title: Arsenic exposure in pregnancy increases the risk of lower respiratory tract infection and diarrhea during infancy in Bangladesh.
abstract: BACKGROUND
  Previous studies have reported associations between prenatal arsenic exposure and increased risk of infant mortality. An increase in infectious diseases has been proposed as the underlying cause of these associations, but there is no epidemiologic research to support the hypothesis.
  
  
  OBJECTIVE
  We evaluated the association between arsenic exposure in pregnancy and morbidity during infancy.
  
  
  METHODS
  This prospective population-based cohort study included 1,552 live-born infants of women enrolled during 2002-2004 in Matlab, Bangladesh. Arsenic exposure was assessed by the concentrations of metabolites of inorganic arsenic in maternal urine samples collected at gestational weeks 8 and 30. Information on symptoms of lower respiratory tract infection (LRTI) and diarrhea in infants was collected by 7-day recalls at monthly home visits.
  
  
  RESULTS
  In total, 115,850 person-days of observation were contributed by the infants during a 12-month follow-up period. The estimated risk of LRTI and severe LRTI increased by 69% [adjusted relative risk (RR) = 1.69; 95% confidence interval (CI), 1.36-2.09)] and 54% (RR = 1.54; 95% CI, 1.21-1.97), respectively, for infants of mothers with urinary arsenic concentrations in the highest quintile (average of arsenic concentrations measured in early and late gestation, 262-977 µg/L) relative to those with exposure in the lowest quintile (< 39 µg/L). The corresponding figure for diarrhea was 20% (RR = 1.20; 95% CI, 1.01-1.43).
  
  
  CONCLUSIONS
  Arsenic exposure during pregnancy was associated with increased morbidity in infectious diseases during infancy. Taken together with the previous evidence of adverse effects on health, the findings strongly emphasize the need to reduce arsenic exposure via drinking water.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. anisur.rahman@kbh.uu.se
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.forename: Marie
authors.initials: M
authors.lastname: Vahter
authors.forename: Eva-Charlotte
authors.initials: EC
authors.lastname: Ekström
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Persson
mesh_terms: D000328:Adult; D001151:Arsenic / Q000633:toxicity* / Q000652:urine; D001459:Bangladesh / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D001151:Arsenic