title: Arsenic exposure and hepatitis E virus infection during pregnancy.
abstract: BACKGROUND
  Arsenic has immunomodulatory properties and may have the potential to alter susceptibility to infection in humans.
  
  
  OBJECTIVE
  We aimed to assess the relation of arsenic exposure during pregnancy with immune function and hepatitis E virus (HEV) infection, defined as seroconversion during pregnancy and postpartum.
  
  
  METHODS
  We assessed IgG seroconversion to HEV between 1st and 3rd trimester (TM) and 3 months postpartum (PP) among 1100 pregnancies in a multiple micronutrient supplementation trial in rural Bangladesh. Forty women seroconverted to HEV and were matched with 40 non-seroconverting women (controls) by age, parity and intervention. We assessed urinary inorganic arsenic plus methylated species (∑As) (µg/L) at 1st and 3rd TM and plasma cytokines (pg/mL) at 1st and 3rd TM and 3 months PP.
  
  
  RESULTS
  HEV seroconverters' urinary ∑As was elevated throughout pregnancy. Non-seroconverters' urinary ∑As was similar to HEV seroconverters at 1st TM but declined at 3rd TM. The adjusted odds ratio (95% confidence interval) of HEV seroconversion was 2.17 (1.07, 4.39) per interquartile range (IQR) increase in average-pregnancy urinary ∑As. Increased urinary ∑As was associated with increased concentrations of IL-2 during the 1st and 3rd TM and 3 months PP among HEV seroconverters but not non-seroconverters.
  
  
  CONCLUSIONS
  The relation of urinary arsenic during pregnancy with incident HEV seroconversion and with IL-2 levels among HEV-seroconverting pregnant women suggests arsenic exposure during pregnancy may enhance susceptibility to HEV infection.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: cheaney1@jhu.edu.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Heaney
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Kmush
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Institute of Chemistry-Analytical Chemistry, Graz University, Austria.
authors.forename: Kevin
authors.initials: K
authors.lastname: Francesconi
authors.affiliation: Institute of Chemistry-Analytical Chemistry, Graz University, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Gössler
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Kerry
authors.initials: K
authors.lastname: Schulze
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: DeLisa
authors.initials: D
authors.lastname: Fairweather
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
authors.affiliation: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Sabra L
authors.initials: SL
authors.lastname: Klein
authors.affiliation: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Hasmot
authors.initials: H
authors.lastname: Ali
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Saijuddin
authors.initials: S
authors.lastname: Shaikh
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Merrill
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D001151:Arsenic / Q000652:urine*; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D004198:Disease Susceptibility; D004781:Environmental Exposure / Q000032:analysis; D004785:Environmental Pollutants / Q000652:urine*; D005260:Female; D016751:Hepatitis E / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000652:urine; D016752:Hepatitis E virus / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D011247:Pregnancy / Q000097:blood / Q000652:urine; D011261:Pregnancy Trimester, First / Q000097:blood / Q000652:urine; D011263:Pregnancy Trimester, Third / Q000097:blood / Q000652:urine; D000069078:Seroconversion; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D016207:Cytokines; D004785:Environmental Pollutants; D007074:Immunoglobulin G; D001151:Arsenic
keywords: Arsenic; Cytokines; Hepatitis E virus; Immunotoxicity; Infection; Pregnancy