title: A prospective cohort study of the association between drinking water arsenic exposure and self-reported maternal health symptoms during pregnancy in Bangladesh.
abstract: BACKGROUND
  Arsenic, a common groundwater pollutant, is associated with adverse reproductive health but few studies have examined its effect on maternal health.
  
  
  METHODS
  A prospective cohort was recruited in Bangladesh from 2008-2011 (N = 1,458). At enrollment (<16 weeks gestational age [WGA]), arsenic was measured in personal drinking water using inductively-coupled plasma mass spectrometry. Questionnaires collected health data at enrollment, at 28 WGA, and within one month of delivery. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) for self-reported health symptoms were estimated for each arsenic quartile using logistic regression.
  
  
  RESULTS
  Overall, the mean concentration of arsenic was 38 μg/L (Standard deviation, 92.7 μg/L). A total of 795 women reported one or more of the following symptoms during pregnancy (cold/flu/infection, nausea/vomiting, abdominal cramping, headache, vaginal bleeding, or swollen ankles). Compared to participants exposed to the lowest quartile of arsenic (≤0.9 μg/L), the aOR for reporting any symptom during pregnancy was 0.62 (95% CI = 0.44-0.88) in the second quartile, 1.83 (95% CI = 1.25-2.69) in the third quartile, and 2.11 (95% CI = 1.42-3.13) in the fourth quartile where the mean arsenic concentration in each quartile was 1.5 μg/L, 12.0 μg/L and 144.7 μg/L, respectively. Upon examining individual symptoms, only nausea/vomiting and abdominal cramping showed consistent associations with arsenic exposure. The odds of self-reported nausea/vomiting was 0.98 (95% CI: 0.68, 1.41), 1.52 (95% CI: 1.05, 2.18), and 1.81 (95% CI: 1.26, 2.60) in the second, third and fourth quartile of arsenic relative to the lowest quartile after adjusting for age, body mass index, second-hand tobacco smoke exposure, educational status, parity, anemia, ferritin, medication usage, type of sanitation at home, and household income. A positive trend was also observed for abdominal cramping (P for trend <0.0001). A marginal negative association was observed between arsenic quartiles and odds of self-reported cold/flu/infection (P for trend = 0.08). No association was observed between arsenic and self-reported headache (P for trend = 0.19).
  
  
  CONCLUSIONS
  Moderate exposure to arsenic contaminated drinking water early in pregnancy was associated with increased odds of experiencing nausea/vomiting and abdominal cramping. Preventing exposure to arsenic contaminated drinking water during pregnancy could improve maternal health.
authors.affiliation: Department of Public Health, College of Public Health and Human Sciences, Oregon State University, 15 Milam, Corvallis, OR 97331, USA. Molly.Kile@oregonstate.edu.
authors.forename: Molly L
authors.initials: ML
authors.lastname: Kile
authors.forename: Ema G
authors.initials: EG
authors.lastname: Rodrigues
authors.forename: Maitreyi
authors.initials: M
authors.lastname: Mazumdar
authors.forename: Christine B
authors.initials: CB
authors.lastname: Dobson
authors.forename: Nancy
authors.initials: N
authors.lastname: Diao
authors.forename: Mostofa
authors.initials: M
authors.lastname: Golam
authors.forename: Quazi
authors.initials: Q
authors.lastname: Quamruzzaman
authors.forename: Mahmudar
authors.initials: M
authors.lastname: Rahman
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000328:Adult; D001151:Arsenic / Q000032:analysis / Q000633:toxicity*; D001459:Bangladesh / Q000453:epidemiology; D060766:Drinking Water / Q000009:adverse effects* / Q000032:analysis; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006801:Humans; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D009325:Nausea / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D011446:Prospective Studies; D057566:Self Report; D014839:Vomiting / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*; D055815:Young Adult
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic
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