Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes

Garima Yadav; Shailja Chambial; Neha Agrawal; Meenakshi Gothwal; Priyanka Kathuria; Pratibha Singh; Praveen Sharma; Prem Prakash Sharma

doi:10.4103/jfmpc.jfmpc_78_20

Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes

J Family Med Prim Care. 2020 Jun 30;9(6):3106-3111. doi: 10.4103/jfmpc.jfmpc_78_20. eCollection 2020 Jun.

Authors

Garima Yadav¹, Shailja Chambial², Neha Agrawal¹, Meenakshi Gothwal¹, Priyanka Kathuria¹, Pratibha Singh¹, Praveen Sharma², Prem Prakash Sharma³

Affiliations

¹ Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
² Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
³ Department of Biostatistics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Abstract

Objectives: Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes.

Materials and methods: This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels.

Results: We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl-16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels.

Conclusions: We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.

Keywords: Adverse pregnancy outcomes; blood lead levels; iron deficiency anemia.