Background

Millions of individuals worldwide, particularly in Bangladesh, are exposed to arsenic, mainly through drinking water from tube wells. Arsenic is a reproductive toxicant, but there is limited knowledge of whether it influences pubertal development.

Objectives

We evaluated the association between prenatal arsenic exposure and age at menarche.

Methods

This prospective study was based on data from two studies conducted in Matlab, Bangladesh—the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial and the Health Consequences of Arsenic in Matlab (AsMat) study. We included 809 MINIMat girls who participated in assessing age at menarche from July 2016 to June 2017 and had prenatal arsenic exposure data through the AsMat study via measurements in tube well water used by the mothers during pregnancy. The exposure was categorized into <10, 10–49, 50–99, 100–199, and ≥200 µg/L. We used Kaplan-Meier and Cox proportional hazards analyses with adjustment for potential confounders to evaluate the association between arsenic exposure and age at menarche. The results were presented by adjusted hazards ratio (aHR) with a 95% confidence interval (CI).

Results

The median arsenic concentration in tube well water consumed by pregnant women was 80 µg/L (interquartile range 2–262 µg/L), and 55% drank water with concentrations above Bangladesh’s acceptable value of 50 µg/L. The median age at menarche was 13.0 years. The unadjusted analysis revealed 3.2 months delay in menarche for girls exposed to arsenic concentrations ≥200 µg/L compared with the girl exposed to arsenic concentrations <10 µg/L. Girls exposed to the same higher arsenic concentrations were 23% (aHR 0.77, 95% CI: 0.63–0.95) less likely to have reached menarche than girls exposed to low arsenic concentrations.

Conclusions

Increased levels of prenatal arsenic exposure were associated with older age at menarche. This delay may indicate endocrine disruptions that could potentially result in adverse health consequences in later life. This finding, along with other severe adverse health reinforces the need for arsenic mitigation at the population level.

中文翻译：

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孟加拉国农村地区产前砷暴露与初潮年龄之间关联的队列研究

背景

世界各地，尤其是在孟加拉国，数百万人主要通过管道井中的饮用水接触砷。砷是一种生殖毒物，但对它是否影响青春期发育的认识还很有限。

目标

我们评估了产前砷暴露与初潮年龄之间的关联。

方法

这项前瞻性研究基于孟加拉国Matlab进行的两项研究（Matlab中的母婴营养干预（MINIMat）试验）和Matlab中砷对健康的后果（AsMat）研究得出的数据。我们纳入了809名MINIMat女孩，这些女孩参加了2016年7月至2017年6月的初潮年龄评估，并通过AsMat研究通过测量母亲在怀孕期间使用的管井水获得了产前砷暴露数据。暴露分为<10、10–49、50–99、100–199和≥200µg / L。我们使用了Kaplan-Meier和Cox比例风险分析，并对潜在的混杂因素进行了调整，以评估砷暴露与初潮年龄之间的关联。通过调整后的危险比（aHR）和95％的置信区间（CI）表示结果。

结果

孕妇摄入的管井水中砷的中位浓度为80 µg / L（四分位数范围为2–262 µg / L），喝水的55％砷的浓度超过孟加拉国可接受的50 µg / L。初潮的中位年龄为13.0岁。未经调整的分析显示，暴露于砷浓度≥200 µg / L的女孩的初潮延迟了3.2个月，而暴露于砷浓度<10μg/ L的女孩的初潮延迟了3.2个月。暴露于相同较高砷浓度的女孩比暴露于低砷浓度的女孩的月经初潮的可能性要低23％（aHR 0.77，95％CI：0.63-0.95）。

结论

产前砷暴露水平的升高与月经初潮年龄较大有关。这种延迟可能表明内分泌干扰，可能会在以后的生活中对健康造成不利影响。这一发现与其他严重的不良健康现象一起，增强了在人群水平上减少砷的需求。