title: Association of arsenic with adverse pregnancy outcomes/infant mortality: a systematic review and meta-analysis.
abstract: BACKGROUND
  Exposure to arsenic is one of the major global health problems, affecting > 300 million people worldwide, but arsenic's effects on human reproduction are uncertain.
  
  
  OBJECTIVE
  We conducted a systematic review and meta-analysis to examine the association between arsenic and adverse pregnancy outcomes/infant mortality.
  
  
  METHODS
  We searched PubMed and Ovid MEDLINE (from 1946 through July 2013) and EMBASE (from 1988 through July 2013) databases and the reference lists of reviews and relevant articles. Studies satisfying our a priori eligibility criteria were evaluated independently by two authors.
  
  
  RESULTS
  Our systematic search yielded 888 articles; of these, 23 were included in the systematic review. Sixteen provided sufficient data for our quantitative analysis. Arsenic in groundwater (≥ 50 μg/L) was associated with increased risk of spontaneous abortion (6 studies: OR = 1.98; 95% CI: 1.27, 3.10), stillbirth (9 studies: OR = 1.77; 95% CI: 1.32, 2.36), moderate risk of neonatal mortality (5 studies: OR = 1.51; 95% CI: 1.28, 1.78), and infant mortality (7 studies: OR = 1.35; 95% CI: 1.12, 1.62). Exposure to environmental arsenic was associated with a significant reduction in birth weight (4 studies: β = -53.2 g; 95% CI: -94.9, -11.4). There was paucity of evidence for low-to-moderate arsenic dose.
  
  
  CONCLUSIONS
  Arsenic is associated with adverse pregnancy outcomes and infant mortality. The interpretation of the causal association is hampered by methodological challenges and limited number of studies on dose response. Exposure to arsenic continues to be a major global health issue, and we therefore advocate for high-quality prospective studies that include individual-level data to quantify the impact of arsenic on adverse pregnancy outcomes/infant mortality.
authors.affiliation: Centre for Environmental and Respiratory Health Research, Faculty of Medicine, University Of Oulu, Finland.
authors.forename: Reginald
authors.initials: R
authors.lastname: Quansah
authors.forename: Frederick Ato
authors.initials: FA
authors.lastname: Armah
authors.forename: David Kofi
authors.initials: DK
authors.lastname: Essumang
authors.forename: Isaac
authors.initials: I
authors.lastname: Luginaah
authors.forename: Edith
authors.initials: E
authors.lastname: Clarke
authors.forename: Kissinger
authors.initials: K
authors.lastname: Marfoh
authors.forename: Samuel Jerry
authors.initials: SJ
authors.lastname: Cobbina
authors.forename: Edward
authors.initials: E
authors.lastname: Nketiah-Amponsah
authors.forename: Proscovia Bazanya
authors.initials: PB
authors.lastname: Namujju
authors.forename: Samuel
authors.initials: S
authors.lastname: Obiri
authors.forename: Mawuli
authors.initials: M
authors.lastname: Dzodzomenyo
mesh_terms: D001151:Arsenic / Q000633:toxicity*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D014873:Water Pollutants / Q000633:toxicity*
chemical_list: D014873:Water Pollutants; D001151:Arsenic