In utero metal exposures measured in deciduous teeth and birth outcomes in a racially-diverse urban cohort

Andrea E. Cassidy-Bushrow, Kuan Han Hank Wu, Alexandra R. Sitarik, Sung Kyun Park, Lawrence F. Bielak, Christine Austin, Chris Gennings, Paul Curtin, Christine Cole Johnson, Manish Arora

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


A growing number of studies have examined associations of metal exposures with birth outcomes, however, results from these studies have been inconsistent, and hampered by methodological limitations. We measured direct fetal exposure to three metals (lead, manganese and zinc) during the second and third trimester and examined its association with birth weight and gestational age at delivery. Participants in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS), a population-based birth cohort established between September 2003 and December 2007, were invited to donate teeth to the study. Lead, manganese and zinc during the second and third trimesters were measured via high-resolution microspatial mapping of dentin growth rings, a validated biomarker for prenatal metal exposure. Gestational age at delivery and infant birth weight were obtained from the delivery medical record. A total of 145 children had tooth metal measurements and birth outcome data. Mean birth weight was 3431 ± 472 g and mean gestational age at delivery was 39.0 ± 1.3 weeks. Overall, there was a positive association between second (β = 0.21, 95% CI: 0.05, 0.37, P = 0.01) and third trimester (β = 0.21, 95% CI: 0.05, 0.37, P = 0.01) tooth manganese and birth weight Z-score; this remained statistically significant after covariate adjustment. There was also a negative association between second trimester tooth lead level and birth weight Z-score (β = −0.20, 95% CI: −0.38, −0.02, P = 0.02), however, this was attenuated after adjusting for covariates. Mixture analysis revealed similar findings. There was evidence for a sex-specific effect of manganese with birth weight Z-score, with the association stronger in female compared to male infants. Overall, we found evidence suggesting that higher in utero manganese is associated with larger birth weight Z-scores and that these associations may vary by infant sex.

Original languageEnglish
Pages (from-to)444-451
Number of pages8
JournalEnvironmental Research
StatePublished - Apr 2019


  • Birth outcome
  • Birth weight
  • Gestational age
  • Metals
  • Teeth


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