title: Early exposure to toxic metals has a limited effect on blood pressure or kidney function in later childhood, rural Bangladesh.
abstract: BACKGROUND
  Chronic exposure to toxic metals such as arsenic and cadmium has been implicated in the development of kidney and cardiovascular diseases but few studies have directly measured exposure during inutero and early child development.
  
  
  METHODS
  We investigated the impact of exposure to arsenic (mainly in drinking water) and cadmium (mainly in rice) during pregnancy on blood pressure and kidney function at 4.5 years of age in rural Bangladesh. The effect of arsenic exposure in infancy was also assessed.
  
  
  RESULTS
  Within a cohort of 1887 children recruited into the MINIMat study, exposure to arsenic (maternal urinary arsenic, U-As), but not cadmium, during in utero development was associated with a minimal increase in blood pressure at 4.5 years. Each 1 mg/l increase in pregnancy U-As was associated with 3.69 mmHg (95% CI: 0.74, 6.63; P: 0.01) increase in child systolic and a 2.91 mmHg (95% CI: 0.41, 5.42; P: 0.02) increase in child diastolic blood pressure. Similarly, a 1 mg/l increase in child U-As at 18 months of age was associated with a 8.25 mmHg (95% CI: 1.37, 15.1; P: 0.02) increase in systolic blood pressure at 4.5 years. There was also a marginal inverse association between infancy U-As and glomerular filtration rate at 4.5 years (-33.4 ml/min/1.72 m(2); 95% CI: -70.2, 3.34; P: 0.08). No association was observed between early arsenic or cadmium exposure and kidney volume at 4.5 years assessed by ultrasound.
  
  
  CONCLUSIONS
  These modest effect sizes provide some evidence that arsenic exposure in early life has long-term consequences for blood pressure and maybe kidney function.
authors.affiliation: Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK. Sophie.hawkesworth@lshtm.ac.uk
authors.forename: Sophie
authors.initials: S
authors.lastname: Hawkesworth
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wagatsuma
authors.forename: Maria
authors.initials: M
authors.lastname: Kippler
authors.forename: Anthony J C
authors.initials: AJ
authors.lastname: Fulford
authors.forename: Shams E
authors.initials: SE
authors.lastname: Arifeen
authors.forename: Lars-Ake
authors.initials: LA
authors.lastname: Persson
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Moore
authors.forename: Marie
authors.initials: M
authors.lastname: Vahter
mesh_terms: D001151:Arsenic / Q000633:toxicity* / Q000652:urine; D001459:Bangladesh; D001794:Blood Pressure / Q000187:drug effects*; D019187:Cadmium Compounds / Q000633:toxicity* / Q000652:urine; D002675:Child, Preschool; D060766:Drinking Water; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D018811:Maternal Exposure; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012044:Regression Analysis; D012424:Rural Population; D014874:Water Pollutants, Chemical / Q000633:toxicity
chemical_list: D019187:Cadmium Compounds; D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic