PEDIATRICS Vol. 100 No. 5 November 1997, pp. 856-862
Decrease in Birth Weight in Relation to Maternal Bone-Lead Burden
Received Nov 25, 1996; accepted Mar 24, 1997.
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From the * Centro de Investigaciones en Salud Poblacional,
Instituto Nacional de Salud Púcblica, Cuernavaca, Morelos,
México; Departments of Maternal and Child Health and
Nutrition, Harvard School of Public Health, Boston Massachusetts;
§ Universidad Autónoma de Chihuahua, Chihuahua, México;
American British Cowdray Hospital, México City, México;
¶ Secretaría del Medio Ambiente, Departamento del Distrito
Federal, México City, México; and # Channing Laboratory,
Department of Medicine, Brigham and Women's Hospital, Harvard Medical
School and Occupational Health Program, Department of Environmental
Health, Harvard School of Public Health, Boston, Massachusetts.
Objectives. Birth weight predicts infant survival, growth, and development. Previous research suggests that low levels of fetal lead exposure, as estimated by umbilical cord blood-lead levels at birth, may have an adverse effect on birth weight. This report examines the relationship of lead levels in cord blood and maternal bone to birth weight.
Methods. Umbilical cord and maternal venous blood samples and anthropometric and sociodemographic data were obtained at delivery and 1-month postpartum. Blood-lead levels were analyzed by atomic absorption spectrophotometry. Maternal tibia and patella lead levels were determined at 1-month postpartum with use of a spot-source 109Cd K-X-ray fluorescence instrument. The relationship between birth weight and lead burden was evaluated by multiple regression with control of known determinants of size at birth.
Results. Data on all variables of interest were obtained for 272 mother-infant pairs. After adjustment for other determinants of birth weight, tibia lead was the only lead biomarker clearly related to birth weight. The decline in birth weight associated to increments in tibia lead was nonlinear and accelerated at the highest tibia lead quartile. In the upper quartile, neonates were on average, 156 grams lighter than those in the lowest quartile. Other significant birth weight predictors included maternal nutritional status, parity, education, gestational age, and smoking during pregnancy.
Conclusions. Our results indicate that bone-lead burden is inversely related to birth weight. Taken together with other research indicating that lead can mobilize from bone into plasma without detectable changes in whole blood lead, these findings suggest that bone lead might be a better biomarker than blood lead. Because lead remains in bone for years to decades, mobilization of bone lead during pregnancy may pose a significant fetal exposure with health consequences, long after maternal external lead exposure has declined.
Key words: bone lead, birth weight, pregnancy, fetus, epidemiology, x-ray fluorescence.
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