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Children's Health Advance Publication

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Environ Health Perspect; DOI:10.1289/ehp.1409282

Infant Infections and Respiratory Symptoms in Relation to in Utero Arsenic Exposure in a U.S. Cohort

Shohreh F. Farzan1,2, Zhigang Li1,2, Susan A. Korrick3,4, Donna Spiegelman5, Richard Enelow1,6, Kari Nadeau7, Emily Baker8, and Margaret R. Karagas1,2

Author Affiliations open
1Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA; 2Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA; 3Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA; 4Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; 5Departments of Biostatistics, Epidemiology, Global Health and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA; 6Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA; 7Division of Immunology and Allergy, Stanford Medical School and Lucile Packard Children’s Hospital, Stanford, California, USA; 8Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA

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  • Background: Arsenic has been linked to disrupted immune function and greater infection susceptibility in highly exposed populations. Well arsenic levels above the EPA limit occur in our U.S. study area and are of particular concern for pregnant women and infants.

    Objectives: We investigated whether in utero arsenic exposure affects the risk of infections and respiratory symptoms over the first year of life.

    Methods: We prospectively obtained information on infant infections and symptoms, including their duration and treatment (n = 412) at 4, 8 and 12 months using a parental telephone survey. Using generalized estimating equation models adjusted for potential confounders, we evaluated the association between maternal pregnancy urinary arsenic and infant infections and symptoms over the first year.

    Results: Each doubling of maternal urinary arsenic was related to increases in the total number of infections requiring prescription medication in the first year (RR = 1.1; 95% CI: 1.0, 1.2). Urinary arsenic was related specifically to respiratory symptoms (difficulty breathing, wheezing and cough) lasting ≥ 2 days or requiring prescription medication (RR = 1.1; 95% CI: 1.0, 1.2; RR = 1.2; 95% CI: 1.0, 1.5, respectively), and wheezing lasting ≥2 days, resulting in a doctor visit or prescription medication treatment (RR = 1.3; 95% CI: 1.0, 1.7; RR = 1.3; 95% CI: 1.0, 1.8, and RR = 1.5; 95% CI: 1.0, 2.2). Associations also were observed with diarrhea (RR = 1.4; 95% CI: 1.1, 1.9) and fever resulting in a doctor visit (RR = 1.2; 95% CI: 1.0, 1.5).

    Conclusions: In utero arsenic exposure was associated with a higher risk of infection during the first year of life in our study population, particularly infections requiring medical treatment, and with diarrhea and respiratory symptoms.

  • This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

    Citation: Farzan SF, Li Z, Korrick SA, Spiegelman D, Enelow R, Nadeau K, Baker E, Karagas MR. Infant Infections and Respiratory Symptoms in Relation to in Utero Arsenic Exposure in a U.S. Cohort. Environ Health Perspect;

    Received: 30 September 2014
    Accepted: 4 September 2015
    Advance Publication: 11 September 2015

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