title: Preeclampsia and toxic metals: a case-control study in Kinshasa, DR Congo.
abstract: BACKGROUND
  Preeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season. We tested whether preeclampsia was associated with exposure to environmental metals.
  
  
  METHODS
  Using a case-control design, 88 women hospitalized with preeclampsia (cases) and 88 healthy pregnant women from the antenatal clinic (controls) were included in the study; 67 and 109 women were enrolled during the rainy and dry season, respectively. The concentrations of 24 elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) in 24-h urine collections. Differences in the urinary excretion of metals were investigated between cases and controls, and the interaction with season was assessed.
  
  
  RESULTS
  Cases and controls were well matched regarding age, parity and duration of pregnancy. In controls, the urinary concentrations of most elements were substantially higher than reference values for adults from industrially developed countries, e.g. for lead: geometric mean (GM) 8.0 μg/L [25(th)-75(th) percentile 3.1-13.8]. The daily urinary excretions of 14 metals were significantly higher in women with preeclampsia than in control women, e.g. for lead: GM 61 μg/day (25(th)-75(th) percentile 8-345) in women with preeclampsia vs 9 μg/day (25(th)-75(th) percentile 3-21) in controls (p < 0.001). A significant interaction was found between season and preeclampsia for several elements, with higher urinary excretions in preeclamptic women than controls during the dry season, but not during the rainy season.
  
  
  CONCLUSIONS
  This study revealed not only that women with preeclampsia excrete higher amounts of several toxic metals, especially lead, than control women, but also that this excretion exhibits seasonal variation, thus possibly explaining the high incidence and seasonal variation of preeclampsia in Kinshasa. Although the exact sources of this exposure are unknown, these findings underscore the need for preventing environmental exposures to lead and other toxic metals.
authors.affiliation: Department of Gynecology and Obstetrics, University of Kinshasa, and General Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo. elongi2002@yahoo.fr.|Hôpital Général de Kinshasa, Avenue de l'Hôpital, Commune de la Gombe, Kinshasa, DR, Congo. elongi2002@yahoo.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Elongi Moyene
authors.affiliation: Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Scheers
authors.affiliation: Department of Gynecology and Obstetrics, University of Kinshasa, and General Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Barthélémy
authors.initials: B
authors.lastname: Tandu-Umba
authors.affiliation: Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Haufroid
authors.affiliation: Department of Gynecology and Obstetrics, University of Kinshasa, and General Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Baudouin
authors.initials: B
authors.lastname: Buassa-Bu-Tsumbu
authors.affiliation: Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Fons
authors.initials: F
authors.lastname: Verdonck
authors.affiliation: Department of Development and Regeneration (Pregnancy, Foetus and Newborn), KU Leuven, Leuven, Belgium.|Division of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Spitz
authors.affiliation: Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Nemery
mesh_terms: D000328:Adult; D001151:Arsenic / Q000652:urine*; D016022:Case-Control Studies; D002947:Cities / Q000453:epidemiology; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000652:urine*; D005260:Female; D006801:Humans; D018811:Maternal Exposure; D008670:Metals / Q000652:urine*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000652:urine*; D011247:Pregnancy; D012621:Seasons; D012643:Selenium / Q000652:urine*; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D008670:Metals; D012643:Selenium; D001151:Arsenic
keywords: Developing country; Global health; Hypertension; Lead; Metal pollution; Preeclampsia; Seasonality