Blood Lead Concentrations and The Neuropsychology Scores of Pregnant Women in Klang Valley.
Malaysia Shamsul Bahari Shamsudin1.
Jamal Hisham Hashim2.
Nik Nasri Nik Ismail3.
Jamal A.
Rahman3.
Maharani Pertiwi Koentjoro4 Department of Community and Family Medicine.
Faculty of Medicine & Health Sciences.
Universiti Malaysia Sabah.
Sabah.
Malaysia United Nations University Ae International Institute for Global Health (UNUAeIIGH) Building.
UKM Medical Centre.
Kuala Lumpur.
Malasyia Universiti Kebangsaan Malaysia Medical Centre.
Kuala Lumpur.
Wilayah Persekutuan.
Malasyia Department of Medical Laboratory Technology.
Faculty of Health.
Universitas Nahdlatul Ulama Surabaya.
Surabaya.
Indonesia Correspondence:
Shamsul Bahari Shamsudin.
Faculty of Medical and Health Sciences.
Universiti Malaysia Sabah.
Kota Kinabalu.
Sabah.
Malasyia Zip Code : 88400 Email: shamsul@ums.
Received: March 13, 2020 Revised: March 16, 2020 Accepted: April 4, 2020 Abstract Pregnant women with high blood lead posed high risk to their fetus as placental transfer can occurs to the fetus.
The objective of this study was to identify the relationship between blood lead and the neuropsychological score of women who were in their 3rd trimester of pregnancy.
These respondents were undergoing a routine antenatal checkup at a teaching hospital located in Klang Valley areas.
Blood lead concentrations were analyzed using graphite furnace Atomic Absorption Spectrophotometer (AAS).
The neuropsychological scores were measured with WHO Neurobehavioral Core Test battery (NCTB).
The test consists of 7 items, which made up of the Digit Symbol.
Trail Making.
Digit Span.
Benton Visual Retention Test.
Pursuit Aiming.
Santa Ana Manual Dexterity.
Reaction Time and Movement Time tests.
The mean blood lead was 78A4.
77 AAg/dL.
The mean score for the total NCTB test 00A5.
Statistical analysis showed blood lead concentrations were inversely correlated with the total NCTB score .
= Ae0.
462, pO0.
The correlation was about The General Linear Model (GLM) showed that age (= Ae0.
15, p = 0.
, weight ( = 2.
67, p = 0.
and height (= Ae1.
97, p = 0.
also influence the total neuropsychological scores.
In conclusion, blood lead reduces the total neuropsychological scores.
The scores for each of the 7 items were inversely and significantly correlated with blood lead concentrations except for the Trail Making and Santa Ana Manual Dexterity tests.
Keywords Neuropsychological scores, blood lead concentrations, pregnant mothers Shamsul Bahari Shamsudin, et al.
INTRODUCTION
cause pregnant women to have preAe Lead could be produced by human eclampsia and endanger the motherAos kidney, activities such as industrial, mining and while BLLs <10 g/dL can increase blood agricultural activities that can spread by air, water and soil .
Lead route of entry to research done by Bayat et al, 2016 showed human body through the inhalation, ingestion there was an increase in systolic blood and skin contact.
Lead has no function in pressure .
014 mmH.
and diastolic .
human body.
Previous study suggested lead mmH.
following the increase of 1 g/dL of has a negative effect on human health even BLLs .
= 0.
or hypertension .
Another though at very low level.
Lead is a neurotoxin This study aims to investigate the and its toxicity affect the function of the association of BLLs with neuropsychology of central nervous system and peripheral nerve.
pregnant women in Klang Valley.
Malaysia.
For adults, the main effects are peripheral Klang Valley area was an ex-mining erea in neuropathy whereby the impulse conduction Peninsular Malaysia.
Active mining activity in the nerve is slowed down.
Peripheral was in 1950-1970.
The residue of lead and neuropathies influence the motor and sensory others heavy metal was still high in air, water The effects are the wrist and the ankle and soil.
The Neurobehavioral Core Test drop that are the result of the defect in the battery (NCTB) can detect early signs of radial and peroneal nerves .
disturbance or failure on the functions of Pregnant woman is at very high risk to nervous system.
WHO was introduced the lead toxicity because pregnant mothers NCTB identifying the nervous dysfunction need high level of nutrient such as calcium as among workers who are working with the well as iron to support the growth and the neurotoxin chemicals .
development of the fetus.
Lead could replace the function of calcium and iron.
