 |
 |
 |
 |
 |
 |
Sains Malaysiana 53(10)(2024): 3455-3464
http://doi.org/10.17576/jsm-2024-5310-18
Association between Gestational Bisphenol A Exposure and Maternofoetal Outcomes: A Cohort Study in a
Single Tertiary Hospital in Klang Valley
(Perkaitan antara Dedahan Bisfenol A Gestational dan Hasil
Maternofoetal: Suatu Kajian Kohort di Hospital Tertiari Tunggal di Lembah Klang)
JULIANA
YUSOF1#, SARAH ZULKIFLI2#, MOHD SHAHRIL AHMAD SAMAN3,
DANIAL EFENDY GOON4, NURLIANA ABD MUTALIB5, NUR IZZATY
YUSNAZERY6, IZZUAN KHIRMAN ADNAN6 & SITI HAMIMAH
SHEIKH ABDUL KADIR2,*
1Department of Obstetrics
and Gynaecology, Hospital Al Sultan Abdullah, Universiti Teknologi MARA (UiTM), 42300 Puncak Alam, Selangor, Malaysia
2Institute of Pathology,
Laboratory and Forensic Medicine (I-PPerForM),
Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor, Malaysia
3Department of Public Health
Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor,
Malaysia
4Novo Nordisk Pharma (M) Sdn. Bhd., Jalan Tun Sambanthan,
50470 Kuala Lumpur, Malaysia
5Atta-Ur-Rahman Institute
for Natural Product Discovery (AuRIns), Universiti Teknologi MARA (UiTM),
42300 Puncak Alam, Selangor, Malaysia
6National Institute of
Health, Ministry of Health Malaysia, 40170 Shah Alam, Selangor, Malaysia
Received: 16 January 2024/Accepted: 29 August
2024
Abstract
A growing body of
literature has documented the adverse effects of bisphenol A (BPA) exposure on
pregnancy and birth outcomes. Regardless, how gestational BPA exposure affects
mother-newborn pairs in Malaysia is yet to be explored. Hence, this study aimed
to investigate urinary BPA levels of pregnant women living in Klang Valley and
their associations with adverse obstetric and birth outcomes. This
cross-sectional study involved pregnant women in their third trimester
attending antenatal clinic in Hospital Al Sultan Abdullah (HASA), UiTM Puncak Alam, who planned to have their delivery in HASA.
Information on maternal age, parity, education, household income, gestational
age, and obstetric complications, such as Gestational Diabetes Mellitus (GDM),
preeclampsia, preterm labour, and foetal growth restriction (FGR) were
collected. Maternal urine samples were also obtained and evaluated using liquid
chromatography-tandem mass spectrometry (LC-MS/MS). Additionally, the neonatal
outcomes including mode of delivery, gestational age, birth weight and need for
NICU admission were documented. Our LC-MS/MS analysis showed that BPA was
present in all the urine samples, with levels varying from 4.42 to 30.86 ng/mL. The median level was 15.96 ng/mL. Urinary BPA level
has no significant correlation with gestational hypertension (GHTN), preterm
labour and low birth weight babies. Babies who need NICU admission were born to
mothers who exhibited significantly different urinary BPA levels compared to
those whose babies were not admitted (p=0.049). Finding from this study suggestive of further investigation
on level of gestational urinary BPA with NICU admission, ideally with a larger
sample size to validate these results.
Keywords: Bisphenol A (BPA); foetal
outcome; pregnancy outcome
Abstrak
Badan kepustakaanyang semakin meningkat telah mendokumentasikan
kesan buruk bisfenol A (BPA) terhadap kehamilan dan kelahiran. Namun begitu,
bagaimana pendedahan BPA semasa kehamilan memberi kesan terhadap pasangan ibu
dan bayi baru lahir di Malaysia masih belum diterokai. Oleh itu, penyelidikan
ini bertujuan untuk mengkaji tahap BPA dalam air kencing wanita hamil yang
tinggal di Lembah Klang dan kaitannya dengan kesan buruk obstetrik dan
kelahiran. Kajian keratan rentas ini melibatkan wanita hamil dalam trimester
ketiga yang menghadiri klinik antenatal di Hospital Al Sultan Abdullah (HASA),
UiTM Puncak Alam, yang merancang untuk bersalin di HASA. Maklumat mengenai umur
ibu, pariti, pendidikan, pendapatan isi rumah, usia kehamilan dan komplikasi
obstetrik, seperti Gestational Diabetes Mellitus (GDM), preeklampsia, kelahiran
pramatang dan sekatan pertumbuhan janin (FGR) telah dikumpulkan. Sampel air
kencing pesakit juga diambil dan dianalisis menggunakan kromatografi cecair
spektrometri jisim tandem (LC-MS/MS). Di samping itu, hasil neonatal termasuk
cara melahirkan, umur kehamilan, berat bayi ketika lahir dan keperluan untuk kemasukan NICU telah didokumenkan. Semua sampel air kencing didapati mengandungi BPA dan parasnya adalah antara 4.42 hingga 30.86 ng/mL. Tahap median ialah 15.96 ng/mL. Tahap BPA kencing tidak mempunyai korelasi yang signifikan dengan hipertensi semasa hamil (GHTN), kelahiran pramatang dan berat lahir bayi yang rendah. Bayi yang memerlukan kemasukan NICU dilahirkan oleh ibu yang menunjukkan tahap BPA kencing yang berbeza
secara ketara berbanding mereka yang bayinya tidak dimasukkan (p = 0.049).
