The Effect of Heavy Metals on Preterm Mortality and Morbidity

C H A P T E R

5 The Effect of Heavy Metals on Preterm Mortality and Morbidity Gülcan Türker, MD Kocaeli University, Kocaeli, Turkey

INTRODUCTION

identified for prematurity or mortality are related to the mother and complications that occur during pregnancy, labor, and delivery, which may affect both the fetus and the newborn. These include maternal hypertension, placenta praevia, premature placental detachment, other abnormalities of the placenta, respiratory distress syndrome (RDS), cardiovascular disorders specific to the perinatal period (such as patent ductus arteriosus, PDA), infections, intrauterine growth restriction (IUGR), and low birth weight (LBW) [6,7]. Some lifestyle factors that contribute to spontaneous preterm birth include stress and excessive physical work or long times spent standing [8]. Smoking and excessive alcohol consumption as well as periodontal disease also has been associated with increased risk of preterm birth [9]. Also, nowadays a change in lifestyle has led to the development of new risk factors for preterm birth and preterm mortality with the worldwide increase of industrial pollution and anthropogenic or natural combustion activities. The environmental pollutants that cause preterm birth are environmental contaminants such as heavy metals, organic hydrocarbons, and pesticides. The influence of these pollutants on public health has been increasingly acknowledged, especially during the period of growth and development. Prenatal life is the most sensitive stage of human development due to the high degree of fetal cellular division and differentiation. The fetus is highly susceptible to teratogens, typically at low exposure levels that do not harm the mother due to differences compared to the adult in many biochemical pathways [10]. Also, if prenatal exposure occurs during organogenesis, permanent structural changes might occur. Alternatively, exposures after completion of organogenesis might result in functional consequences. More recently, studies have indicated that exposure to air pollution may be associated with LBW and preterm birth [11]. In addition, urban air pollution has also been directly implicated in perinatal

Prematurity is the leading cause of neonatal morbidity and mortality. Although the mortality of premature infants has decreased in developed countries over the past decades, low-income and middle-income countries still have a higher neonatal mortality [1–4]. Approximately 15 million babies are born preterm; 5% of whom are under 28 weeks’ gestation according to the World Health Organization (WHO). An estimated 2–8 million neonates are born preterm or small-for-gestational-age (SGA). Of the 1.2 million preterm births that occur in high-income regions, more than 0.5 million (42%) are in the United States [3]. Each year, an estimated 1.1 million neonates die from complications of preterm birth as estimated in 2010 [1–5]. Preterm birth is now the second most common cause of death in children under 5 years of age globally after pneumonia, and being born preterm also increases a baby’s risk of death due to other causes. Preterm birth is a risk factor in over 50% of all neonatal deaths [3]. Every year an estimated 4 million babies die in the neonatal period [3]. A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week – the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focus on the 1% of deaths in rich countries. In addition, preterm birth is the leading risk factor for 393,000 deaths due to neonatal infections and contributes to long-term growth impairment and significant long-term morbidity such as cognitive, visual, and learning impairments [2,4]. Perinatal mortality is an indicator of the health of the mother and child and may reflect the conditions of reproductive health, which are related to socioeconomic status, quality of antenatal care, nutrition, and delivery factors. Some of the risk factors Handbook of Fertility. http://dx.doi.org/10.1016/B978-0-12-800872-0.00005-6 Copyright © 2015 Elsevier Inc. All rights reserved.

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46 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity mortality [12]. The association between death in the neonatal period and air pollution was identified by Lipfert et al. and Hajat et al. [13,14]. An association between maternal exposure to ambient air pollution and very low birth weight (VLBW) (<1500 g) delivery has been demonstrated [15]. VLBW delivery, which is a high risk for serious morbidity and death of the infant, almost always is associated with delivery before 32 completed weeks of gestation and is often accompanied by IUGR [16]. Also, in utero exposure to heavy metals has been studied extensively over the last few decades; the threats posed on pregnancy outcomes and/or adverse developmental effects at levels lower than international guidelines have been observed [17–19]. Mattison suggested that impacts of environmental exposures on pregnancy outcome or development may have no thresholds, and the only reasonable approach is to keep environmental exposures for all individuals as low as possible [20]. Therefore, in this chapter the risk of preterm mortality and the effect of heavy metals on preterm mortality will be revised.

HEAVY METALS AND PRETERM MORTALITY AND MORBIDITY Fetal exposure to environmental factors occurs through the amniotic fluid, the placenta, and the umbilical cord. During pregnancy, the placenta acts as a selective barrier by allowing nutrients and oxygen to pass to the fetus, and preventing toxic compounds from crossing through [21–23]. However, the placental barrier is not completely impermeable to the passage of harmful substances, such as drugs or toxic agents [22]. Several studies have used either in vitro or in vivo placental models to investigate the effects of environmental exposure on fetal growth [21,24,25]. Evaluation of in utero exposure to environmental pollutants has been mainly achieved by using umbilical cord and/or maternal blood samples [26–28]. As a noninvasive matrix, placenta has been used in biomonitoring studies as a dual biomarker for toxic metals to assess maternal and fetal health [29,30]. Also, the other biomarker for toxic metals is meconium, which can be obtained easily and noninvasively, and is representative of a long duration of fetal exposure to pesticides or metals during gestation [31–35]. Few studies have investigated the effect of heavy metals on prematurity or growth or preterm mortality [21,36–40]. Osman et al. suggested that the levels of lead in cord blood were a negative predictor of birth weight and length [21]. Also, we found higher heavy metals (Pb, Cd) levels in preterm newborns, especially with unknown etiology, than term newborns, and we suggested that these metals may affect gestational age at the fetal stage [36].

Heavy metals, such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb), have no beneficial effects in humans [41]. The general population is exposed to heavy metals at several concentrations either voluntarily through supplementation or involuntarily through intake of contaminated food and water or contact with contaminated soil, dust or air, alcoholic drinks, and tobacco [41–46]. Cigarette smoke contains about 30 metals, of which Cd, As, and Pb have the highest concentrations, and exposure to these toxic metals is associated with many serious diseases [45]. In 2009, Prasher et al. defined heavy metals as chemical elements with a specific gravity that is at least five times the specific gravity of water [44]. Although there is no clear definition of “heavy metal” density, heavy metals can be defined as chemical compounds having a specific density of more than 5 g/cm [3,44]. Hazardous waste sites provide a list of all hazards according to their prevalence and severity of their toxicity assessed by the U.S. Agency for Toxic Substances and Disease Registry (ATSDR). The first, second, third, and sixth hazards on the list are heavy metals: Pb, Hg, As, and Cd, respectively [46]. In small quantities, certain heavy metals are essential nutrients for a healthy life, belonging to the so-called “essential elements or trace minerals” group such as zinc (Zn), iron (Fe), manganese (Mn), and copper (Cu) [41–43]. They are absorbed through food along with proteins and complex carbohydrates and are necessary to maintain the normal functions of many enzymes and transcription factors [41–45]. Trace elements exist in all tissues and cells, and the dynamic balance of elements depends on their intestinal absorption and excretion by the intestine and kidneys [43]. Essential trace element levels change with acute stress and trauma; blood Zn and Fe concentrations often reduce during inflammation and infection [45,46]. At the initiation of the stress response, kidneys increase the excretion of trace elements. Preterm infants show acutely low blood levels of Zn, selenium (Se), and Fe, with low correlation with the degree of prematurity as patients with severe trauma [47,48]. Trace element levels of the body are susceptible to pathological conditions and large amounts of trace elements are needed. Also toxic levels of trace elements are harmful for humans and the high levels of trace elements and heavy metals appear to interfere with the other trace element metabolisms by altering their gastrointestinal and urinary excretion or absorption. Individuals will absorb more lead through their food if their diets are deficient in Ca, Fe, or Zn. During pregnancy, the placenta behaves as a very active transporter of essential elements (Ca, Cu, Zn, and Fe) and toxic elements (Cd, Hg, Nickel) to the developing fetus [22]. For example, elevated blood Pb levels during pregnancy is associated with increased plasma Cu and Fe but a decreased plasma Zn. Extra-lead is released from maternal

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Lead

skeleton during pregnancy due to mobilization of bone Pb stores, particularly in women who smoke or women whose Ca intake is low. Complications of pregnancy, such as gestational hypertension, malaria, and LBW deliveries, may be induced by elevated prenatal blood Pb, which alters trace element metabolism [49]. Pb and/or Cd exposure cause deficiency of antioxidant trace elements like Zn, Cu, Mn, Se, and Fe by promoting their urinary loss, which could result in further oxidative damage [50–52]. Replacing trace element deficiencies or detoxifying after toxic metal or trace elements exposure decreased mortality and morbidity. For example, replacing Fe, Zn, and folic acid during pregnancy has been shown to reduce the number of LBW and SGA babies, preterm delivery, and maternal anemia [53,54]. Replacement of Cu and Se in preterm infant during early postnatal management may decrease the ROP risk factors and may prevent ­diseases due to trace element deficiencies [55]. Although the effect of a high-level exposure to the heavy metals are well known for animals and humans, the data on the effects of the environmental exposure on the preterm mortality and placental fetal-maternal compartment are limited. Also, despite adults, the fetus is highly susceptible to subtle teratogens at low exposure levels that do not significantly compromise the clinical status of the pregnant woman. The number of live births did not markedly affect the levels of Cd and Pb but was negatively associated with Hg [56,57]. If exposure occurs during the organogenesis, heavy metals could produce permanent structural and anatomical changes. Also, if the exposure occurs after the end of the organogenesis, it might result in functional consequences. The immune, respiratory, and central nervous systems are also susceptible to postnatal exposures because they are immature at birth and characterized by a prolonged period of postnatal maturation [22,42,58].

LEAD Lead is a widespread environmental pollutant associated with adverse health effects in humans. Sixty percent of lead is used for the manufacture of batteries (automobile batteries, in particular), while the remainder is used in the production of pigments, glazes, solder, plastics, cable sheathing, ammunition, weights, gasoline additive, and a variety of other products. Such industries continue to pose a significant risk to workers, as well as surrounding communities. Water with a lower pH can increase the impact of lead exposures. Lead in soil tends to concentrate in root vegetables and leafy green vegetables. Other more uncommon sources of lead exposure also continue to be sporadically found, such as improperly glazed ceramics, lead crystal, imported candies, certain herbal folk remedies, and vinyl plastic toys and

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tobacco smoking [58]. Over the last few decades, however, Pb emissions in developed countries have decreased markedly due to the introduction of unleaded petrol. Subsequently, blood Pb levels in the general population have decreased [58]. Although remarkable reductions in Pb exposure of the general population have been achieved in most of North America and Europe, adults and children worldwide continue to be exposed through a variety of environmental media and informal sector ­occupations [59].

Lead and Placenta Lead was found to easily cross the placental barrier by means of passive diffusion [60]. Similarly, a positive correlation was observed in the majority of the studies between placental and cord blood levels Pb, Hg, and Cd [61]. Pb may alter Ca-mediated cellular processes in syncytiotrophoblasts. Pb may precipitate, along with Ca, in the microvilli around the trophoblast [62,63]. Pb storage observed in syncytiotrophoblast cells may be related to a reduced cytochrome oxidase activity [64]. Pb can persist in bone for decades after exposure, which in turn serves as an internal source of exposure [65,66]. Endogenous Pb exposure is an important independent predictor of adverse health outcomes, such as cognitive decline [67,68], cardiovascular disease [69], and decreased fetal growth [70–72]. During pregnancy, these internal stores of Pb mobilize to a marked degree, partitioning into red blood cells (∼99%) and plasma (∼1%). The pattern of association between plasma and whole blood Pb remains largely unclear and whole blood Pb levels are not an accurate reflection of plasma Pb levels [73,74]. Lead levels in children continue to be a health hazard as the current limit of 10 mg/dl is considered to be too high with the WHO estimate of 40% of children having blood levels greater than 5 mg/dl. Some authors have suggested that a new limit should be set at 2 mg/dl [44,45]. Also, the length of gestation and intrauterine growth decrease inversely with the maternal blood Pb levels, thus Pb increases the risk of prematurity and SGA [75–77]. Thereby, Pb increases the risk of mortality and morbidity due to increased prematurity and SGA [1–5,75–77].

The Effect of Heavy Metals on HypothalamicPituitary-Adrenal Axis Preterm delivery is a complex condition with a multifactorial etiology. The mechanisms of effect for Pb exposure are unclear on preterm birth. However, it was shown that Pb may alter the hypothalamic-pituitary-adrenal (HPA) axis. Activation of the fetal HPA axis starts

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48 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity parturition through the fetal hypothalamus and/or the placenta increase in secretion of corticotropin-releasing hormone (CRH) ultimately leading to uterine contraction, cervical maturating, and decidual/fetal membrane activation [78]. Altering the pathway of CRH release during pregnancy has been suggested as one possible mechanism that can lead to preterm birth [79–82]. Increased maternal stress is a known risk factor in preterm delivery, which is supposed to act through the maternal/­ fetal HPA pathway by altering CRH release [83]. Lead exposure may play an important role by increasing the overall baseline level of corticosterone in rats and increasing the response to acute stressors [84,85]. Therefore, we may suggest that increased Pb exposure early in gestation may alter corticotrophin-releasing hormone release alone or together with increased maternal stress responses.

The Effect of Heavy Metals on Oxidative Stress Heavy metals, such as in preterm mortality and morbidity, can damage human health through an oxidative cell stress (e.g., Cd, Cr, Pb, As), neurological or renal damage (e.g., Pb, Hg), DNA injury (e.g., As, Cr, Cb), or altered glucose (e.g., As) [20–26,84–98]. However, the exact mechanisms of toxicity for these heavy metals are not fully understood. It was shown that Pb exposure raises superoxide and hydrogen peroxide in human endothelial and vascular smooth muscle cells. Pb may play a role in enzymatic inhibition or impaired antioxidant metabolism and in induction of oxidative stress [98,99]. The toxic effects of heavy metals is not only in the induction of oxidative stress, but may also be associated with substitute diverse polyvalent cations (Ca, Zn, and Mg) [98] that function as charge carriers, intermediaries in catalyzed reactions, or as structural elements in the maintenance of protein conformation. Indeed, metals accumulate in cellular organelles and interfere with their function [98–100]. Oxidative stress, defined as an imbalance between cellular reactive oxygen species (ROS) and their control by antioxidants, is one of the most important toxic effects of Pb [101–105]. An oxidative stress occurs at birth in all newborns as a result of the hyperoxic environment due to the transition from the hypoxic intrauterine environment to extrauterine life. Free radical sources (such as inflammation, hydroxyl radicals, hypoxia–hyperoxia, and ischemia), glutamate, and high free Fe release increase oxidative stress during the perinatal period [106–110]. In addition, preterm babies have reduced antioxidant defenses that are not able to counteract the harmful effects of ROS leading to the so called “free-radicals-related disease” of newborns including bronchopulmonary dysplasia (BPD), reperfusion injury after hypoxia, intraventricular hemorrhage (IVH), necrotizing enterocolitis

(NEC), retinopathy of prematurity (ROP), increased ferritin levels due to more packed red cell transfusion, and infections [106–110]. Also, pro-inflammatory cytokines, vascular growth factors, and lipid peroxidation increase in these diseases [109,110]. Free-radicals-related diseases, RDS, PDA, acute renal failure, perinatal hypoxia, and infections are responsible for preterm morbidity and mortality. Also, it is known that Pb may cause a reduction in the activity of antioxidant enzymes and in glutathione content because of the metal’s high affinity to sulfhydryl groups and metal cofactors [101]. The activity of antioxidant enzymes and glutathione content in preterm are less than that in term infant [111,112]. Also, preterm infants are more susceptible to oxidative stress than term infants and adults [106–112]. From a mechanistic point of view, as Shachar et al. hypothesized about preterm birth in their review, Pb seems to play a role in the pathogenesis of free-radicals-related diseases and mortality with enzymatic inhibition and in impaired antioxidant metabolism, and affects oxidative stress in preterm infants [102]. In addition to decreasing antioxidant defense, Pb may interfere with membrane integrity and fatty-acid composition, contributing to the production of ROS [113]. Polymorphisms in genes related to oxidative stress have been observed to modulate the effects of heavy metals exposure in medical conditions such as cardiovascular disease and cancer [69,84,99,100,113]. Although there are many findings showing that heavy metals exposure causes preterm birth, no published study has explored the potential interactive effects between oxidative stress genes and heavy metal exposure on risk susceptibility to preterm birth [36–40,70,73,76–79]. However, in light of the information that shows the effects of heavy metals on polymorphisms in genes related to oxidative stress, Shachar et al. noted that lead seems to play a role in the pathogenesis of preterm birth [98–108]. Also, heavy metals affect regulation of detoxification genes, which in turn modulate oxidative stress. Detoxification processes involve two major phases: phase I, entailing the polarization of toxic compounds, and phase II. Cytochrome P450 1A1(CYP1A1) is a phase I hepatic and extra hepatic enzyme whose activity is modulated by heavy metals (Pb, Cd, Cu, chromium, vanadium, and especially Fe) via regulating the aryl hydrocarbon receptor signaling pathway of CYP1A1 [113]. Glutathione S-transferase theta 1 (GSTT1) is a phase II detoxification enzyme catalyzing the conjugation of glutathione to heavy metals and other toxicants [114–122]. For example, the selenoenzymes thioredoxin reductase and glutathione peroxidase were inhibited via interaction with heavy metals especially Hg [115]. CYP1A1 and GSTT1 are highly polymorphic genes and the polymorphisms are associated with differential susceptibility to the adverse effects of heavy metals [114–122]. Deletions

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Lead

in glutathione S-transferases mu 1 (GSTM1) and GSTT1 were found to be associated with higher Hg levels [114– 122]. Polymorphisms in CYP1A1, GSTM1, and GSTT1 have been associated with differential risk for preterm birth [120,121]. Nukui et al. found that women and fetuses exposed to cigarette smoke during pregnancy and those who were characterized by a GSTT1 null genotype had an elevated risk for preterm birth [121]. Also, Tsai et al. showed the association between Cd exposure, highrisk CYP1A1 and GSTT1 genotypes polymorphisms, and preterm birth in maternal cigarette smoking [122]. Human paraoxonases (PONs) are a family of proteins that provide protection from physiological oxidative stress and inflammatory processes. In particular, paraoxonase 1 (PON1) is a high-density lipoprotein-binding enzyme exhibiting calcium-dependent enzyme esterase, lactonase, and peroxidase activity and hydrolyzes toxic oxidized lipids and protects against cardiovascular diseases [123,124]. There is a link between genetic polymorphisms of PON1 and hyperlipidemia and increased lipid oxidation [123–126]. Lüersen et al. showed that Pb exposure is associated with decreased serum PON1 activity and PON1 R192 genotypes [127]. The low-antioxidant PON1 R192 allele is associated with increased tumor necrosis factor (TNF)-alpha, a pro-inflammatory cytokine known to be involved in the initiation process of atherosclerosis [127]. Metal ions, particularly Pb, Cu, and Hg, may bind to free sulfhydryl groups of the PON1 enzyme thus reducing its hydrolytic activity and its antioxidant function [128]. Subjects who are homozygous for the Q192R PON1 allele are more susceptible to Pb toxicity, or subjects who have the 192R alloform have higher levels of As and Pb blood levels [128,129]. Based on the relationship of heavy metals with atherosclerosis and of PON1 with lipoproteins, Chen et al. hypothesized that the variants in the gene of PON1 enzyme may be related to vascular endothelial damage, placental insufficiency, and thrombosis, and thus could lead to adverse pregnancy [130]. Later, Ryckman et al. showed maternal and fetal genetic associations of PTGER3 and PON1 with preterm birth [131]. The PON1 gene has three polymorphisms that are considered to be strong determinants of PON1 levels (especially Q192R and L55M in the coding region and C-108T in the promoter region) [132]. InfanteRivard showed that an increased risk of SGA birth is associated with these variants of the PON1 gene [132]. An increased risk of preterm birth was found among infants with PON1 Q192R genotype compared with other genotypes. Baker et al. found lower mid-gestation PON1 activity in women who later had spontaneous preterm birth [133]. Lee et al. found an increased risk for preterm birth among women with elevated body mass index (BMI > 30) and PON1 Q192R allele [134]. An increased concentration of products of lipid peroxidation,

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­TNF-alpha, and vascular growth factors were demonstrated in postnatal free-radicals-related diseases as hypoxic ischemic encephalopathy, BPD, NEC, ROP, PVL, and so on were demonstrated in premature infants and higher levels were found in those who subsequently developed BPD [106–110]. A positive correlation was found between the duration of oxygen and ventilation therapy and lipid peroxidation by Inder et al. [135]. Therefore, it may be hypothesized that increased lipid peroxidation, TNF-alpha as pro-inflammatory cytokines and reduced PON1 antioxidant activity due to Pb, Cd, Hg, may promote a pro-oxidant situation and enhance the risk for preterm birth and free-radicals-related diseases, such as BPD, NEC, ROP, and sepsis, and mortality [120–137]. Heme-oxygenase (HO) is the enzyme of the microsomal heme degradation pathway that yields biliverdin, carbon monoxide, and iron [138]. Also, the expression of the HO 1 (HO-1) related gene, which contributes to the maintenance and development of a healthy full-term pregnancy, can be induced by heavy metals, especially Cd [139]. The promoter region of the HO-1 gene contains a Cd response element, the binding site for Cd, which is a potent inducer of HO-1 transcription [139]. The polymorphism of the human HO-1 gene promoter composes of the single nucleotide polymorphism and dinucleotide polymorphism, which may contribute to the fine-tuning of the transcription. Long alleles have been found to be associated with susceptibility to smoking-induced ­emphysema or coronary artery disease, while they may be linked to resistance to cerebral malaria [135–139]. However, the effects of heavy metals on HO-1 gene polymorphisms have not been studied in association with preterm birth or preterm mortality and morbidity. Despite this, it may be possible that Cd exposure and susceptibility are linked to preterm birth through the binding of Cd to the Cd ­response element of the HO-1 gene [139–141]. Furthermore, the toxic effects of heavy metals, apart from inducing oxidative stress, can also be attributed to their ability to substitute diverse polyvalent cations (Ca, Zn, and Hg) that function as charge carriers, intermediaries in catalyzed reactions, or as structural elements in the maintenance of protein conformation. Indeed, metals accumulate in cellular organelles and interfere with their function. For example, it has been observed that Pb accumulation in mitochondria induces several changes such as inhibition of Ca2 uptake, reduction of the transmembrane potential, oxidation of pyridine nucleotides, and a fast release of accumulated Ca2+ [142].