Tests on the MATERIALS AND METHODS biochemical and physiological process found The study population is women in their that the concentration of calcium and iron in 3rd trimester of pregnancy who reside in the the blood are inversely proportional to the Klang Valley areas.
These pregnant women lead concentrations .
attending their Study shows blood lead levels (BBL.
in checkup at a hospital in Kuala Lumpur.
Total pregnant women at 20.
8 g/dL can cause 202 respondents were selected through maternal disorders, when BLLs reaches 2.
g/dL, it can cause stress and fatigue levels criteria, that she must be Malaysian citizen, in pregnant women .
BLLs <5 g/dL may in the 3rd trimester pregnancy and have sampling based on Ina J Med Lab Sci Tech 2020.
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Shamsul Bahari Shamsudin, et al.
Their (EDTA) and 5 g ammonium dehydrogenate pregnancies were categorized as AuhighAeriskAy phosphate in 1Aeliter deionizer distilled water.
because they were referral cases from private Lypocheck sample were used as a reference or government clinics within the areas.
These sample for quality control procedure during women were either in their 1st or 5th the analysis.
pregnancies, had hypertension, diabetes.
Neuropsychological Assessment anemia or a history of previous delivery A neuropsychological test conducted in this study were Neuropsychological Core Questionnaire interviews were carried Test Battery (NCTB) and it is commonly out to collect information on the demographic used by WHO .
It was an instrument used as well as socioeconomic background and to detect early nervous systems failure their health status.
The questionnaire consists because of the exposure of neurotoxin agents.
of the questions on their age, ethnicity.
This instrument is very sensitive and can number of children, educational level, detect early sign of nerve disturbance at a occupation and areas of residential.
While the very low level of exposure.
It consists of the questions on health status include of number Benton Visual Retention.
Digit Span.
Digit of deliveries, medical history, smoking habit.
Symbol.
Pursuit Aiming.
Reaction Time.
Santa Ana Manual Dexterity and Profile of Mood States (POMS) tests.
However, the Blood Sampling and Analysis POMS test was not be conducted in this Venous blood was sampled during or study, instead it was replaced by two more after the 28 weeks of pregnancy.
Five .
ml tests.
Movement Time and Trail Making of the blood samples were put into a special The description and functional domain vacuum container tube, which contained of the tests are shown in Table 1.
All sample of blood Standard Score Calculation lead were analyzed using Graphite Furnace Atomic Absorption The raw score obtained from the Spectrophotometer neurobehavioral tests, was transformed into model HITACHI Z5700 with polarized standard scores.
From these transformed data Zeeman.
Blood sample were diluted with or standard scores, the mean value is 50 and matrix modifier solution in a ratio of 1:5.
The the standard deviation is 10.
The calculation modified matrix solution also acts as for the standard score is shown:
antifreeze agent during storage.
The modified Standard score = [.
aw data Ae mea.
/ matrix solution consists of 10 mL TritonAeX, standard deviatio.
x 10 50.
Ina J Med Lab Sci Tech 2020.
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10% 0.
3 g ethylene diamine tetra acetic acid Shamsul Bahari Shamsudin, et al.
Table 1.
Descriptions of Neuropsychological (NCTB) Tests Functional domain Test Description Reaction/Movement Attention/Response It measures how fast a person reacts/moves.
& movement speed requires sustained attention by the subject.
Digit span Auditory memory It is a test of immediate .
hortAeter.
auditory memory that requires focused attention.
Santa Ana Manual Manual dexterity It requires rapid eyeAehand coordination Dexterity Digit symbol PerceptualAemotor It is a test of perceptual motor speed that also requires learning of associations.
Benton visual Visual It is a shortAeterm visual memory that requires perception/memory focused attention.
It also measures the ability to organize geometrical patterns in space and memorize them.
Pursuit aiming Motor steadiness It measures the ability to make quick and accurate movements with the hand.
Trail making Motor tracking It measures visual motor tracking and visual It requires an attention.
Source: WHO.
Operational Guide for The WHO Neurobehavioral Core Test Battery.
World Health Organization.
Geneva.
15 Februari .
period was 31.
6 weeks.
The ethnic and Ethical Clearance This research was approved by the religious distributions of the respondents are Research Ethics Committee of Hospital shown in Table 2.
The Malays made up 58.
Universiti Kebangsaan Malaysia of the About (UKM/EC711002105465-.
Involvement of respondents are full time housewives.
respondents is based on a written agreement others work as general worker, operate a with filling a consent form.
Respondents may business, selfAeemployed or partAetime wage withdraw at any time if they do not agree or The average household income is RM are not satisfied with any study procedures.
