Hospital centered surveillance of births in Gaza, Palestine, 2011-2017 and heavy metal contamination of the mothers reveals long-term impact of wars

Reprod Toxicol. 2019 Jun;86:23-32. doi: 10.1016/j.reprotox.2019.02.003. Epub 2019 Mar 5.


Prevalence of preterm, low birth weight and birth defects increased significantly since 2011 in Gaza, Palestine. No change in known co-factors of reproductive health justified this rise. Two military attacks in 2012 and 2014 introduced novel risk factors for outcomes at birth: contamination by teratogenic and carcinogenic heavy metals weapon-remnants, ongoing impoverishment, and impaired rehabilitation of waste management. It was previously shown that mothers exposed to military attacks had higher metal load than those unexposed and mother's heavy metals trans-pass placenta. We investigated association in time of heavy metal contamination and reproductive health using hospital-based surveillance (2011-2016-2017) of births, accompanied by assessment in 2016 of metal load in mother and newborn hair. Mother's housing proximal to unmanaged waste predicted preterm birth and birth defects, and these women had highest load of heavy metals. Poor diet predicted low birth weight. Circumstances prevent investigation of heavy metals molecular impact(s) during fetal development.

Keywords: Pregnant women intake of heavy metals; Risk factors and pregnancy outcome; Surveillance at birth; War-remnants.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Armed Conflicts*
  • Congenital Abnormalities
  • Diet
  • Environmental Monitoring
  • Environmental Pollutants / analysis*
  • Female
  • Hair / chemistry*
  • Hazardous Waste Sites
  • Hospitals
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Maternal-Fetal Exchange*
  • Metals, Heavy / analysis*
  • Middle East
  • Mothers
  • Pregnancy
  • Premature Birth


  • Environmental Pollutants
  • Metals, Heavy