The Other Effects of Lead Moreover, metals bind to proteins [143] and inhibit a large number of enzymes including the mitochondrial ones [144]. Nucleic-acid-binding proteins are also involved, while it has been shown that metals can also

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50 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity bind to DNA, affecting the expression of genes. Finally, some metals interfere with various voltage- and ligandgated ionic channels exerting neurotoxic effects. For instance, Pb affects the N-methyl-d-aspartic acid (NMDA) receptor, subtypes of voltage- and Ca-gated K channels, cholinergic receptors, and voltage-gated Ca channels [144]. We found an association between heavy metals (Pb and Cd) levels and mortality, in addition to nonsurviving preterm infants, with low Apgar scores as in the study of Al-Saleh et al. [37,38]. These ionic channels also play a role in the pathogenesis of hypoxic ischemic encephalopathy. Therefore, it may be suggested that the relationship of ionic channels activity due to Pb, Cd, and Hg may promote perinatal hypoxia and enhance the risk for mortality.

­methylmercury [149]. Multiple studies have concluded that there is no association between prenatal or perinatal exposure to thimerosal and autism spectrum disorders [150,151]. However, psychomotor development index was negatively affected by EtHg. Age of talking was negatively affected by Hg in hair [152]. Hg0 is absorbed mainly through the respiratory tract. Then it is oxidized mainly by erythrocyte catalase to mercurous (Hg+) and mercuric (Hg2+) ions. These ions are toxic to several organs, such as the central nervous system (CNS), but particularly the kidneys. Conversely, a certain amount of blood Hg0 passes through the BBB, reaching the CNS. Data on the distribution of brain Hg after Hg0 exposure are limited [137,145,146,153–157]. In an experimental study, Hg was found in both glial cells and neurons mainly in the cortical areas and in the fiber systems by Warfvinge et al. [158]. MERCURY The interactions of MeHg with sulfhydryl-containing proteins (i.e., neurotransmitter receptors, transporters, Mercury is present in the environment due to both antioxidant enzymes, etc.), as well as with nonprotein natural (evaporation of earth’s surface and volcanic thiols (i.e., glutathione, cysteine), are crucial events in eruptions) and anthropogenic (emissions from coal- mediating MeHg’s neurotoxicity [159–161]. By direct burning power stations and incinerators) sources. Differ- interaction with thiols, as well as indirect mechanisms, ent chemical forms of Hg are present, such as elemental MeHg can modify the oxidation state of the –SH groups Hg (Hg0), inorganic (divalent and monovalent cationic on proteins, modulating their functions [161]. Conseforms: Hg2+ and Hg+), and organic (i.e., methylmercury quently, the activities of several SH-containing proteins (MeHg) and ethylmercury (EtHg)) Hg compounds [145]. whose roles are decisive for proper homeostasis of neuMetallic Hg is used in thermometers, dental amal- ronal and glial cells (creatine kinase [162], GSH reductase gams, and some batteries. Metallic Hg is a liquid. It is [163], Ca2+-ATPase [164], thioredoxin reductase [165], not hazardous if ingested. Although metallic Hg is not choline acetyltransferase and enolase [166]) are disturbed significantly absorbed in this form, if aerosolized, metal- after MeHg exposure. Altered protein function has been lic mercury is well absorbed by the lungs. Divalent and posited as a causative factor in MeHg-induced neurotoxmonovalent cationic forms of mercury are encountered in icity and neurodegeneration [167]. Moreover, several in some chemical, metal-processing, electrical-equipment, vitro and in vivo studies have shown that MeHg exposure automotive, and building industries, and in medical and causes GSH depletion [168–172]. Ni et al. compared the dental services. These cationic forms, inorganic and or- responses of astrocytes and microglia following MeHg ganic compounds combined with other chemicals, can exposure, specifically addressing the effects of MeHg on readily be absorbed through ingestion. All three forms of cell viability, ROS generation, and GSH levels, as well as mercury are toxic to various degrees [146]. Hg uptake and the expression of NF-E2-related factor 2 MeHg is actively transferred from the placenta to the (Nrf2). They showed that microglia are more sensitive to fetus, reaching the fetal brain as its cysteine conjugate MeHg than astrocytes, a finding that is consistent with via the neutral amino acid carrier system as well as a their higher Hg uptake and lower basal GSH levels. Migreat retention in the fetus brain [146–148]. Its high entry croglia also demonstrated higher ROS generation comin the developing brain is related to the lack of functional pared with astrocytes. Nrf2 and its downstream genes blood–brain barrier (BBB) [148]. Maternal exposure to were upregulated in microglia with much faster kinetics MeHg during pregnancy causes neurological deficits in than in astrocytes. Therefore, Ni et al. suggested that mitheir offspring [137,145–148]. MeHg affects cell differen- croglia and astrocytes each exhibit a distinct sensitivity tiation, migration, and synaptogenesis [147,148]. There- to MeHg, resulting in their differential temporal adaptive fore, exposure to MeHg during early fetal development responses; these unique sensitivities appear to be depenleads to subtle brain injury at levels much lower than dent on the cellular thiol status of the particular cell type those affecting the mature brain [147]. [169]. Franco et al. noted that the exposure of lactating EtHg exposure occurs only through thimerosal-­ mice to MeHg causes significant impairments in motor containing vaccines widely used in pediatric populations performance in the offspring, which may be related to a of third-world countries. Ethylmercury is eliminated decrease in the cerebellar thiol status, and the increased more rapidly and bioaccumulates much less than GSH levels and glutathione reductase activity, observed A.  Overview on Fertility



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Cadmium

only in the cerebellums of MeHg-exposed dams, could represent compensatory pathophysiologic responses to the oxidative effects of MeHg toward ­endogenous GSH [170]. GSH has a crucial role in maintaining redox homeostasis [161]. Drescher et al. recently showed a gene–environment interaction between the rs705379 polymorphism and MeHg exposure on PON1 activity levels in the aboriginal population [173]. Therefore, we suggested that antioxidant depletion, increased lipid oxidation, and increased oxidative stress due to exposure of MeHg seem to play a role in the pathogenesis of preterm birth, mortality, morbidity, and PVL due to free-radicals or inflammatory-related diseases [106–110,168–172]. Also, low-level Hg is toxic to the fetal and infant nervous system. Mothers exposed to Hg in the 1955 disaster in Minamata Bay, Japan, gave birth to infants with mental retardation, retention of primitive reflexes, cerebellar symptoms, and other abnormalities. Recent research in the Faroe Islands has demonstrated that even at much lower levels, it is associated with decrements in motor function, language, memory, and neural transmission in the offspring [174] Organic mercury, the form of mercury bioconcentrated in fish and whale meat, readily crosses the placenta and appears in breast milk and meconium. Organic mercury can also be excreted via the biliary route, likely complexed to GSH, as a GSH mercaptide [174,175]. Matrix metalloproteinases are also thought to modulate the effects of heavy metals especially Hg. Matrix metalloproteinases hydrolyze extracellular matrix components in a variety of processes ranging from implantation and embryogenesis to inflammation, injury healing, metastasis, and angiogenesis [176]. Matrix metalloproteinases expression may be promoted by inflammatory cytokines, growth factors, hormones, extracellular matrix components, and ROS. BPD is characterized by a tissue remodeling, and is divided into different phases ending in the chronic phase with an increased number of fibroblasts and fibrotic areas. Matrix metalloproteins are important in regulating fibrotic processes; they degrade extracellular matrix proteins and fibrillar collagen. The balance between matrix metalloproteins and their inhibitors is of primary importance in the development and regulation of fibrosis. Oxidative stress increases both matrix metalloproteins and their inhibitors [112], so it may lead to lung damage by increasing collagenase activity, causing disruption of the extracellular matrix. Also, matrix metalloproteins expression in addition to inflammatory cytokines, growth factors, and ROS may play a role in pathogenesis and postnatal angiogenesis of BPD and ROP [174,175]. Conversely, matrix metalloproteins secreting cells also produce tissue inhibitors of metalloproteinases [174,175]. Metalloproteinases, whose production is enhanced by prostaglandins, play

an important role in promoting uterine contractions and preterm birth by stimulating cervical ripening and membrane activation [178]. In particular, metalloproteinases degrade extracellular matrix proteins, such as collagens and fibronectins, leading to weakening of membranes and their subsequent rupture [179]. In a recent study by Sundrani et al. [180], placental metalloprotein 1 and metalloprotein 9 levels were significantly increased in women with spontaneous preterm birth compared to those delivering at term, suggesting that placental metalloprotein 1/metalloprotein 9 levels may be involved in the initiation of parturition [181]. Polymorphisms in metalloproteinases and tissue inhibitors of metalloproteinases have been found to modulate the risks for PPROM and preterm birth [181,182]. Several polymorphisms in metalloproteinases and tissue inhibitors of metalloproteinases have been found to modulate the effects of heavy metal exposure (especially Hg) on the risk of cardiovascular diseases [177]. Also, the single nucleotide polymorphisms in these genes are associated with differential risk of preterm birth [183,184]. Several other oxidative stress-related genes have been associated independently with heavy metals exposure and adverse pregnancy outcomes. Early-life exposures to this metal have been associated with long-lasting and enduring neurobehavioral and neurochemical deficits [185]. AlSaleh et al. showed that Hg in the breast milk of mothers and in the urine of infants affected the excretion of urinary 8-hydroxy-29-deoxyguanosine (8-OH 2-dG) and malondialdehyde (MDA), which are biomarkers of oxidative stress [186]. Also, they showed the association of high levels of heavy metals (Hg and Cd) with low Apgar score [38]. They suggested that exposure to Hg-induced oxidative stress in the newborn or fetus may play a role in pathogenesis, particularly during neurodevelopment [186]. Therefore, it may be suggested that the effect of Hg on glial cell reactivity and Hg-induced oxidative stress via matrix metalloproteinases or PON1 modulating the effects of heavy metals seem also to play a role in the pathogenesis of preterm birth, perinatal hypoxia, BPD, preterm brain inflammation, and mortality.

CADMIUM Cadmium is frequently used in electroplating, pigments, paints, welding, and Ni–Cd batteries. Workers in these occupations are exposed to Cd at significantly higher levels than the general population [187]. The general population is exposed to Cd via drinking water, food, and cigarette smoking [188]. Alcoholic beverages, including wine, can be contaminated with metals in concentrations exceeding the tolerable limits and causing toxic effects, particularly in heavy drinkers [46].

A.  Overview on Fertility

52 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity Cd, at a high dose, is a potent teratogen in rodents [189,190]. When administered to mice during gestation, Cd-induced malformations of the neural tube, craniofacial region, limbs, trunk, viscera, and axial skeleton in fetuses are seen [190–196]. In addition, maternal Cd exposure during pregnancy-induced fetal growth restriction [197,198], fetal death and birth defects [197,198], sudden infant death [199], and preterm birth [37–39,200]. In contrast to Pb and Hg, the placenta acts as a barrier for Cd and very little (10%) is transferred to the fetus [201]. Wang et al. showed that Cd passed to fetuses whose mothers were exposed to Cd during the late pregnancy period [202]. Lower IQ test, crown–heel lengths, Apgar 5-min scores, birth weights, and SGA births below the 10th percentile and placental thickness were influenced by Cd levels in the umbilical cord [38,203]. Also, prenatal Cd exposure may have a detrimental effect on head circumference at birth and child growth in the first 3 years of life [204]. Cd caused a significant increase in the quantity of micronucleated polychromatic erythrocytes and micronucleated normochromatic erythrocytes in blood cells of both the mothers and their fetuses. An increased level of oxidation was also found, measured by a rise in the levels of the adduct 8-hydroxy-2’-deoxyguanosine. Also, in a dose-dependent manner, Cd caused external, visceral, and skeletal malformations and increased the level of DNA oxidation [205,206]. Cd induces oxidative stress via similar mechanisms to Hg or Pb [90,93,94,102,103]. Also, Samuel et al. showed that Cd exposure increases lipid peroxidation and H2O2 concentration [207]. They showed that specific activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, glutathione-S-transferase, and serum testosterone, estradiol, and progesterone were significantly decreased. Cd reduced the hematocrit, hemoglobin content, and mean corpuscular volume (MCV) levels. However, the number of erythrocytes increased, which has been demonstrated by Samuel et al. [207]. Inhibition of Zn-dependent enzymes, and metabolic changes in the fetus and postnatal hepatic tissues have also been reported on Cd exposure [208]. Pillai et al. showed that early developmental exposure to Pb and Cd both alone and in combination can suppress the hepatic xenobiotic metabolizing enzyme activities in the liver of phase I generation (NADPH- and NADH-cytochrome c reductase) and phase II hepatic xenobiotic- and steroidmetabolizing enzymes in vivo [209]. It has been demonstrated in rodents that the hypothalamo-pituitary-liver axis is influenced by hormonal signaling during development [210]. Lipid peroxidation indicates free radical toxicity in the liver of Pb- and Cd-treated female and male rats. Reduced glutathione is a major cellular reductant and plays a very important role against the deleterious ­effects of hydroxyl radicals [211–215].

Maternal Cd exposure during pregnancy induces endoplasmic reticulum (ER) stress in the placenta. Alpha-phenyl-N-t-butylnitrone, a free-radical spintrapping agent and antioxidant, significantly alleviated Cd-induced placental ER stress [202]. Thus, the data generated from these studies suggest that prenatal exposure to Cd may play a role via the ­effect on pathogenesis of related oxidative stress in ­preterm birth, morbidity, and mortality [211–215].

ARSENIC Not only millions of people worldwide are exposed to elevated concentrations mainly via drinking water but also via industrial emissions, food, and air [216]. ­Exposure to As leads to an accumulation of As in tissues, such as the skin, hair, and nails, resulting in various clinical symptoms such as hyperpigmentation and keratosis. Arsenic is a potent human carcinogen and general toxicant but little is known about its effects on maternal and fetal health. Arsenic is metabolized via methylation and reduction reactions, methylarsonic acid and dimethylarsinic acid being the main metabolites excreted in urine [217,218]. Inorganic As and its methylated ­metabolites easily pass the placenta and both experimental and epidemiologic studies have shown increased risk of impaired fetal growth, and fetal and infant mortality [219–224]. Also, experimental studies have shown ­associations between fetal exposure and neurotoxicity and behavioral changes [224]. Recent studies have reported that high-level exposure to arsenic in utero is associated with increased infant mortality, LBW, and birth defects [225,226]. Also, another recent study has reported that in utero exposure to low levels of As may affect the epigenome [227]. Engström et al. showed that the effect of the AS3MT polymorphisms is of importance for risk assessment of As and they thought that a low methylation efficiency is associated with increased risk for As toxicity [228]. Arsenic inhibits DNA repair enzymes and antioxidant-related enzymes (e.g., thioredoxin reductase as Hg) [229, 230]. Altered protein function enzyme inhibition and oxidative stress, as well as epigenetic effects mainly via DNA hypomethylation, have been posited as a causative factor in As-induced neurotoxicity, endocrine effects (most classes of steroid hormones), immune suppression, neurotoxicity, and interaction with enzymes critical for fetal development and programming IUGR, spontaneous abortions, premature delivery, malformations, birth defects, learning and behavior deficits, and neonatal deaths [231–236]. Two to three times more spontaneous abortion and stillbirth have been reported among women especially those who were exposed to high As concentrations in their drinking water (>50 mg/l) [231,237].

A.  Overview on Fertility



REFERENCES

Communities with water As levels greater than 5 mg/l should consider a program to document As levels in the population [237]. The fetus and infant are probably partly protected by the increased methylation of As during pregnancy and lactation; the infant is also protected by low As excretion in breast milk [216]. A couple of studies reported increased blood pressure and anemia during pregnancy. Susceptibility to As is dependent on the biomethylation, which occurs via one-carbon metabolism [238–240].

CONCLUSIONS Heavy metals affect fetal development and programming IUGR, spontaneous abortions, premature delivery, malformations, birth defects, learning and behavior deficits, and neonatal deaths and preterm morbidity through increasing oxidative stress, lipid peroxidation, and TNF-alpha such as pro-inflammatory cytokines and reducing PON1 antioxidant activity. Also, heavy metals may be modulated by gene polymorphisms associated with these activities. They induce DNA biomethylation, interfere in the conjugation of detoxification or catalyzing enzymes by binding to these enzymes, or interfere with the trace elements metabolism by altering their gastrointestinal absorption and urinary excretion. Also, the impacts of environmental exposures on pregnancy outcome or development may have no thresholds. Therefore, the approach is to keep environmental exposures for all individuals as low as possible.

References [1] UNICEF. Low Birthweight: Country, Regional and Global Estimates. New York: WHO; 2004. [2] Lee ACC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, et al. Born too small: national and regional estimates of term and preterm small-for-gestational-age in 138 low-income and middle-income countries in 2010. Lancet Glob Health 2013;1(1):e26–36. [3] Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013;10(Suppl 1):S2. [4] Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, Liston R, et al. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000;284:843–9. [5] Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 2013;382(9890):417–25. [6] Jackson DJ, Lang JM, Ganiats TG. Epidemiological issues in perinatal outcomes research. Paediatr Perinat Epidemiol 1999;13:392–404. [7] Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010;88:31–8. [8] Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010;126:443–56.

53

[9] Muglia LJ, Katz M. The enigma of spontaneous preterm birth. N Engl J Med 2010;362:529–35. [10] Gravett MG, Rubens CE, Nunes TM. GAPPS Review Group. Global report on preterm birth and stillbirth (2 of 7): discovery science. BMC Pregnancy Childbirth 2010;10(Suppl 1):S5. [11] Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010;126:443–56. [12] Wu J, Ren C, Delfino RJ, Chung J, Wilhelm M, Ritz B. Association between local traffic-generated air pollution and preeclampsia and preterm delivery in the south coast air basin of California. Environ Health Perspect 2009;117:1773–9. [13] Lipfert FW, Zhang J, Wyzga RE. Infant mortality and air pollution: a comprehensive analysis of U.S. data for 1990. J Air Waste Manag Assoc 2000;50:1350–66. [14] Hajat S, Armstrong B, Wilkinson P, Busby A, Dolk H. Outdoor air pollution and infant mortality: analysis of daily time-series data in 10 English cities. J Epidemiol Community Health 2007; 61:719–22. [15] Rogers JF, Dunlop AL. Air pollution and very low birth weight infants: a target population? Pediatrics 2006;118(1):156–64. [16] Pedersen M, Giorgis-Allemand L, Bernard C, Aguilera I, Andersen AM, Ballester F, et al. Ambient air pollution and low birthweight: European cohort study (ESCAPE). Lancet Respir Med 2013;1(9):695–704. [17] Cantonwine D, Hu H, Sánchez BN, Lamadrid-Figueroa H, Smith D, Ettinger AS, et al. Critical windows of fetal lead exposure: adverse impacts on length of gestation and risk of premature delivery. J Occup Environ Med 2010;52(11):1106–11. [18] Sanin LH, Gonzalez-Cossio T, Romieu I, Peterson KE, Ruíz S, Palazuelos E, et al. Effect of maternal lead burden on infant weight and weight gain at one month of age among breastfed infants. Pediatrics 2001;107:1016–23. [19] Jelliffe-Pawlowski LL, Miles SQ, Courtney JG, Materna B, Charlton V. Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes. J Perinatol 2006;26:154–62. [20] Mattison DR. Environmental exposures and development. Curr Opin Pediatr 2010;22(2):208–18. [21] Osman K, Akesson A, Berglund M, Bremme K, Schütz A, Ask K, et al. Toxic and essential elements in placentas of Swedish women. Clin Biochem 2000;33:131–8. [22] Caserta D, Graziona A, Lo Monte G, Bordi G, Moscarini M. Heavy metals and placental fetal-maternal barrier: a mini-review on the major concerns. Eur Rev Med Pharmacol Sci 2013;17:2198–206. [23] Wier PJ, Miller RK, Maulik D, DiSant’Agnese PA. Toxicity of cadmium in the perfused human placenta. Toxicol Appl Pharmacol 1990;105:156–71. [24] Amaya E, Gil F, Freire C, Olmedo P, Fernández-Rodríguez M, Fernández MF, et al. Placental on centrations of heavy metals in a mother–child cohort. Environ Res 2013;120:63–70. [25] Zdravkovica T, Genbaceva O, Mc Mastera MT, Fisher SJ. The adverse effects of maternal smoking on the human placenta: a review. Placenta 2005;26(Suppl A):S81–6. [26] Torres-Sánchez LE, Berkowitz G, López-Carrillo L, Torres-Arreola L, Ríos C, López-Cervantes M. Intrauterine lead exposure and ­preterm birth. Environ Res 1999;81(4):297–301. [27] Raghunath R, Tripathi RM, Sastry VN, Krishnamoorthy TM. Heavy metals in maternal and cord blood. Sci Total Environ 2000;250(1-3):135–41. [28] Sakamoto M, Yasutake A, Domingo JL, Chan HM, Kubota M, Murata K. Relationships between trace element concentrations in chorionic tissue of placenta and umbilical cord tissue: potential use as indicators for prenatal exposure. Environ Int 2013;60:106–11. [29] Leino O, Kiviranta H, Karjalainen AK, Kronberg-Kippilä C, Sinkko H, Larsen EH, et al. Pollutant concentrations in placenta. Food Chem Toxicol 2013;54:59–69.

A.  Overview on Fertility

54 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity [30] Iyengar GV, Rapp A. Human placenta as a ‘dual’ biomarker for monitoring fetal and maternal environment with special reference to potentially toxic trace elements. Part 3: toxic trace elements in placenta and placenta as a biomarker for these elements. Sci Total Environ 2001;280(1-3):221–38. [31] Turker G, Ergen K, Karakoç Y, Arisoy AE, Barutcu UB. Concentrations of toxic metals and trace elements in the meconium of ­newborns from an industrial city. Biol Neonate 2006;89:244–50. [32] Ostrea EM, Morales V, Ngoumgna E, Prescilla R, Tan E, Hernandez E, et al. Prevalence of fetal exposure to environmental toxins as determined by meconium analysis. Neurotoxicology 2002;23:329–39. [33] Friel JK, Matthew JD, Andrews WL, Skinner CT. Trace elements in meconium from preterm and full-term infants. Biol Neonate 1989;55:214–7. [34] Haram-Mourobet S, Harper RG, Wapnir RA. Mineral composition of meconium: effect of prematurity. J Am Coll Nutr 1998;17:356–60. [35] Ostrea EM Jr, Bielawski DM, Posecion NC Jr, Corrion M, Villanueva-Uy E, Jin Y, et al. A comparison of infant hair, cord blood and meconium analysis to detect fetal exposure to environmental pesticides. Environ Res 2008;106(2):277–83. [36] Özsoy G, Turker G, Özdemir S, Gökalp AS, Barutçu B. The effect of heavy metals and trace elements in the meconium on preterm delivery of unknown etiology. Turkiye Klinikleri J Med Sci 2012;32(4):925–31. [37] Turker G, Özsoy G, Özdemir S, Barutçu B, Gökalp AS. Effect of heavy metals in the meconium on preterm mortality: preliminary study. Pediatr Int 2013;55:30–4. [38] Al-Saleh I, Shinwari N, Mashhour A, Rabah A. Birth outcome measures and maternal exposure to heavy metals (lead, cadmium and mercury) in Saudi Arabian population. Int J Hyg Environ Health 2014;217(2-3):205–18. [39] Cantonwine D, Hu H, Sánchez BN, Lamadrid-Figueroa H, Smith D, Ettinger AS, et al. Critical windows of fetal lead exposure: ­adverse impacts on length of gestation and risk of premature ­delivery. J Occup Environ Med 2010;52(11):1106–11. [40] Vigeh M, Yokoyama K, Seyedaghamiri Z, Shinohara A, Matsukawa T, Chiba M, et al. Blood lead at currently acceptable levels may cause preterm labour. Occup Environ Med 2011;68(3):231–4. [41] Llobet JM, Falcó G, Casas C, Teixidó A, Domingo JL. Concentrations of arsenic, cadmium, mercury, and lead in common foods and estimated daily intake by children, adolescents, adults, and seniors of Catalonia. Spain. J Agric Food Chem 2003;51:838–42. [42] Järup L. Hazards of heavy metal contamination. Br Med Bull 2003;68:167–82. [43] Fraga CG. Relevance, essentiality and toxicity of trace elements in human health. Mol Aspects Med 2005;26:235–44. [44] Prasher D. Heavy metals and noise exposure: health effects. Noise Health 2009;11:141–4. [45] Agency for Toxic Substances and Disease Registry (ATSDR). Public health statement for cadmium, September 2008 [displayed January 3, 2012]. Available from: http://www.atsdr.cdc.gov/phs/ phs.asp?id=46&tid=15. [46] Tariba B, Pizent A, Kljakovic´-Gašpic´ Z. Determination of lead in Croatian wines by graphite furnace atomic absorption spectrometry. Arh Hig Rada Toksikol 2011;62:25–31. [47] Black RE. Micronutrients in pregnancy. Br J Nutr 2001;85:S107–93. [48] Wang BH, Yu XJ, Wang D, Qi XM, Wang HP, Yang TT, et al. Alterations of trace elements (Zn, Se, Cu, Fe) and related metalloenzymes in rabbit blood after severe trauma. J Trace Elem Med Biol 2007;21:102–7. [49] Saaka M, Oosthuizen J, Beatty S. Effect of joint iron and zinc supplementation on malarial infection and anaemia. East Afr J Public Health 2009;6(1):55–62. [50] Wang G, Lai X, Yu X, Wang D, Xu X. Altered levels of trace elements in acute lung injury after severe trauma. Biol Trace Elem Res 2012;147:28–35.

[51] Ugwuja EI, Ejikeme B, Obuna JA. Impacts of elevated prenatal blood lead on trace element status and pregnancy outcomes in occupationally non-exposed women. Int J Ocup Environ Med 2011;2(3):143–56. [52] Wang L, Zhou X, Yang D, Wang Z. Effects of lead and/or cadmium on the distribution patterns of some essential trace elements in ­immature female rats. Hum Exp Toxicol 2011;30(12):1914–23. [53] Shah PS, Ohlsson A. Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis. CMAJ 2009;180(12):E99–E108. [54] Ladipo OA. Nutrition in pregnancy: mineral and vitamin supplements. Am J Clin Nutr 2000;72(Suppl):280S–90S. [55] Yang H, Ding Y, Chen L. Effect of trace elements on retinopathy of prematurity. J Huazhong Univ Sci Technolog Med Sci 2007;27(5):590–2. [56] Hansen S, Nieboer E, Sandanger TM, Wilsgaard T, Thomassen Y, Veyhe AS, et al. Changes in maternal blood concentrations of selected essential and toxic elements during and after pregnancy. J Environ Monit 2011;13:2143–52. [57] Jain RB. Effect of pregnancy on the levels of blood cadmium, lead, and mercury for females aged 17–39 years old: data from national health and nutrition examination survey 2003–2010. J Toxicol ­Environ Health A 2013;76(1):58–69. [58] Hu H. Human health and heavy metals exposure. In: McCally M, editor. Life Support: The Environment and Human Health. MIT Press; 2002. p. 1–10. [59] Ahmed K, Ayana G, Engidawork E. Lead exposure study among workers in lead acid battery repair units of transport service enterprises, Addis Ababa, Ethiopia: a cross-sectional study. J Occup Med Toxicol 2008;3:30. [60] Goyer RA. Transplacental transport of lead. Environ Health ­Perspect 1990;89:101–5. [61] Esteban-Vasallo MD, Aragones N, Pollan M, Lopezabente G, PerezGomez B. Mercury, cadmium, and lead levels in human placenta: a systematic review. Environ Health Perspect 2012;120:1369–77. [62] Al-Saleh I, Shinwari N, Mashhour A, Rabah A. Birth outcome measures and maternal exposure to heavy metals (lead, cadmium and mercury) in Saudi Arabian population. Int J Hyg Environ Health 2014;217(2-3):205–18. [63] Al-Saleh I, Shınwari N, Mashhour A, Mohamed Gel D, Rabah A. Heavy metals (lead, cadmium and mercury) in maternal, cord blood and placenta of healthy women. Int J Hyg Envir Health 2011;214:79–101. [64] Reichrtova E, Dorociak F, Palkovicova L. Sites of Pb and Ni accumulation in the placental tissue. Hum Exp Toxicol 1998;17:176–81. [65] Hu H, Shih R, Rothenberg S, Schwartz BS. The epidemiology of lead toxicity in adults: measuring dose and consideration of other methodologic issues. Environ Health Perspect 2007;115:455–62. [66] Hu H, Rabinowitz M, Smith D. Bone lead as a biological marker in epidemiologic studies of chronic toxicity: conceptual paradigms. Environ Health Perspect 1998;106:1–8. [67] Tellez-Rojo MM, Bellinger DC, Arroyo-Quiroz C, LamadridFigueroa H, Mercado-García A, Schnaas-Arrieta L, et al. Longitudinal associations between blood lead concentrations lower than 10 microg/dL and neurobehavioral development in environmentally exposed children in Mexico City. Pediatrics 2006;118:e323–30. [68] Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, et al. Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis. Environ Health Perspect 2005;113:894–9. [69] Navas-Acien A, Guallar E, Silbergeld EK, Rothenberg SJ. Lead exposure and cardiovascular disease a systematic review. Environ Health Perspect 2007;115:472–82. [70] Bellinger D, Leviton A, Rabinowitz M, Allred E, Needleman H, Schoenbaum S. Weight gain and maturity in fetuses exposed to low levels of lead. Environ Res 1991;54:151–8.

A.  Overview on Fertility



REFERENCES

[71] Gonzalez-Cossio T, Peterson KE, Sanin LH, Fishbein E, Palazuelos E, Aro A, et al. Decrease in birth weight in relation to maternal bone-lead burden. Pediatrics 1997;100:856–62. [72] Sanin LH, Gonzalez-Cossio T, Romieu I, Peterson KE, Ruíz S, ­Palazuelos E, et al. Effect of maternal lead burden on infant weight and weight gain at one month of age among breastfed infants. ­Pediatrics 2001;107:1016–23. [73] Lamadrid-Figueroa H, Tellez-Rojo MM, Hernandez-Cadena L, Mercado-García A, Smith D, Solano-González M, et al. Biological markers of fetal lead exposure at each stage of pregnancy. J Toxicol Environ Health A 2006;69:1781–96. [74] Smith D, Hernandez-Avila M, Tellez-Rojo MM, Mercado A, Hu H. The relationship between lead in plasma and whole blood in women. Environ Health Perspect 2002;110:263–8. [75] Cantonwine D, Hu H, Sánchez BN, Lamadrid-Figueroa H, Smith D, Ettinger AS, et al. Critical windows of fetal lead exposure: adverse impacts on length of gestation and risk of premature delivery. J Occup Environ Med 2010;52(11):1106–11. [76] Jelliffe-Pawlowski LL, Miles SQ, Courtney JG, Materna B, Charlton V. Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes. J Perinatol 2006;26:154–62. [77] Andrews KW, Savitz DA, Hertz-Picciotto I. Prenatal lead exposure in relation to gestational age and birth weight: a review of epidemiologic studies. Am J Ind Med 1994;26(1):13–32. [78] Institute of Medicine (US) Committee on Understanding ­Premature Birth and Assuring Healthy Outcomes. In: Behrman RE, ­Butler AS, editors. Preterm Birth: Causes, Consequences, and Prevention. Washington (DC): National Academies Press (US); 2007. [79] Hobel CJ, Arora CP, Korst LM. Corticotrophin-releasing hormone and CRH-binding protein. Differences between patients at risk for preterm birth and hypertension. Ann New York Acad Sci 1999;897:54–65. [80] Leung TN, Chung TK, Madsen G, Lam C.W., Lam P.K., Walters W.A., et al. Analysis of mid-trimester corticotrophin-releasing hormone and alpha-fetoprotein concentrations for predicting pre-eclampsia. Hum Reprod 2000;15:1813–8. [81] McLean M, Smith R. Corticotropin-releasing hormone in human pregnancy and parturition. Trends Endocrinol Metab 1999;10:174–8. [82] McLean M, Smith R. Corticotrophin-releasing hormone and ­human parturition. Reproduction 2001;121:493–501. [83] Wadhwa PD, Glynn L, Hobel CJ, Garite TJ, Porto M, Chicz-DeMet A, et al. Behavioral perinatology: biobehavioral processes in human fetal development. Regul Pept 2002;108:149–57. [84] Rahman I, MacNee W. Oxidative stress and regulation of glutathione in lung inflammation. Eur Respir J 2000;16(3):534–54. [85] Rastogi SK, Gupta BN, Husain T, Chandra H, Mathur N, Pangtey BS, et al. A cross-sectional study of pulmonary function among workers exposed to multimetals in the glass bangle industry. Am J Ind Med 1991;20:391–9. [86] Costa M, YanY, Zhao D, Salnikow K. Molecular mechanisms of nickel carcinogenesis: gene silencing by nickel delivery to the nucleus and gene activation/inactivation by nickel-induced cell signaling. J Environ Monit 2003;5:222–3. [87] Damek-Poprawa M, Sawicka-Kapusta K. Damage to the liver, ­kidney, and testis with reference to burden of heavy metals in ­yellow-necked mice from areas around steelworks and zinc smelters in Poland. Toxicology 2003;186(1–2):1–10. [88] Ewan KB, Pamphlett R. Increased inorganic mercury in spinal motor neurons following chelating agents. Neurotoxicology 1996;17(2):343–9. [89] Garza A, Vega R, Soto E. Cellular mechanisms of lead neurotoxicity. Med Sci Monit 2006;12:RA57–65. [90] Ghio AJ, Huang YC. Exposure to concentrated ambient particles (CAPs): a review. Inhal Toxicol 2004;16:53–9.

55

[91] Goering PL. Lead-protein interactions as a basis for lead toxicity. Neurotoxicology 1993;14(2–3):45–60. [92] Hertog MG, Hollman PC. Potential health effects of the dietary flavonol quercetin. Eur J Clin Nutr 1996;50:63–71. [93] Huang YC, Ghio AJ. Vascular effects of ambient pollutant particles and metals. Curr Vasc Pharmacol 2006;4:199–203. [94] Kelly FJ. Dietary antioxidants and environmental stress. Proc Nutr Soc 2004;63:579–85. [95] Loghman-Adham M. Renal effects of environmental and occupational lead exposure. Environ Health Perspect 1997;105:928–38. [96] Ratnaike RN. Acute and chronic arsenic toxicity. Postgrad Med J 2003;79(933):391–6. [97] Rahman A, Vahter M, Smith AH, Nermell B, Yunus M, El Arifeen S, et al. Arsenic exposure during pregnancy and size at birth: a prospective cohort study in Bangladesh. Am J Epidemiol 2009; 169(3):304–12. [98] Cory-Slechta DA, Virgolini MB, Rossi-George A, Thiruchelvam M, Lisek R, Weston D. Lifetime consequences of combined maternal lead and stress. Basic Clin Pharmacol Toxicol 2008; 102:218–27. [99] Cory-Slechta DA, Virgolini MB, Thiruchelvam M, Weston DD, Bauter MR. Maternal stress modulates the effects of developmental lead exposure. Environ Health Perspect 2004;112:717–30. [100] Ni Z, Hou S, Barton CH, Vaziri ND. Lead exposure raises superoxide and hydrogen peroxide in human endothelial and vascular smooth muscle cells. Kidney Int 2004;66(6):2329–36. [101] Schober SE, Mirel LB, Graubard BI, Brody DJ, Flegal KM. Blood lead levels and death from all causes, cardiovascular disease, and cancer: results from the NHANES III mortality study. Environ Health Perspect 2006;114(10):1538–41. [102] Shachar BZ, Carmichael SL, Stevenson DK, Shaw GM. Could genetic polymorphisms related to oxidative stress modulate effects of heavy metals for risk of human preterm birth? Reprod Toxicol 2013;42:24–6. [103] Jomova K, Valko M. Advances in metal-induced oxidative stress and human disease. Toxicology 2011;283(2/3):65–87. [104] Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin ­Obstet Gynaecol 2011;25(3):287–99. [105] Xia D, Yu X, Liao S, Shao Q, Mou H, Ma W. Protective effect of Smilax glabra extract against lead-induced oxidative stress in rats. J Ethnopharmacol 2010;130(2):414–20. [106] Clerici G, Slavescu C, Fiengo S, Kanninen TT, Romanelli M, Biondi R, et al. Oxidative stress in pathological pregnancies. ­ J Obstet Gynaecol 2012;32(2):124–7. [107] Karacay O, Sepici-Dincel A, Karcaaltincaba D, Sahin D, Yalvaç S, Akyol M, et al. Aquantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation. Diabetes Res Clin Pract 2010;89(3):231–8. [108] Perrone S, Tataranno MT, Buonocore G. Oxidative stress and bronchopulmonary dysplasia. J Clin Neonatol 2012;1(3):109–14. [109] Kaindl Angela M, Géraldine Favrais, Pierre Gressens. Molecular mechanisms involved in injury to the preterm brain. J Child ­Neurol 2009;24(9):1112–8. [110] Perrone S, Negro S, Tataranno ML, Buonocore G. Oxidative stress and antioxidant strategies in newborns. J Matern Fetal Neonatal Med 2010;23(Suppl 3):63–5. [111] Saugstad OD. Bronchopulmonary dysplasia-oxidative stress and antioxidants. Semin Neonatol 2003;8:39–49. [112] Bhandari V. Postnatal inflammation in the pathogenesis of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014 Mar;100(3):189–201. [113] Malekirad AA, Oryan S, Fani A, Babapor V, Hashemi M, Baeeri M, et al. Study on clinical and biochemical toxicity biomarkers in a zinc-lead mine workers. Toxicol Ind Health 2010; 26(6):331–7.

A.  Overview on Fertility

56 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity [114] Anwar-Mohamed A, Elbekai RH, El-Kadi AO. Regulation of CYP1A1 by heavy metals and consequences for drug metabolism. Expert Opin Drug Metab Toxicol 2009;5(5):501–21. [115] Branco V, Canario J, Lu J, Holmgren A, Carvalho C. Mercury and selenium interaction in vivo: effects on thioredoxin reductase and glutathione peroxidase. Free Radic Biol Med 2012;52:781–93. [116] Franco JL, Posser T, Dunkley PR, Dickson PW, Mattos JJ, ­Martins R, et al. Methylmercury neurotoxicity is associated with inhibition of the antioxidant enzyme glutathione peroxidase. Free Radic Biol Med 2009;47:449–57. [117] Goodrich JM, Wang Y, Gillespie B, Werner R, Franzblau A, Basu N. Glutathione enzyme and selenoprotein polymorphisms associate with mercury biomarker levels in Michigan dental ­ ­professionals. Toxicol Appl Pharmacol 2011;257(2):301–8. [118] Chung CJ, Huang CY, Pu YS, Shiue HS, Su CT, Hsueh YM. The effect of cigarette smoke and arsenic exposure on urothelial carcinoma risk is modified by glutathione S-transferase M1 gene null genotype. Toxicol Appl Pharmacol 2013;266(2):254–9. [119] Gundacker C, Komarnicki G, Jagiello P, Gencikova A, Dahmen N, Wittmann KJ, et al. Glutathione-S-transferase polymorphism, metallothionein expression, and mercury levels among students in Austria. Sci Total Environ 2007;385(1-3):37–47. [120] Suh YJ, Kim YJ, Park H, Park EA, Ha EH. Oxidative stress-related gene interactions with preterm delivery in Korean women. Am J Obstet Gynecol 2008;198(5):541. e1–e7. [121] Nukui T, Day RD, Sims CS, Ness RB, Romkes M. Maternal/­ newborn GSTT1 null genotype contributes to risk of preterm: low birthweight infants. Pharmacogenetics 2004;14(9):569–76. [122] Tsai HJ, Liu X, Mestan K, Yu Y, Zhang S, Fang Y, et al. Maternal cigarette smoking, metabolic gene polymorphisms, and preterm delivery: new insights on GxE interactions and pathogenic pathways. Hum Genet 2008;123(4):359–69. [123] Rosenberg O, Rosenblat M, Coleman R, Shih DM, Aviram M. Paraoxonase (PON1) deficiency is associated with increased macrophage oxidative stress: studies in PON1-knockout mice. Free Radic Biol Med 2003;34(6):774–84. [124] Li WF, Sun CW, Cheng TJ, Chang KH, Chen CJ, Wang SL. Risk of carotid atherosclerosis is associated with low serum paraoxonase (PON1) activity among arsenic exposed residents in southwestern Taiwan. Toxicol Appl Pharmacol 2009;236(2):246–53. [125] Min J, Park H, Park B, Kim YJ, Park J, Lee H, et al. Paraoxonase gene polymorphism and vitamin levels during pregnancy: relationship with maternal oxidative stress and neonatal birthweights. Reprod Toxicol 2006;22(3):418–24. [126] Gonzalvo MC, Gil F, Hernandez AF, Villanueva E, Pla A. ­Inhibition of paraoxonase activity in human liver microsomes by exposure to EDTA: metals and mercurials. Chem Biol Interact 1997;105(3):169–79. [127] Lüersen K, Schmelzer C, Boesch-Saadatmandi C, Kohl C, ­Rimbach G, Döring F. Paraoxonase 1 polymorphism Q192R affects the pro-inflammatory cytokine TNF-alpha in healthy males. BMC Res Notes 2011;4. [128] Li WF, Pan MH, Chung MC, Ho CK, Chuang HY. Lead exposure is associated with decreased serum paraoxonase 1 (PON1) activity and genotypes. Environ Health Perspect 2006;114(8):1233–6. [129] Hernandez AF, Gil F, Leno E, Lopez O, Rodrigo L, Pla A. Interaction between human serum esterases and environmental metal compounds. Neurotoxicology 2009;30(4):628–35. [130] Chen D, Hu Y, Chen C, Yang F, Fang Z, Wang L, et al. Polymorphisms of the paraoxonase gene and risk of preterm delivery. Epidemiology 2004;15(4):466–70. [131] Ryckman KK, Morken NH, White MJ, Velez DR, Menon R, Fortunato SJ, et al. Maternal and fetal genetic associations of PTGER3 and PON1 with preterm birth. PloS One 2010;5(2):e9040. [132] Infante-Rivard C. Genetic association between single nucleotide polymorphisms in the paraoxonase 1 (PON1) gene and

small-for-gestational-age birth in related and unrelated subjects. Am J Epidemiol 2010;171:999–1006. [133] Baker AM, Haeri S, Klein RL, Boggess K. Association of midgestation paraoxonase1 activity and pregnancies complicated by preterm birth. Am J Obstet Gynecol 2010;203(3):246. e1–e4. [134] Lee BE, Park H, Park EA, Gwak H, Ha EH, Pang MG, et al. ­Paraoxonase1 gene and glutathione S-transferase mu 1 gene interaction with preterm delivery in Korean women. Am J Obstet Gynecol 2010;203(6):569. e1–e7. [135] Inder TE, Darlow BA, Sluis KB, Winterbourn CC, Graham P, Sanderson KJ, et al. The correlation of elevated levels of an index of lipid peroxidation (MDA-TBA) with adverse outcome in the very low birthweight infant. Acta Paediatr 1996;85:1116–22. [136] Samuel JB, Stanley JA, Princess RA, Shanthi P, Sebastian MS. ­Gestational cadmium exposure-induced ovotoxicity delays puberty through oxidative stress and impaired steroid hormone levels. J Med Toxicol 2011;7:195–204. [137] Farina M, Avila DS, da Rocha JB, Aschner M. Metals, oxidative stress and neurodegeneration: a focus on iron, manganese and mercury. Neurochem Int 2013;62:575–94. [138] Bainbridge SA, Smith GN. HO in pregnancy. Free Radic Biol Med 2005;38(8):979–88. [139] Takeda K, Ishizawa S, Sato M, Yoshida T, Shibahara S. Identification of a cis-acting element that is responsible for cadmiummediated induction of the human heme oxygenase gene. J Biol Chem 1994;269:22858–67. [140] Yamada N, Yamaya M, Okinaga S, Nakayama K, Sekizawa K, Shibahara S, et al. Microsatellite polymorphism in the heme ­oxygenase-1 gene promoter is associated with susceptibility to emphysema. Am J Hum Gen 2000;66:187–95. [141] Exner M, Schillinger M, Minar E, Mlekusch W, Schlerka G, ­Haumer M, et al. Heme oxygenase-1 gene promoter microsatellite polymorphism is associated with restenosis after percutaneous transluminal angioplasty. J Endovasc Ther 2001;5:433–40. [142] Chavez E, Jay D, Bravo C. The mechanism of lead-induced mitochondrial Ca2+ efflux. J Bioenerg Biomembr 1987;19:285–95. [143] Goering PL. Lead-protein interactions as a basis for lead toxicity. Neurotoxicology 1993;14(2-3):45–60. [144] Rossi E, Taketani S, Garcia-Webb P. Lead and the terminal mitochondrial enzymes of haem biosynthesis. Biomed Chromatogr 1993;7(1):1–6. [145] Clarkson TW, Magos L. The toxicology of mercury and its chemical compounds. Crit Rev Toxicol 2006;36:609–62. [146] Kajiwara Y, Yasutake A, Adachi T, Hirayama K. Methylmercury transport across the placenta via neutral amino acid carrier. Arch Toxicol 1996;70:310–4. [147] Watanabe C, Yoshida K, Kasanuma Y, Kun Y, Satoh H. In utero methylmercury exposure differentially affects the activities of selenoenzymes in the fetal mouse brain. Environ Res 1999;80:208–14. [148] Costa LG, Aschner M, Vitalone A, Syversen T, Soldin OP. Developmental neuropathology of environmental agents. Annu Rev Pharmacol Toxicol 2004;44:87–110. [149] Rodrigues JL, Serpeloni JM, Batista BL, Souza SS, Barbosa F Jr. Identification and distribution of mercury species in rat tissues following administration of thimerosal or methylmercury. Arch Toxicol 2010;84(11):891–6. [150] Yau VM, Green PG, Alaimo CP, Yoshida CK, Lutsky M, Windham GC, et al. Prenatal and neonatal peripheral blood mercury levels and autism spectrum disorders. Environ Res 2014;133:294–303. [151] Hertz-Picciotto I, Green PG, Delwiche L, Hansen R, Walker C, Pessah IN. Blood mercury concentrations in CHARGE Study children with and without autism. Environ Health Perspect 2010;118(1):161–6. [152] Marques RC, Bernardi JVC, Dórea JG, de Fatima R, Moreira M, Malm O. Perinatal multiple exposure to neurotoxic (lead,

A.  Overview on Fertility



REFERENCES

methylmercury, ethylmercury, and aluminum) substances and neurodevelopment at six and 24 months of age. Environ Pollut 2014;187:e130–5. [153] Grandjean P, Weihe P, White RF, Debes F, Araki S, Yokoyama K, et al. Cognitive deficit in 7-year-old children with prenatal ­exposure to methylmercury. Neurotoxicol Teratol 1997;19:417–28. [154] Llop S, Guxens M, Murcia M, Lertxundi A, Ramon R, Riaño I, et al. Prenatal exposure to mercury and infant neurodevelopment in a multicenter cohort in Spain: study of potential modifiers. Am J Epidemiol 2012;175(5):451–65. [155] Theunissen PT, Pennings JL, Robinson JF, Claessen SM, Kleinjans JC, Piersma AH. Time-response evaluation by transcriptomics of methylmercury effects on neural differentiation of murine ­embryonic stem cells. Toxicol Sci 2011;122(2):437–47. [156] Zimmer B, Schildknecht S, Kuegler PB, Tanavde V, Kadereit S, Leist M. Sensitivity of dopaminergic neuron differentiation from stem cells to chronic low-dose methylmercury exposure. Toxicol Sci 2011;121:357–67. [157] Grandjean P, Landrigan PJ. Neurobehavioural effects of developmental toxicity. Lancet 2014;13(3):330–8. [158] Warfvinge K, Hua J, Logdberg B. Mercury distribution in cortical areas and fiber systems of the neonatal and maternal adult cerebrum after exposure of pregnant squirrel monkeys to mercury vapor. Environ Res 1994;67:196–208. [159] Clarkson TW, Magos L, Myers GJ. The toxicology of mercury – current exposures and clinical manifestations. N Engl J Med 2003;349(18):1731–7. [160] Sumi D. Biological effects of and responses to exposure to electrophilic environmental chemicals. J Health Sci 2008;54:267–72. [161] Kim SO, Merchant K, Nudelman R, Beyer WF JJr, Keng T, DeAngelo J, et al. OxyR: a molecular code for redox-related ­ ­signaling. Cell 2002;109:383–96. [162] Glaser V, Leipnitz G, Straliotto MR, Oliveira J, dos Santos VV, Wannmacher CM, et al. Oxidative stress mediated inhibition of brain creatine kinase activity by methylmercury. Neurotoxicology 2010;31:454–60. [163] Stringari J, Nunes AK, Franco JL, Bohrer D, Garcia SC, Dafre AL, et al. Prenatal methylmercury exposure hampers glutathione antioxidant system ontogenesis and causes long-lasting oxidative stress in the mouse brain. Toxicol Appl Pharmacol 2008;227:147–54. [164] Freitas AJ, Rocha JB, Wolosker H, Souza DO. Effects of Hg2+ and CH3Hg+ on Ca2+ fluxes in rat brain microsomes. Brain Res 1996;738:257–64. [165] Branco V, Canario J, Lu J, Holmgren A, Carvalho C. Mercury and selenium interaction in vivo: effects on thioredoxin reductase and glutathione peroxidase. Free Radic Biol Med 2012;52:781–93. [166] Kung MP, Kostyniak P, Olson J, Malone M, Roth JA. Studies of the in vitro effect of methylmercury chloride on rat brain ­neurotransmitter enzymes. J Appl Toxicol 1987;7(2):119–21. [167] Farina M, Rocha JB, Aschner M. Mechanisms of methylmercuryinduced neurotoxicity: evidence from experimental studies. Life Sci 2011;89:555–63. [168] Franco JL, Braga HC, Stringari J, Missau FC, Posser T, Mendes BG, et al. Mercurial-induced hydrogen peroxide generation in mouse brain mitochondria: protective effects of quercetin. Chem Res Toxicol 2007;20:1919–26. [169] Ni M, Li X, Yin Z, Sidoryk-Wegrzynowicz M, Jiang H, Farina M, et al. Comparative study on the response of rat primary astrocytes and microglia to methylmercury toxicity. Glia 2011;59:810–20. [170] Franco JL, Teixeira A, Meotti FC, Ribas CM, Stringari J, ­Garcia Pomblum SC, et al. Cerebellar thiol status and motor deficit after lactational exposure to methylmercury. Environ Res 2006;102:22–8. [171] Stringari J, Nunes AK, Franco JL, Bohrer D, Garcia SC, Dafre AL, et al. Prenatal methylmercury exposure hampers glutathione

57

antioxidant system ontogenesis and causes long-lasting oxidative stress in the mouse brain. Toxicol Appl Pharmacol 2008;227:147–54. [172] Dringen R, Pawlowski PG, Hirrlinger J. Peroxide detoxification by brain cells. J Neurosci Res 2005;79:157–65. [173] Drescher O, Dewailly E, Diorio C, Ouellet N, Sidi EA, Abdous B, et al. Methylmercury exposure, PON1 gene variants and serum paraoxonase activity in Eastern James Bay Cree adults. J Expo Sci Environ Epidemiol 2014;. [174] Budtz-Jørgensen E, Grandjean P, Weihe P. Separation of risks and benefits of seafood intake. Environ Health Perspect 2007;115:323–7. [175] Ballatori N, Gatmaitan Z, Truong AT. Impaired biliary excretion and whole body elimination of methylmercury in rats with congenital defect in biliary glutathione excretion. Hepatology 1995;22:1469–73. [176] Hernandez-Perez M, Mahalingam M. Matrix metalloproteinases in health and disease: insights from dermatopathology. Am J Dermatopathol 2012;34(6):565–79. [177] Pepper MS. Role of the matrix metalloproteinase and plasminogen activator-plasmin systems in angiogenesis. Arterioscler Thromb Vasc Biol 2001;21(7):1104–17. [178] Xu P, Alfaidy N, Challis JR. Expression of matrix metalloproteinase (MMP)-2 and MMP-9 in human placenta and fetal membranes in relation to preterm and term labor. J Clin Endocrinol Metab 2002;87(3):1353–61. [179] Vu TD, Yun F, Placido J, Reznik SE. Placental matrix metalloproteinase-1 expression is increased in labor. Reprod Sci 2008;15(4):420–4. [180] Sundrani DP, Chavan-Gautam PM, Pisal HR, Mehendale SS, Joshi SR. Matrixmetalloproteinase-1 and -9 in human placenta during spontaneous vaginal delivery and caesarean sectioning in preterm pregnancy. PLoS One 2012;7(1):e29855. [181] Maymon E, Romero R, Pacora P, Gervasi MT, Bianco K, Ghezzi F, et al. Evidence for the participation of interstitial collagenase (matrix metalloproteinase 1) in preterm premature rupture of membranes. Am J Obstet Gynecol 2000;183(4):914–20. [182] Cockle JV, Gopichandran N, Walker JJ, Levene MI, Orsi NM. Matrix metalloproteinases and their tissue inhibitors in preterm perinatal complications. Reprod Sci 2007;14(7):629–45. [183] Jacob-Ferreira AL, Lacchini R, Gerlach RF, Passos CJ, Barbosa F Jr, Tanus-Santos JE. A common matrix metalloproteinase (MMP)-2 polymorphism affects plasma MMP-2 levels in subjects environmentally exposed to mercury. Sci Total Environ 2011;409(20):4242–6. [184] Jacob-Ferreira AL, Passos CJ, Gerlach RF, Barbosa F Jr, Tanus-Santos JE. A functional matrix metalloproteinase (MMP)-9 polymorphism modifies plasma MMP-9 levels in subjects environmentally exposed to mercury. Sci Total Environ 2010;408(19):4085–92. [185] Yorifuji T, Debes F, Weihe P, Grandjean P. Prenatal exposure to lead and cognitive deficit in 7- and 14-year-old children in the presence of concomitant exposure to similar molar concentration of methylmercury. Neurotoxicol Teratol 2011;33:205–11. [186] Al-Saleh I, Abduljabbar M, Al-Rouqi R, Elkhatib R, Alshabbaheen A. Mercury (Hg) exposure in breast-Fed infants and their mothers and the evidence of oxidative Stress. Biol Trace Elem Res 2013;153:145–54. [187] Beveridge R, Pintos J, Parent ME, Asselin J, Siemiatycki J. Lung cancer risk associated with occupational exposure to nickel, chromium VI, and cadmium in two population-based case–control studies in Montreal. Am J Ind Med 2010;53(5):476–85. [188] Honda R, Swaddiwudhipong W, Nishijo M, Mahasakpan P, Teeyakasem W, Ruangyuttikarn W, et al. Cadmium induced renal dysfunction among residents of rice farming area downstream from a zinc-mineralized belt in Thailand. Toxicol Lett 2010;198(1):26–32.

