Low-moderate drinking water arsenic is associated with an increased risk for spontaneous abortion among more highly educated women in Timis County, Romania

摘要

Background: Maternal exposure to inorganic arsenic (iAs) in groundwater at ＞10 μg/L was a risk factor for spontaneous pregnancy loss in several epidemiologic studies; however, these involved populations with extensive exposures. A far larger global population is exposed to mild-moderate iAs concentrations in drinking water (＜10 μg/L). Aims: A preliminary evaluation of associations between drinking water iAs exposure and spontaneous pregnancy loss in Timis County Romania, an area known for mild-moderate groundwater iAs contamination. Methods: We recruited 150 women with incident spontaneous pregnancy losses of 5-20 weeks gestation as cases (median=8 weeks), and 150 women with ongoing pregnancies matched by gestational age (+1 week) as controls. Women received government funded, compulsory pregnancy services at a large urban medical center. Individual drinking water exposure histories were reconstructed using data collected by nurse-administered questionnaire, and weighted by iAs concentrations in reported primary and secondary residential sources measured using hydride generation-atomic absorption spectrometry. Results: Average concentrations of 0 to 175.1 μg/L iAs (median=0.52,75th %tile=3.61) were measured for reported residential sources. The interquartile ranges for cumulative iAs doses across gestation were 0.0-3.23 μg/kg and 0.0-4.91 μg/kg, for cases and for controls, respectively (P=0.16). However, multivariable conditional logistic regression analysis indicates an interaction between formal education, as a proxy for socioeconomic status, and exposure (P=0.04), adjusting for age and cigarette smoking. Women completing high school are at a 26% increased risk for loss per 1 μg/kg increase in cumulative iAs exposure (OR=1.26), whereas women not completing high school are at a 3% increased risk (OR=1.03). Conclusions: Increased levels of iAs exposure via drinking water are associated with an increased risk for pregnancy loss, in particular for more educated women.