7 (Table .
The mean blood lead level 78 with standard deviation of 4.
RESULTS
AAg/dL.
Figure 1 shows the data distribution of socioeconomic background information of blood lead for the respondents.
KolmogorovAe the respondents.
The mean age for mothers Smirnov Normality Test shows that the 6 years old and their mean gestation distribution was normal .
> 0.
Table 2 shows the demography and Ina J Med Lab Sci Tech 2020.
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Shamsul Bahari Shamsudin, et al.
Frequency Venous blood lead conc.
g/dL) Fig 1.
Distributions of Blood Lead Concentrations (AAg/dL) Table 2.
RespondentsAo Demographic and Socioeconomic Background Variable Range Mean Mother age (Yea.
19 Ae 44 Mother Education (Yea.
6 Ae 19 FatherAos education (Yea.
6 Ae 22 Total Household Income (RM) 750 Ae 8500 MotherAos height .
43 Ae 1.
MotherAos weight .
0 Ae 92.
Pregnancy duration .
28 Ae 36
Number of pregnancies 1Ae6
Number of children
1Ae6
N = 202
Table neuropsychological test (NCTB) that was Std.
Dev.
were calculated from the raw scores and used for all statistical analysis.
carried out on the respondents.
It took about Figure 2 shows the standardized NCTB 30Ae45 minutes to complete all the 7 types of score test distributions, which were normal .
NCTB test.
Standard Score Index Values > 0.
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Shamsul Bahari Shamsudin, et al.
Frequency NCTB average score Fig 2.
Distributions of Neuropsychological Scores Table 3.
Neuropsychological Scores (NCTB) of Pregnant Mothers Neuropsychological scores (NCTB) Range Mean Digit Symbol 0 Ae 78.
Pursuit Aiming 5 Ae 80.
Trail Making 4 Ae 73.
Digit Span 8 Ae 85.
Benton Visual Retention Test 8 Ae 67.
Santa Ana Manual Dexterity 1 Ae 70.
Reaction Time 5 Ae 72.
Total Score Total Score 3 Ae 67.
N = 202
Std.
Dev.
Table 4 shows the correlation between neuropsychological scores.
Table 5 shows blood lead and each NCTB test.
The total that the total NCTB scores were influenced NCTB by the respondentsAo blood lead, age, weight significant correlation with the respondentsAo and height after all the confounding factors blood lead except for the Pursuit Aiming and were adjusted.
This model shows that these Santa Ana Manual Dexterity tests.
The linear factors contribute 27% of the variations in the model shows that about 21.
3% of the NCTB scores.
variations in blood lead contributed to the Ina J Med Lab Sci Tech 2020.
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Shamsul Bahari Shamsudin, et al.
NCTB average score Rsq = 0.
Venous blood lead conc.
g/dL) Fig 3.
Correlation Between Blood Lead Concentrations and Neuropsychological Scores Table 4.
Correlation Blood Lead and Neuropsychological Scores Neuropsychological test Blood lead (AAg /dL) (NCTB) p value Digit Symbol Ae0.
< 0.
Pursuit Aiming Ae 0.
Trail Making Ae 0.
< 0.
Digit Span Ae 0.
< 0.
Benton Visual Retention Test Ae 0.
< 0.
Santa Ana Manual Dexterity Ae 0.
Reaction Time Ae 0.
< 0.
Total score Ae0.
< 0.
N = 202
Significant at p < 0.
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Table 5.
Correlations of Blood Lead on The Neuropsychological Scores After Adjustment of Confounders Regression Dependant variable Statistict p value (Mean Neuropsychological scor.
(Constan.
c < 0.
Blood lead (AAg /dL) Ae 0.
Ae 7.
< 0.
Age .
Ae 0.
Ae 2.
Weight .
Height .
Ae 0.
Ae 1.
Educational level .
Household income (RM) Ae 0.
Ae 1.
N = 202
Significant at p O 0.
F value = 12.
787, p < 0.
Significant at p O 0.
r = 0.
R2 = 0.
Shamsul Bahari Shamsudin, et al.
blood lead .
55A5.
5 AAg/dL) than those DISCUSSION The mean blood lead of the respondents working in offices .
44A2.
77 AAg/dL), 78 AAg/dL (Figure .
, which is more factories .
61A3.
39 AAg/dL) and shops than the blood lead of electronic industries .
01A3.
13 AAg/dL).
However, the difference soldering workers .
10 AAg/L) .
Pregnant was not statistically significant.
