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Article

The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study

1
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
2
Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
3
Global Biostatistics and Data Science, Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(19), 3700; https://doi.org/10.3390/ijerph16193700
Received: 28 July 2019 / Revised: 23 September 2019 / Accepted: 26 September 2019 / Published: 1 October 2019
(This article belongs to the Special Issue Social Stressors and Susceptibility to Chemical Exposures)
Metals, stress, and sociodemographics are commonly studied separately for their effects on birth outcomes, yet often jointly contribute to adverse outcomes. This study analyzes two methods for measuring cumulative risk to understand how maternal chemical and nonchemical stressors may contribute to small for gestational age (SGA). SGA was calculated using sex-specific fetal growth curves for infants of pregnant mothers (n = 2562) enrolled in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Study. The exposures (maternal lead, mercury, cadmium, Cohen’s perceived stress, Edinburgh depression scores, race/ethnicity, income, and education) were grouped into three domains: metals, psychosocial stress, and sociodemographics. In Method 1 we created cumulative risk scores using tertiles. Method 2 employed weighted quantile sum (WQS) regression. For each method, logistic models were built with three exposure domains individually and race/ethnicity, adjusting for age, parity, pregnancy weight gain, and marital status. The adjusted effect of overall cumulative risk with three domains, was also modeled using each method. Sociodemographics was the only exposure associated with SGA in unadjusted models ((odds ratio) OR: 1.35, 95% (confidence interval) CI: 1.08, 1.68). The three cumulative variables in adjusted models were not significant individually, but the overall index was associated with SGA (OR: 1.17, 95% CI: 1.02, 1.35). In the WQS model, only the sociodemographics domain was significantly associated with SGA. Sociodemographics tended to be the strongest risk factor for SGA in both risk score and WQS models. View Full-Text
Keywords: cumulative risk; chemical exposures; nonchemical exposures; perinatal health cumulative risk; chemical exposures; nonchemical exposures; perinatal health
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MDPI and ACS Style

Zilversmit Pao, L.; Harville, E.W.; Wickliffe, J.K.; Shankar, A.; Buekens, P. The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study. Int. J. Environ. Res. Public Health 2019, 16, 3700. https://doi.org/10.3390/ijerph16193700

AMA Style

Zilversmit Pao L, Harville EW, Wickliffe JK, Shankar A, Buekens P. The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study. International Journal of Environmental Research and Public Health. 2019; 16(19):3700. https://doi.org/10.3390/ijerph16193700

Chicago/Turabian Style

Zilversmit Pao, Leah, Emily W. Harville, Jeffrey K. Wickliffe, Arti Shankar, and Pierre Buekens. 2019. "The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study" International Journal of Environmental Research and Public Health 16, no. 19: 3700. https://doi.org/10.3390/ijerph16193700

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