Associations between prenatal arsenic exposure with adverse pregnancy outcome and child mortality

Environ Res. 2017 Oct;158:456-461. doi: 10.1016/j.envres.2017.07.004. Epub 2017 Aug 1.


Background: Chronic arsenic exposure is a public health concern in many parts of the world, with elevated concentrations in groundwater posing a threat to millions of people. Arsenic is associated with various cancers and an array of chronic diseases; however, the relationship with adverse pregnancy outcomes and child mortality is less established.

Objectives: We evaluated associations between individual-level prenatal arsenic exposure with adverse pregnancy outcomes and child mortality in a pregnancy study among 498 women nested in a larger population-based cohort in rural Bangladesh.

Methods: Creatinine-adjusted urinary total arsenic concentration, a comprehensive measure of exposure from water, food, and air sources, reflective of the prenatal period was available for participants. Self-reported pregnancy outcomes (livebirth, stillbirth, spontaneous/elective abortion) were ascertained. Generalized estimating equations, accounting for multiple pregnancies of participants, were used to estimate odds ratios and 95% confidence intervals in relation to adverse pregnancy outcomes. Vital status of livebirths was subsequently ascertained through November 2015. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals in relation to child mortality.

Results: We observed a significant association between prenatal arsenic exposure and the risk of stillbirth (greater than median; adjusted OR = 2.50; 95% CI = 1.04, 6.01). We also observed elevated risk of child mortality (greater than median; adjusted HR = 1.92; 95% CI = 0.78, 4.68) in relation to prenatal arsenic exposure.

Conclusions: Prospective studies should continue to evaluate prenatal and early life health effects of arsenic exposure and arsenic remediation strategies for women of child-bearing age.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Abortion, Spontaneous / chemically induced
  • Abortion, Spontaneous / epidemiology
  • Abortion, Therapeutic
  • Adult
  • Arsenic / toxicity*
  • Arsenic / urine
  • Bangladesh / epidemiology
  • Child
  • Child Mortality*
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Maternal Exposure / adverse effects*
  • Odds Ratio
  • Pregnancy
  • Pregnancy Outcome*
  • Prenatal Exposure Delayed Effects / chemically induced
  • Prenatal Exposure Delayed Effects / epidemiology*
  • Proportional Hazards Models
  • Stillbirth / epidemiology
  • Water Pollutants, Chemical / toxicity*
  • Water Pollutants, Chemical / urine


  • Water Pollutants, Chemical
  • Arsenic