Arsenic modifies the effect of folic acid in spina bifida prevention, a large hospital-based case-control study in Bangladesh.

IF 5.3 2区 环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES Environmental Health Pub Date : 2024-06-03 DOI:10.1186/s12940-024-01091-1
Chih-Fu Wei, Sudipta Kumer Mukherjee, Sheikh Muhammad Ekramullah, D M Arman, Md Joynul Islam, Mubinul Azim, Asifur Rahman, Md Nafaur Rahman, Md Ziauddin, Gwen Tindula, Hafiza Sultana Suchanda, Diana F Gomberg, Marc G Weisskopf, Liming Liang, Benjamin C Warf, David C Christiani, Maitreyi Mazumdar
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Abstract

Background: Spina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. This study examines the relationships between mother's arsenic exposure, folic acid, and spina bifida risk in Bangladesh.

Methods: We conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified by a neurosurgeon and imaging. Controls were drawn from children seen at NINS&H and nearby Dhaka Shishu Hospital. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression to examine the associations between arsenic and spina bifida. We used stratified models to examine the associations between folic acid and spina bifida at different levels of arsenic exposure.

Results: We evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother's arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median value of 0.46 µg/g, and no association was seen among mothers with toenail arsenic concentrations higher than 0.46 µg/g (adjusted OR: 1.09, 95% CI: 0.52-2.29, p = 0.82).

Conclusions: Mother's arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

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砷改变了叶酸预防脊柱裂的效果--孟加拉国一项基于医院的大型病例对照研究。
背景:脊柱裂是一种脊髓发育畸形,死亡率和致残率都很高。尽管以叶酸为基础的预防策略已成功降低了脊柱裂的发病率,但由于化学物质的暴露,一些地区的发病风险仍然较高。孟加拉国因饮用水受污染而接触大量砷,脊柱裂发病率也很高。本研究探讨了孟加拉国母亲砷暴露、叶酸和脊柱裂风险之间的关系:我们于 2016 年 12 月至 2022 年 12 月在孟加拉国达卡的国家神经科学研究所和医院(NINS&H)开展了一项基于医院的病例对照研究。病例为一岁以下患有脊柱裂的婴儿,由神经外科医生和影像学进一步分类。对照组来自在 NINS&H 和附近的达卡 Shishu 医院就诊的儿童。母亲报告在怀孕期间服用叶酸,我们则通过血清检测评估叶酸状况。我们使用石墨炉原子吸收分光光度法(GF-AAS)估算了饮用水中的砷暴露量,并使用电感耦合等离子体质谱法(ICP-MS)估算了脚趾甲中的砷暴露量。我们采用逻辑回归法研究砷与脊柱裂之间的关联。我们使用分层模型研究了不同砷暴露水平下叶酸与脊柱裂之间的关系:我们评估了 294 例脊柱裂病例和 163 例对照组的数据。我们没有发现母亲砷暴露量对脊柱裂风险的主要影响。然而,在分层分析中,叶酸的使用与脊柱裂发生几率的降低有关(调整后的几率比 [OR]:0.50,95% 置信区间 [CI]:在趾甲砷浓度低于中位值 0.46 微克/克的妇女中,叶酸的使用与脊柱裂的发生几率较低(调整后的几率比 [OR]:0.50,95% 置信区间 [CI]:0.25-1.00,p = 0.05),而在趾甲砷浓度高于 0.46 微克/克的母亲中,叶酸的使用与脊柱裂的发生几率无关(调整后的几率比 [OR]:1.09,95% 置信区间 [CI]:0.52-2.29,p = 0.82):母亲的砷暴露改变了叶酸对脊柱裂的保护作用。结论:母亲的砷暴露改变了叶酸与脊柱裂的保护关系。在砷暴露较高的地区,需要加强监测并采取额外的预防策略,如叶酸强化和减少砷的摄入。
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来源期刊
Environmental Health
Environmental Health 环境科学-公共卫生、环境卫生与职业卫生
CiteScore
10.10
自引率
1.70%
发文量
115
审稿时长
3.0 months
期刊介绍: Environmental Health publishes manuscripts on all aspects of environmental and occupational medicine and related studies in toxicology and epidemiology. Environmental Health is aimed at scientists and practitioners in all areas of environmental science where human health and well-being are involved, either directly or indirectly. Environmental Health is a public health journal serving the public health community and scientists working on matters of public health interest and importance pertaining to the environment.
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