Q&A: Prenatal chemical exposure linked to liver injury in mothers, children 10 years later
Key takeaways:
- Prenatal exposure to air pollutants, phthalates and pesticides increased the risk for liver injury, especially among children.
- Maternal intake of at least 600 µg of folic acid daily may attenuate this risk.
Exposure to environmental chemicals during pregnancy may increase the risk for liver injury and steatosis in children and mothers, which could be mitigated by higher folic acid supplementation, according to a study in Journal of Hepatology.
“We generally refer to metabolism-disrupting chemicals, or MDCs, as chemicals with hormone-disrupting properties that can alter metabolic processes and, in this way, increase risk for many metabolic disorders and diseases such as chronic liver diseases,” Damaskini “Dania” Valvi, MD, MPH, PhD, study author and associate professor in the department of environmental medicine and climate science at Icahn School of Medicine at Mount Sinai, told Healio.
“The pregnancy period is considered particularly sensitive to the effects of MDCs due to the multiple hormonal and physiological changes occurring for both mothers and fetuses,” she continued. “Importantly, MDC exposures during this sensitive period can alter fetal development and programming and, in this way, increase risk for multiple long-term adverse health effects in later life.”
Valvi and colleagues investigated the effects of MDC exposures on 10-year liver outcomes in a study of mother-child pairs from Mexico City in the ongoing, prospective, population-based PROGRESS cohort. They included 234 mothers, who were exposed during pregnancy between 2007 and 2011, and 205 children, all of whom underwent liver enzyme testing.
The researchers measured 43 MDCs, including 14 nonessential metals or elements, 10 high molecular weight phthalates (HMWPs), seven essential metals or trace elements, five low molecular weight phthalates (LMWPs), five organophosphate pesticide metabolites and two air pollutants.
According to the results among children, every one-quartile increase in gestational HMWP mixtures was associated with increases of 10.1% (95% CI, 1.67-19.4) in alanine aminotransferase and 5.27% (95% CI, 0.8-10.1) in aspartate aminotransferase. Similarly, every one-quartile increase in LMWP mixtures was associated with an AST increase of 4.98% (95% CI, 0.73-9.75), with increases in air pollutants linked to a rise in ALT levels by 9.66% (95% CI, 1.05-19.6).
Among mothers, every one-quartile increase in LMWPs was associated with an increased likelihood of steatosis.
The researchers noted that maternal folic acid supplementation of at least 600 µg per day attenuated the risk for most adverse liver outcomes for both mothers and children.
In a Healio exclusive, Valvi provides additional insight into the link between MDCs and liver injury and how these results might influence patient care.
Healio: What is the link between MDCs and liver injury?
Valvi: Growing evidence from experimental and human studies suggests that MDC exposures may contribute to liver injury, MASLD and/or MASH, likely in combination with other genetic, environmental and lifestyle factors.
Our study in a Mexican population with high rates of obesity and liver steatosis showed that MDC exposures in pregnancy may increase risk for liver injury, particularly in the offspring, and opened a new avenue for the potential of vitamin B supplementation as a way to partially mitigate the MDC liver effects for both mothers and their children.
Healio: Why did your team undertake this investigation?
Valvi: We aimed to fill critical gaps and advance the knowledge about the impacts of MDCs on liver health at a population level, by examining the effects of several ubiquitous MDC exposures as a mixture, evaluating the potential role of folic acid supplementation and characterizing these associations for the first time in children and their mothers.
Healio: What were the key takeaways?
Valvi: Higher MDC exposures during pregnancy may increase the likelihood of liver injury and steatosis a decade after pregnancy, particularly in children compared to their mothers.
Adequate folic acid supplementation and higher blood cobalt levels in pregnancy were found to attenuate MDC associations with liver injury and steatosis for both children and mothers.
Healio: How do these results add to patient care going forward?
Valvi: These findings are important as they can inform the design of clinical intervention studies in the future that help to mitigate the MDC health effects in exposed women and their offspring.
Healio: What else can be done to protect both mothers and children?
Valvi: It is important for women to consult with their physician about specific vitamins and supplements that they may need, especially when trying to conceive and during pregnancy. Prenatal vitamin supplementation is critical because it protects both mother and child from pregnancy complications and health risks in the future.
Following a healthy diet and lifestyle and trying to limit the use of consumer products that contain MDCs can help to reduce some of these exposure in pregnancy. However, because MDC exposures are so ubiquitous and some of these chemicals are very persistent in environment, we can reduce but cannot completely eliminate our environmental chemical exposures on our own.
Therefore, it is also crucial to also advocate for stronger environmental regulations that limit air pollution and the presence of environmental contaminants acting as MDCs in consumer products, as well as in our food and drinking water.
Healio: What additional research is needed?
Valvi: Our research is currently focusing on replicating these findings in other independent ethnically diverse populations, integrating liver imaging methods with innovative exposome data science approaches. We are particularly interested in better understanding of the role of folate, folic acid and other B vitamins in MDC effects on the liver.
Further research from in vivo/in vitro and clinical studies can help us to better understand these interrelationships and translate results into effective interventions that aim to protect the health of women and their offsprings from hazardous environmental chemical exposures.
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