Elevated manganese concentrations in drinking water may be beneficial for fetal survival.
BACKGROUND
Elevated exposure to the essential element manganese (Mn) can be toxic. Manganese concentrations in ground water vary considerably, and reported associations between Mn and early-life mortality and impaired development have raised concern. We assessed the effects of drinking water Mn exposure during pregnancy upon fetal and infant survival.


METHODS
In this population-based cohort study, we identified the outcomes of pregnancies registered between February 2002 and April 2003 in Matlab, Bangladesh. Using inductively coupled plasma mass spectrometry, we measured the concentrations of Mn and other elements in the pregnant women's drinking water.


RESULTS
A total of 1,875 women were included in the analysis of spontaneous abortions (n=158) and 1,887 women in the perinatal mortality analysis (n=70). Water Mn ranged from 3.0-6,550 µg/L (median=217 µg/L). The adjusted odds ratio (OR) for spontaneous abortion was 0.65 (95% CI 0.43-0.99) in the highest water Mn tertile (median=1,292 µg/L) as compared to the lowest tertile (median=56 µg/L). The corresponding OR for perinatal mortality was 0.69 (95% CI 0.28-1.71), which increased to 0.78 (95% CI 0.29-2.08) after adjustment for BMI and place of delivery (home/health facility; n=1,648).


CONCLUSIONS
Elevated water Mn concentrations during pregnancy appear protective for the fetus, particularly in undernourished women. This effect may be due to the element's role in antioxidant defense.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Syed Moshfiqur
SM
Rahman
Agneta
A
Akesson
Maria
M
Kippler
Margaretha
M
Grandér
Jena Derakhshani
JD
Hamadani
Peter Kim
PK
Streatfield
Lars-Åke
LÅ
Persson
Shams
S
El Arifeen
Marie
M
Vahter
D000022:Abortion, Spontaneous / Q000517:prevention & control; D000328:Adult; D001459:Bangladesh; D060766:Drinking Water / Q000032:analysis*; D005260:Female; D006801:Humans; D008345:Manganese / Q000494:pharmacology*; D011247:Pregnancy
D060766:Drinking Water; D008345:Manganese