Abstract:
Background: Exposure to arsenic is one of the major global health problems, affecting
> 300 million people worldwide, but arsenic’s effects on human reproduction are uncertain.
oBjectives: We conducted a systematic review and meta-analysis to examine the association
between arsenic and adverse pregnancy outcomes/infant mortality.
Methods: We searched PubMed and Ovid MEDLINE (from 1946 through July 2013) and
EMBASE (from 1988 through July 2013) databases and the reference lists of reviews and
relevant articles. Studies satisfying our a priori eligibility criteria were evaluated independently by
two authors.
results: Our systematic search yielded 888 articles; of these, 23 were included in the systematic
review. Sixteen provided sufficient data for our quantitative analysis. Arsenic in groundwater
(≥ 50 μg/L) was associated with increased risk of spontaneous abortion (6 studies: OR = 1.98;
95% CI: 1.27, 3.10), stillbirth (9 studies: OR = 1.77; 95% CI: 1.32, 2.36), moderate risk of
neonatal mortality (5 studies: OR = 1.51; 95% CI: 1.28, 1.78), and infant mortality (7 studies:
OR = 1.35; 95% CI: 1.12, 1.62). Exposure to environmental arsenic was associated with a significant reduction in birth weight (4 studies: β = –53.2 g; 95% CI: –94.9, –11.4). There was paucity of
evidence for low-to-moderate arsenic dose.
conclusions: Arsenic is associated with adverse pregnancy outcomes and infant mortality. The
interpretation of the causal association is hampered by methodological challenges and limited
number of studies on dose response. Exposure to arsenic continues to be a major global health issue,
and we therefore advocate for high-quality prospective studies that include individual-level data to
quantify the impact of arsenic on adverse pregnancy outcomes/infant mortality.
citation: Quansah R, Armah FA, Essumang DK, Luginaah I, Clarke E, Marfoh K, Cobbina SJ,
Nketiah-Amponsah E, Namujju PB, Obiri S, Dzodzomenyo M. 2015. Association of arsenic with
adverse pregnancy outcomes/infant mortality: a systematic review and meta-analysis. Environ
Health Perspect 123:412–421; http://dx.doi.org/10.1289/ehp.1307894
