ObjectiveThis study aimed to evaluate the effects of toxic heavy metal co-exposure on DNA oxidative damage in neonates from a primitive e-waste recycling region, Guiyu town, China. MethodsOur participants included 201 pregnant women: 126 from Guiyu town and 75 from Jinping district of Shantou city, where no e-waste recycling and dismantling activities existed. Structured interview questionnaires were administered to the pregnant women and umbilical cord blood (UCB) samples were collected after delivery. The UCB concentrations of lead, cadmium, chromium, and nickel were analyzed by graphite furnace atomic absorption spectrometry (GFAAS). Levels of UCB plasma 8-hydroxydeoxyguanosine (8-OHdG, a DNA oxidative damage biomarker) were determined by enzyme-linked immunosorbent assay. ResultsOur results suggested that UCB lead and cadmium concentrations in neonates of Guiyu were significantly higher than those of Jinping (lead: median 110.45ng/mL vs. 57.31ng/mL; cadmium: median 2.50ng/mL vs. 0.33ng/mL, both P<0.001). Parents' residence in Guiyu, and parents' work related to e-waste recycling were the risk factors associated with neonate's UCB lead and cadmium levels. No significant difference of UCB plasma 8-OHdG levels was found between Guiyu and the control area. After adjusting for potential confounders, cord plasma 8-OHdG concentrations (ng/mL) were positively associated with blood cadmium (β=0.126ng/mL, 95% CI: 0.055 to 0.198ng/mL), chromium (β=0.086ng/mL, 95% CI: 0.014 to 0.158ng/mL) and nickel (β=0.215ng/mL, 95% CI: 0.113 to 0.317ng/mL) concentrations. ConclusionsThe primitive e-waste recycling and dismantling activities may contribute to the elevated umbilical cord blood toxic heavy metal levels in neonates born in Guiyu. Exposures to cadmium, chromium and nickel were associated with increased oxidative DNA damage in neonates.