TY - JOUR
T1 - Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries
AU - Zajac, Lauren
AU - Kobrosly, Roni W.
AU - Ericson, Bret
AU - Caravanos, Jack
AU - Landrigan, Philip J.
AU - Riederer, Anne M.
N1 - Funding Information:
This specific research study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector; however, a portion of LZ's time on this project was funded through her postdoctoral training grant from the National Institutes of Health [Grant Number: 5T32HD049311–09, years 2013–2015 ]. The Toxic Site Identification Program (TSIP) has been supported by the European Commission [Contract Number: DCI-ENV/2015/371157 ], the World Bank, United Nations Industrial Development Organization, the United States Agency for International Development [Cooperative Agreement Number: AID-OAA-A-16-00019 ], Green Cross Switzerland, and Asian Development Bank. BE is employed by Pure Earth, which is an international nonprofit organization dedicated to solving pollution problems in low- and middle-income countries. JC, PJL, and AMR are members of the Technical Advisory Board for Pure Earth. The Icahn School of Medicine at Mount Sinai previously received funding from Pure Earth. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the funders.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Prior estimates of pediatric lead-related disease burden in low- and middle-income countries (LMICs) used population estimates of maternal blood lead levels (BLLs). This approach may underestimate fetal BLLs by not considering potentially high prenatal lead exposure from toxic hotspots. Objectives: We developed a probabilistic approach to using the Adult Lead Methodology (ALM) to estimate fetal BLLs from prenatal exposure to lead-contaminated soil at hotspots in the Toxic Site Identification Program (TSIP). Methods: We created distributions for each ALM parameter using published literature and extracted soil lead measurements from the TSIP database. Each iteration of the probabilistic ALM randomly selected values from the input distributions to generate a site-specific fetal BLL estimate. For each site, we ran 5000 model iterations, producing a site-specific fetal BLL distribution. Results: 195 TSIP sites, in 33 LMICs, met our study inclusion criteria; an estimated 820,000 women of childbearing age are at risk for lead exposure at these sites. The predicted geometric means (GM) for site-specific fetal BLLs ranged from 3.3 μg/dL to 534 μg/dL, and 98% of sites had estimated GM fetal BLLs >5 μg/dL, the current reference level of the United States Centers for Disease Control and Prevention (CDC), while 11 sites had estimated GM fetal BLLs above the CDC chelation threshold of 45 μg/dL. Discussion: The TSIP soil lead data and this probabilistic approach to the ALM show that pregnant women living near TSIP sites may have BLLs that put their fetus at risk for neurologic damage and other sequelae, underscoring the need for interventions to reduce lead exposure at toxic hotspots.
AB - Background: Prior estimates of pediatric lead-related disease burden in low- and middle-income countries (LMICs) used population estimates of maternal blood lead levels (BLLs). This approach may underestimate fetal BLLs by not considering potentially high prenatal lead exposure from toxic hotspots. Objectives: We developed a probabilistic approach to using the Adult Lead Methodology (ALM) to estimate fetal BLLs from prenatal exposure to lead-contaminated soil at hotspots in the Toxic Site Identification Program (TSIP). Methods: We created distributions for each ALM parameter using published literature and extracted soil lead measurements from the TSIP database. Each iteration of the probabilistic ALM randomly selected values from the input distributions to generate a site-specific fetal BLL estimate. For each site, we ran 5000 model iterations, producing a site-specific fetal BLL distribution. Results: 195 TSIP sites, in 33 LMICs, met our study inclusion criteria; an estimated 820,000 women of childbearing age are at risk for lead exposure at these sites. The predicted geometric means (GM) for site-specific fetal BLLs ranged from 3.3 μg/dL to 534 μg/dL, and 98% of sites had estimated GM fetal BLLs >5 μg/dL, the current reference level of the United States Centers for Disease Control and Prevention (CDC), while 11 sites had estimated GM fetal BLLs above the CDC chelation threshold of 45 μg/dL. Discussion: The TSIP soil lead data and this probabilistic approach to the ALM show that pregnant women living near TSIP sites may have BLLs that put their fetus at risk for neurologic damage and other sequelae, underscoring the need for interventions to reduce lead exposure at toxic hotspots.
KW - Blood lead level
KW - Prenatal lead exposure
KW - Probabilistic simulation
KW - Soil contamination
KW - Toxic waste sites
UR - http://www.scopus.com/inward/record.url?scp=85080141281&partnerID=8YFLogxK
U2 - 10.1016/j.envres.2020.109251
DO - 10.1016/j.envres.2020.109251
M3 - Article
C2 - 32311907
AN - SCOPUS:85080141281
VL - 183
JO - Environmental Research
JF - Environmental Research
SN - 0013-9351
M1 - 109251
ER -