing environmental exposures to lead and other toxic metals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0132-1) contains supplementary material, which is available to authorized users.
Highlights
Preeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season
Preeclampsia has been associated with exposure to Elongi Moyene et al Environmental Health (2016) 15:48 metals, such as lead [5], and a high degree of pollution by trace metals has been shown in Kinshasa [6]
Artisanal activities close to home tended to be more frequently reported in the preeclamptic group (p = 0.064). Pooling these activities into a single category gave a significant association with preeclampsia (OR = 2.34, 95 % confidence intervals (CI) 1.13–4.85, p = 0.02)
Summary
Preeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season. We tested whether preeclampsia was associated with exposure to environmental metals. The causes for the high incidence and seasonal variation of preeclampsia in Kinshasa are not known. Preeclampsia has been associated with exposure to Elongi Moyene et al Environmental Health (2016) 15:48 metals, such as lead [5], and a high degree of pollution by trace metals has been shown in Kinshasa [6]. The extent and sources of this pollution are not well known, but like many other megacities in low-to-middle income countries, Kinshasa suffers from considerable air, soil and water pollution, as a result of heavy traffic (with many old cars and resuspension of road dust), smoke from burning biomass and refuse, road and building works, unregulated activity of lots of small enterprises and workshops (welding, battery recycling, ...) in residential areas, etc. Studies in US children have documented that the uptake of lead increases during the dry season because of resuspension of lead-contaminated soil dust [7]
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