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Environ Health. 2015 Apr 10;14:34. doi: 10.1186/s12940-015-0020-0.

Arsenic is associated with reduced effect of folic acid in myelomeningocele prevention: a case control study in Bangladesh.

Author information

1
Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA. maitreyi.mazumdar@childrens.harvard.edu.
2
Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, USA. maitreyi.mazumdar@childrens.harvard.edu.
3
Dhaka Community Hospital, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, 1217, Bangladesh. sharif_paed@yahoo.com.
4
Bangladesh Medical College, 14/A Dhanmondi, Dhaka, 1209, Bangladesh. rezina.hamid@gmail.com.
5
Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA, USA. liv839@mail.harvard.edu.
6
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA. ligi.paul_pottenplackel@tufts.edu.
7
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA. jacob.selhub@tufts.edu.
8
Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA. emarod@hsph.harvard.edu.
9
Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, USA. emarod@hsph.harvard.edu.
10
Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA. fareesa.silva@childrens.harvard.edu.
11
Dhaka Community Hospital, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, 1217, Bangladesh. dch@bangla.net.bd.
12
Dhaka Community Hospital, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, 1217, Bangladesh. mostofa07@gmail.com.
13
Dhaka Community Hospital, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, 1217, Bangladesh. qzaman07@gmail.com.
14
Dhaka Community Hospital, 190/1 Baro Moghbazar, Wireless Railgate, Dhaka, 1217, Bangladesh. dcht87@gmail.com.
15
Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, USA. dchris@hsph.harvard.edu.

Abstract

BACKGROUND:

Arsenic induces neural tube defects in several animal models, but its potential to cause neural tube defects in humans is unknown. Our objective was to investigate the associations between maternal arsenic exposure, periconceptional folic acid supplementation, and risk of posterior neural tube defect (myelomeningocele) among a highly exposed population in rural Bangladesh.

METHODS:

We performed a case-control study that recruited physician-confirmed cases from community health clinics served by Dhaka Community Hospital in Bangladesh, as well as local health facilities that treat children with myelomeningocele. Controls were selected from pregnancy registries in the same areas. Maternal arsenic exposure was estimated from drinking water samples taken from wells used during the first trimester of pregnancy. Periconceptional folic acid use was ascertained by self-report, and maternal folate status was further assessed by plasma folate levels measured at the time of the study visit.

RESULTS:

Fifty-seven cases of myelomeningocele were identified along with 55 controls. A significant interaction was observed between drinking water inorganic arsenic and periconceptional folic acid use. As drinking water inorganic arsenic concentrations increased from 1 to 25 μg/L, the estimated protective effect of folic acid use declined (OR 0.22 to 1.03), and was not protective at higher concentrations of arsenic. No main effect of arsenic exposure on myelomeningocele risk was identified.

CONCLUSIONS:

Our study found a significant interaction between drinking water inorganic arsenic concentration from wells used during the first trimester of pregnancy and reported intake of periconceptional folic acid supplements. Results suggest that environmental arsenic exposure reduces the effectiveness of folic acid supplementation in preventing myelomeningocele.

PMID:
25885259
PMCID:
PMC4404044
DOI:
10.1186/s12940-015-0020-0
[Indexed for MEDLINE]
Free PMC Article

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