title: Preliminary analysis of in utero low-level arsenic exposure and fetal growth using biometric measurements extracted from fetal ultrasound reports.
abstract: BACKGROUND
  Early life exposure to arsenic is associated with decreased birth weight in highly exposed populations but little is known about effects of low-level arsenic exposure on growth in utero.
  
  
  METHODS
  Using a sample of 272 pregnancies from New Hampshire we obtained biometric measurements directly from fetal ultrasound reports commonly found in electronic medical records. We used information extraction methods to develop and validate an automated approach for mining biometric measurements from the text of clinical reports. As a preliminary analysis, we examined associations between in utero low-level arsenic exposure (as measured by maternal urinary arsenic concentration) and fetal growth measures (converted to Z-scores based on reference populations for estimated fetal weight, head, and other body measures) at approximately 18 weeks of gestation.
  
  
  RESULTS
  In a preliminary cross-sectional analysis of 223 out of 272 pregnancies, maternal urinary arsenic concentration (excluding arsenobetaine) was associated with a reduction in head circumference Z-score (Spearman correlation coefficient, rs = -0.08, p-value = 0.21) and a stronger association was observed among female fetuses at approximately 18 weeks of gestation (rs = - 0.21, p-value < 0.05). Although, associations were attenuated in adjusted analyses - among female fetuses a 1 μg/L increase in maternal urinary arsenic concentration was associated with a decrease of 0.047 (95% CI: -0.115, 0.021) in head circumference and 0.072 (95% CI: -0.151, 0.007) decrease in biparietal head diameter Z-score.
  
  
  CONCLUSIONS
  Our study demonstrates that useful data can be extracted directly from electronic medical records for epidemiologic research. We also found evidence that exposure to low-level arsenic may be associated with reduced head circumference in a sex dependent manner that warrants further investigation.
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA.|Institute for Quantitative Biomedical Sciences Graduate Program, Dartmouth College, Hanover, NH, USA.|University of Michigan School of Nursing, Ann Arbor, MI, USA.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Davis
authors.affiliation: Collaboratory for Healthcare and Biomedical Informatics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Higgins
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA.|Department of Biostatistics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Gilbert-Diamond
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA.|Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Baker
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA.|Collaboratory for Healthcare and Biomedical Informatics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Das
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA. Margaret.R.Karagas@Dartmouth.edu.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Margaret.R.Karagas@Dartmouth.edu.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive, 7927 Rubin Building, 03756, Lebanon, NH, USA. Margaret.R.Karagas@Dartmouth.edu.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
mesh_terms: D000293:Adolescent; D000328:Adult; D001151:Arsenic / Q000633:toxicity*; D001724:Birth Weight / Q000187:drug effects*; D002508:Cephalometry; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D004781:Environmental Exposure; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal; D055815:Young Adult
chemical_list: D001151:Arsenic