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. 2023 May 15;59(5):951.
doi: 10.3390/medicina59050951.

The Effect of Maternal Exposure to Air Pollutants and Heavy Metals during Pregnancy on the Risk of Neurological Disorders Using the National Health Insurance Claims Data of South Korea

Kuen Su Lee  1 , Won Kee Min  2 , Yoon Ji Choi  2 , Sejong Jin  3 , Kyu Hee Park  4 , Suhyun Kim  5
Affiliations

The Effect of Maternal Exposure to Air Pollutants and Heavy Metals during Pregnancy on the Risk of Neurological Disorders Using the National Health Insurance Claims Data of South Korea

Kuen Su Lee et al. Medicina (Kaunas). .

Abstract

The objective of this study was to evaluate the effects of high levels of maternal exposure to ambient air pollution and heavy metals on risks of autism spectrum disorder (ASD) and epilepsy using the National Health Insurance claims data of South Korea. The data of mothers and their newborns from 2016 to 2018 provided by the National Health Insurance Service were used (n = 843,134). Data on exposure to ambient air pollutants (PM2.5, CO, SO2, NO2, and O3) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during pregnancy were matched based on the mother's National Health Insurance registration area. SO2 (OR: 2.723, 95% CI: 1.971-3.761) and Pb (OR: 1.063, 95% CI: 1.019-1.11) were more closely associated with the incidence of ASD when infants were exposed to them in the third trimester of pregnancy. Pb (OR: 1.109, 95% CI: 1.043-1.179) in the first trimester of pregnancy and Cd (OR: 2.193, 95% CI: 1.074-4.477) in the third trimester of pregnancy were associated with the incidence of epilepsy. Thus, exposure to SO2, NO2, and Pb during pregnancy could affect the development of a neurologic disorder based on the timing of exposure, suggesting a relationship with fetal development. However, further research is needed.

Keywords: air pollution; autism spectrum disorder; epilepsy; heavy metals.

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Conflict of interest statement

The authors have no conflict of interest relevant to this study to disclose.

Figures

Figure 1
Figure 1
Consort flow diagram of this study.
Figure 2
Figure 2
Spatial distribution of the mean PM2.5 and NO2 concentrations and the number of neurologic disorders in South Korea. (a) PM2.5 and autism spectrum disorder, (b) PM2.5 and epilepsy, (c) Pb and autism spectrum disorder, (d) Pb and epilepsy. Data are presented as the mean and number of patients.
Figure 3
Figure 3
Adjusted odds ratios and 95% Cis for neurologic disorders and exposure to air pollutants and heavy metals by months of pregnancy in a one-pollutant model. (a) Pb and autism spectrum disorder by months of pregnancy, (b) Pb and epilepsy by months of pregnancy, (c) Cd and autism spectrum disorder by months of pregnancy, and (d) Cd and epilepsy by months of pregnancy. Logistic regression model adjusted for maternal age, education, infant sex, season of conception, and household income.
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