Maternal metal concentration during gestation and pediatric morbidity in children: an exploratory analysis

Isabella Karakis, Daniella Landau, Roni Gat, Nofar Shemesh, Ofir Tirosh, Maayan Yitshak-Sade, Batia Sarov, Lena Novack

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: The majority of studies linking exposure to metals with certain health outcomes focus on known toxic metals. Alternatively, this study assesses the extent to which exposure to a wider range of metals during gestation is associated with childhood morbidity. Methods: We analyzed the concentrations of 25 metals found in urine samples of 111 pregnant women of Arab-Bedouin origin collected prior to birth. In addition, we collected medical records on their offspring for six years following birth, including every interaction with HMOs, local hospitals, and pharmacies. Results: The main types of morbidities diagnosed and treated during this period were preterm births, malformations, asthma-like morbidity, cardiovascular and behavioral problems, and obesity. Multivariable analysis showed that offspring born before term were more likely to have been exposed to elevated maternal concentrations of zinc, thallium, aluminum, manganese, and uranium, all with adjusted relative risk above 1.40 for an increase by each quintile. Likewise, children with asthma had been exposed to higher levels of magnesium, strontium, and barium at gestation, while behavioral outcomes were associated with elevated biometals, i.e., sodium, magnesium, calcium, selenium, and zinc, as well as higher levels of lithium, cobalt, nickel, strontium, cadmium, vanadium, arsenic, and molybdenum. A heatmap of adjusted relative risk estimates indicates the considerable implications that exposure to metals may have for preterm birth and developmental outcomes. Conclusions: The current study shows that perinatal exposure to metals is adversely associated with pediatric morbidity. Further such analyses on additional samples are warranted.

Original languageEnglish
Article number40
JournalEnvironmental Health and Preventive Medicine
Issue number1
StatePublished - Dec 2021
Externally publishedYes


  • Cohort
  • Exploratory Analysis
  • Heavy metals
  • Morbidity
  • Pediatric
  • Pregnancy


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