A.  Overview on Fertility

58 5.  The Effect of Heavy Metals on Preterm Mortality and Morbidity [189] Barr M Jr. The teratogenicity of cadmium chloride in two stocks of Wistar rats. Teratology 1973;7(3):237–42. [190] Thompson J, Bannigan J. Cadmium: toxic effects on the reproductive system and the embryo. Reprod Toxicol 2008;25(3):304–15. [191] Hovland DN Jr, Machado AF, Scott WJ Jr, Collins MD. Differential sensitivity of the SWV and C57BL/6mouse strains to the teratogenic action of single administrations of cadmium given throughout the period of anterior neuropore closure. Teratology 1999;60(1):13–21. [192] Paniagua-Castro N, Escalona-Cardoso G, Chamorro-Cevallos G. Glycine reduces cadmium-induced teratogenic damage in mice. Reprod Toxicol 2007;23(1):92–7. [193] Robinson JF, Yu X, Hong S, Griffith WC, Beyer R, Kim E, et al. Cadmium-induced differential toxicogenomic response in resistant and sensitive mouse strains undergoing neurulation. Toxicol Sci 2009;107(1):206–19. [194] Scott WJ Jr, Schreiner CM, Goetz JA, Robbins D, Bell SM. Cadmium-induced postaxial forelimb ectrodactyly: association with altered sonic hedgehog signaling. Reprod Toxicol 2005;19(4):479–85. [195] Ahokas RA, Dilts PV Jr, LaHaye EB. Cadmium-induced fetal growth retardation: protective effect of excess dietary zinc. Am J Obstet Gynecol 1980;136(2):216–21. [196] Ji YL, Wang H, Liu P, Zhao XF, Zhang Y, Wang Q, et al. Effects of maternal cadmium exposure during late pregnant period on testicular steroidogenesis in male offspring. Toxicol Lett 2011;205(1):69–78. [197] Nishijo M, Tawara K, Honda R, Nakagawa H, Tanebe K, Saito S. Relationship between newborn size and mother’s blood ­cadmium levels. Arch Environ Health 2004;59(1):22–5. [198] Watson ED, Cross JC. Development of structures and transport functions in the mouse placenta. Physiology (Bethesda) 2005;20:180–93. [199] Wigle DT, Arbuckle TE, Turner MC, Bérubé A, Yang Q, Liu S, et al. Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants. J Toxicol Environ Health B Crit Rev 2008;11(5–6):373–517. [200] Laudanski T, Sipowicz P, Modzelewski J, Bolinski J, Szamatowicz J, Razniewska G, et al. Influence of high lead and cadmium soil content on human reproductive outcome. Int J Gynecol Obstet 1991;366:309–15. [201] Osman K, Akesson A, Berglund M, Bremme K, Schütz A, Ask K, et al. Toxic and essential elements in placentas of Swedish women. Clin Biochem 2000;33(2):131–8. [202] Wang Z, Wang H, Xu ZM, Ji YL, Chen YH, Zhang ZH, et al. ­Cadmium-induced teratogenicity: association with ROS-mediated endoplasmic reticulum stress in placenta. Toxicol Appl Pharmacol 2012;259(2):236–47. [203] Llanos MN, Ronco AM. Fetal growth restriction is related to placental levels of cadmium, lead and arsenic but not with ­ ­antioxidant activities. Reprod Toxicol 2009;27(1):88–92. [204] Lin CM, Doyle P, Wang D, Hwang YH, Chen PC. Does prenatal cadmium exposure affect fetal and child growth? Occup Environ Med 2011;68:641–6. [205] Argüelles-Velázquez N, Alvarez-González I, Madrigal-Bujaidar E, Chamorro-Cevallos G. Amelioration of cadmium-produced teratogenicity and genotoxicity in mice given Arthrospira maxima (Spirulina) treatment. Evid Based Complement Alternat Med 2013;2013:604535. [206] Kampa Marilena, Castanas Elias. Human health effects of air pollution. Environ Pollut 2008;151(2):362–7. [207] Samuel JB, Stanley JA, Princess RA, Shanthi P, Sebastian MS. Gestational cadmium exposure-induced ovotoxicity delays puberty through oxidative stress and impaired steroid hormone levels. J Med Toxicol 2011;7(3):195–204.

[208] Samarawickrama GP, Webb M. The acute toxicity and teratogenicity of cadmium in the pregnant rat. J Appl Toxicol 1981;1:264–9. [209] Pillai P, Patel R, Pandya C, Gupta S. Sex-specific effects of gestational and lactational coexposure to lead and cadmium on hepatic phase I and phase II xenobiotic/steroid-metabolizing enzymes and antioxidant status. J Med Toxicol 2011;7(3):195–204. [210] Legraverend C, Agneta M, Wells T, Robinson I, Gustafsson JA. Hepatic steroid hydroxylating enzymes are controlled by the sexually dimorphic pattern of growth hormone secretion in normal and dwarf rats. FASEB J 1992;6:711–8. [211] Valko M, Morris H, Cronin MT. Metals, toxicity and oxidative stress. Curr Med Chem 2005;12:1161–208. [212] Ercal N, Gurer-Orhan H, Aykin-Burns N. Toxic metals and oxidative stress part I: mechanisms involved in metal-induced oxidative damage. Curr Top Med Chem 2001;1:529–39. [213] Gobe G, Crane D. Mitochondria, reactive oxygen species and cadmium toxicity in the kidney. Toxicol Lett 2010;198:49–55. [214] Roberts RA, Smith RA, Safe S, Szabo C, Tjalkens RB, Robertson FM. Toxicological and pathophysiological roles of reactive ­oxygen and nitrogen species. Toxicology 2010;276:85–94. [215] Gundacker C, Fröhlich S, Graf-Rohrmeister K, Eibenberger B, Jessenig V, Gicic D, et al. Perinatal lead and mercury exposure in Austria. Sci Total Environ 2010;408:5744–9. [216] National Research Council. Arsenic in Drinking Water: 2001 ­Update. Washington, DC: National Academy Press; 2001. [217] Vahter M. Methylation of inorganic arsenic in different mammalian species and population groups. Sci Prog 1999;82(pt 1):69–88. [218] Vahter M. Health effects of early life exposure to arsenic. Basic Clin Pharmacol Toxicol 2008;102(2):204–11. [219] Concha G, Vogler G, Lezcano D, Nermell B, Vahter M. Exposure to inorganic arsenic metabolites during early human development. Toxicol Sci 1998;44:185–90. [220] Rahman A, Vahter M, Ekstrom EC, Rahman M, Golam Mustafa AH, Wahed MA, et al. Association of arsenic exposure during pregnancy with fetal loss and infant death: a cohort study in ­Bangladesh. Am J Epidemiol 2007;165:1389–96. [221] Golub MS, Macintosh MS, Baumrind N. Developmental and reproductive toxicity of inorganic arsenic: animal studies and human concerns. J Toxicol Environ Health B Crit Rev 1998;1:199–241. [222] Ahmad SA, Sayed MH, Barua S, Khan MH, Faruquee MH, Jalil A, et al. Arsenic in drinking water and pregnancy outcomes. ­Environ Health Perspect 2001;109:629–31. [223] Milton AH, Smith W, Rahman B, Hasan Z, Kulsum U, Dear K, et al. Chronic arsenic exposure and adverse pregnancy outcomes in Bangladesh. Epidemiology 2005;16:82–6. [224] Wang A, Holladay SD, Wolf DC, Ahmed SA, Robertson JL. ­Reproductive and developmental toxicity of arsenic in rodents: a review. Int J Toxicol 2006;25:319–31. [225] Rahman A, Vahter M, Smith AH, Nermell B, Yunus M, El Arifeen S, et al. Arsenic exposure during pregnancy and size at birth: a prospective cohort study in Bangladesh. Am J Epidemiol 2009;169(3):301–4. [226] Rahman A, Persson LÅ, Nermell B, El Arifeen S, Ekström EC, Smith AH, et al. Arsenic exposure and risk of spontaneous abortion, stillbirth, and infant mortality. Epidemiology 2010;21(6):797–804. [227] Koestler DC, Avissar-Whiting M, Houseman EA, Karagas MR, Marsit CJ. Differential DNA methylation in umbilical cord blood of infants exposed to low levels of arsenic in utero. Environ Health Perspect 2013;121(8):971–7. [228] Engström K, Vahter M, Mlakar SJ, Concha G, Nermell B, Raqib R, et al. Polymorphisms in arsenic (+III oxidation state) methyltransferase (AS3MT) predict gene expression of AS3MT as well as arsenic metabolism. Environ Health Perspect 2011;119(2):182–8.

A.  Overview on Fertility



REFERENCES

[229] Hartwig A, Blessing H, Schwerdtle T, Walter I. Modulation of DNA repair processes by arsenic and selenium compounds. ­Toxicology 2003;193:161–9. [230] Lin S, Del Razo LM, Styblo M, Wang C, Cullen WR, Thomas DJ. Arsenicals inhibit thioredoxin reductase in cultured rat hepatocytes. Chem Res Toxicol 2001;14:305–11. [231] von Ehrenstein OS, Guha Mazumder DN, Hira-Smith M, Ghosh N, Yuan Y, Windham G, et al. Pregnancy outcomes, infant mortality, and arsenic in drinking water in West Bengal, India. Am J Epidemiol 2006;163:662–9. [232] Hopenhayn-Rich C, Browning SR, Hertz-Picciotto I, Ferreccio C, Peralta C, Gibb H. Chronic arsenic exposure and risk of infant mortality in two areas of Chile. Environ Health Perspect 2000;108:667–73. [233] Rahman M, Vahter M, Wahed MA, Sohel N, Yunus M, Streatfield PK, et al. Prevalence of arsenic exposure and skin lesions. A population based survey in Matlab, Bangladesh. J Epidemiol Community Health 2006;60:242–8. [234] Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med 1988;319:189–94.

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[235] Simpson JL, Mills JL, Holmes LB, Ober CL, Aarons J, Jovanovic L, et al. Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA 1987;258:2555–7. [236] Sweeney AM, LaPorte RE. Advances in early fetal loss research: importance for risk assessment. Environ Health Perspect 1991;90:165–9. [237] World Health Organization. Guidelines for drinking-water ­quality, vol.1. 3rd ed. Recommendations. Geneva. Switzerland: World Health Organization; 2004. http://www.who.int/water_ sanitation_health/dwq/GDWQ2004web.pdf. [238] Rahman A, Persson LÅ, Nermell B, El Arifeen S, Ekström EC, Smith AH, et al. Arsenic exposure and risk of spontaneous abortion, stillbirth, and infant mortality. Epidemiology 2010;21(6):797–804. [239] Chou WC, Chung YT, Chen HY, Wang CJ, Ying TH, Chuang CY, et al. Maternal arsenic exposure and DNA damage biomarkers, and the associations with birth outcomes in a general population from Taiwan. PloS One 2014;9(2):e86398. [240] Vahter M. Mechanisms of arsenic biotransformation. Toxicology 2002;181–2. 211-217.

A.  Overview on Fertility