Study by .
women need an optimum nutrient such as reported that the mean blood lead for women Ca2 and Fe2 or Fe3 , for the growth of the in the Avon are of the UK was range 0.
41Ae babies .
The body tends to absorb lead if 14 AAg/dL.
Studies at Port Pirie.
Australia the calcium and iron intake were insufficient .
reported that 646 women who are 30 to in the diet.
Lead in the mothersAo blood 36 weeks pregnant had an almost similar systems has a potential of being transferred to mean blood lead level of 7.
2 AAg/dL and 28% the fetus through the placenta and this had blood lead of more than 10 AAg/dL.
process began 2Ae3 months at an early stage of In general, neuropsychological scores Blood lead concentrations for were calculated from the 7 tests in the NCTB.
pregnant mothers should not exceed 10 Correlation tests indicated that blood lead for AAg/dL .
However, almost 27% of the these pregnant mothers had an inverse respondents have blood lead concentrations significant correlation with Digit Symbol, of more than 10 AAg/dL.
Studies .
in African Digit Span.
Trail Making.
Benton Visual reported that mean blood lead for pregnant Retention Test and Reaction Time (Table .
mothers who live in the city and the rural Only Pursuit Aiming and Santa Ana ranged from 0.
83 to 99 AAg/dL.
The difference Manual of those data was significantly difference.
significantly correlated with blood lead This proves that environment can influence (Table .
The NCTB test result shows that lead concentrations in the blood.
There was pregnant mother with high blood lead have no significant relationship between blood difficulties in concentrating and have shortAe lead with age and the gestation period.
term hearing and visual abilities (Digit Span However, the mean blood lead in previous Test.
Benton Visual Retention Tes.
They study was higher than this study.
have slow motor speed through vision (Digit Another study .
, on pregnant women Symbol Tes.
slow reaction toward visual stimulation (Reaction Time Tes.
and low concentration was 8.
59 A 4.
45 AAg/dL and attention ability, visual scanning and visual 8% respondents had blood lead motor trailing (Trail Making Tes.
Dexterity concentrations higher than 10 AAg/dL.
The study found that housewives had higher In Figure 3 Shown ultiple regression test Ina J Med Lab Sci Tech 2020.
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Shamsul Bahari Shamsudin, et al.
(F = 18.
23, p < 0.
with the R2 value, mothers were influenced by blood lead ( = which shows that 27% of the variations in the Ae0.
56, p < 0.
, age ( = 0.
12, p < 0.
NCTB scores were influenced by the weight ( = 0.
12, p = 0.
and height ( = Ae variables shown below:
01, p = 0.
The model was significant NCTB mean score = 65.
71 Ae 0.
lood lea.
Ae 0.
Ae 0.
Previous studies showed that blood lead They also had slow reaction to stimulation among female workers had the abilities to due to poor ability to pay attention and low lower the NCTB score .
Studies .
attention ability, which cause poor visual showed that 140 female factory operators had motor tracking as well as poor visual a mean blood lead concentration of 30.
AAg/dL and it was inversely correlated only Blood lead concentrations, age, weight with the Reaction Time test .
= Ae0.
201, p = and height influenced 27% of the variations Meanwhile .
found that mean blood in neuropsychological score after adjusting lead for female soldering workers at an for confounders.
About 1 AAg/dL increment in electronic factory was 6.
1 AAg/dL, and the comparative group was 4.
6 AAg/dL.
The neuropsychological mean score of these respondents' blood lead had significant pregnant mothers.
relationships with Digit Span Test .
= .
Santa Ana Manual Dexterity Test .
CONCLUSIONS = 0.
and total NCTB scores .
= 0.
In conclusion, even though the blood The exposed workers had significantly lower lead concentration is quite low, it affects the mean score compared to unexposed workers for Digit Symbol Test.
Trail Making Test and Digit Symbol.
Digit Span.
Trail Pursuit Aiming Test.
Making.
Benton Visual Retention and Pregnant mothers with high blood lead had problems with the ability to concentrate Reaction Time test scores had significant inverse correlations with the blood lead.
and have poor shortAeterm auditory and visual memory and have the inability to organize geometry patterns in space and memorizing ACKNOWLADGEMENTS Appreciation goes to all respondents and Management and fail to match between symbol and digits.
Laboratory.
Hospital Universiti Kebangsaan Ina J Med Lab Sci Tech 2020.
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Environmental Health They have poor perceptual motor speed Shamsul Bahari Shamsudin, et al.
Malaysia who gave the commitment that this CONFLICT OF INTEREST study can be implemented successfully.
There are no conflicts of interest.
REFERENCES