Penemuan daripada kajian ini mencadangkan kajian lanjut mengenai tahap BPA
dalam air kencing semasa kehamilan dengan kemasukan NICU, idealnya dengan saiz
sampel yang lebih besar untuk mengesahkan keputusan ini.
Kata kunci: Bisfenol A (BPA); hasil kehamilan; hasil kelahiran
REFERENCES
Babu, S., Uppu, S.,
Claville, M.O. & Uppu, R.M. 2013. Prooxidant
actions of bisphenol A (BPA) phenoxyl radicals: Implications to BPA-related
oxidative stress and toxicity. Toxicology Mechanisms and Methods 23(4):
273-280. https://doi.org/10.3109/15376516.2012.753969
Bae, S., Lim, Y-H., Lee, Y.A., Shin, C.H., Oh,
S-Y. & Hong, Y-C. 2017. Maternal urinary bisphenol A concentration during
midterm pregnancy and children’s blood pressure at age 4. Hypertension 69(2):
367-374. https://doi.org/10.1161/HYPERTENSIONAHA.116.08281
Bellavia, A., Cantonwine, D.E., Meeker, J.D.,
Hauser, R., Seely, E.W., McElrath, T.F. & James-Todd, T. 2018. Pregnancy
urinary bisphenol A concentrations and glucose levels across BMI categories. Environment
International 113: 35-41. https://doi.org/10.1016/j.envint.2018.01.012
Benachour, N. & Aris, A. 2009. Toxic
effects of low doses of bisphenol-A on human placental cells. Toxicology and
Applied Pharmacology 241(3): 322-328.
https://doi.org/10.1016/j.taap.2009.09.005
Bindhumol, V., Chitra, K.C. & Mathur, P.P.
2003. Bisphenol A induces reactive oxygen species generation in the liver of
male rats. Toxicology 188(2-3): 117-124. https://doi.org/10.1016/s0300-483x(03)00056-8
Buonocore, G., Perrone,
S., Longini, M., Vezzosi, P., Marzocchi, B., Paffetti, P. & Bracci, R.
2002. Oxidative stress in preterm neonates at birth
and on the seventh day of life. Pediatric Research 52(1): 46-49.
https://doi.org/10.1203/00006450-200207000-00010
Cantonwine, D.E., Ferguson, K.K., Mukherjee, B., McElrath, T.F. &
Meeker, J.D. 2015. Urinary bisphenol A levels during pregnancy and risk of
preterm birth. Environ. Health Perspect 123(9): 895-901. https://doi.org/10.1289/ehp.1408126
Casas,
M., Valvi, D., Ballesteros-Gomez, A., Gascon, M., Fernandez, M.F.,
Garcia-Esteban, R., Iñiguez, C., Martínez, D., Murcia, M., Monfort, N., Luque,
N., Rubio, S., Ventura, R., Sunyer, J. & Vrijheid, M. 2016.
Exposure to bisphenol A and phthalates during pregnancy and ultrasound measures
of fetal growth in the INMA-Sabadell cohort. Environ Health Perspect.
124(4): 521-528. https://doi.org/10.1289/ehp.14 09190
Chu, P-W., Yang, Z-J., Huang, H-H., Chang,
A-A., Cheng, Y-C., Wu, G-J. & Lan, H-C. 2018. Low-dose bisphenol A
activates the ERK signaling pathway and attenuates steroidogenic gene
expression in human placental cells. Biology of Reproduction 98(2):
250-258. https://doi.org/10.1093/biolre/iox162
Cleveland
Clinic. 2024. Third Trimester.
Accessed on 10 August 2024. https://my.clevelandclinic.org/health/articles/third-trimester
Dagdeviren, G., Arslan, B., Keles, A., Yücel
Çelik, Ö., Arat, Ö. & Caglar, A.T. 2023. The evaluation of serum bisphenol
A in patients with preeclampsia. The Journal of Obstetrics and Gynaecology
Research 49(5): 1322-1327. https://doi.org/10.1111/jog.15616
Hanson, M.A. & Gluckman, P.D. 2014. Early
developmental conditioning of later health and disease: Physiology or
pathophysiology? Physiological Reviews 94(4): 1027-1076.
https://doi.org/10.1152/physrev.00029.2013
Heng Yaw Yong, Zalilah Mohd Shariff, Zulida
Rejali, Barakatun Nisak Mohd Yusof, Jacques Bindels, Yvonne Yee Siang Tee &
Eline M. van der Beek. 2021. Adverse pregnancy outcomes are associated with
lower cut-offs for maternal hyperglycemia in Malaysian women: A retrospective
cohort study. Mal. J. Med. Health Sci. 17(3): 55-62.
Hu, C.Y., Li, F.L.,
Hua, X.G., Jiang, W., Mao, C. & Zhang, X.J. 2018. The association between
prenatal bisphenol A exposure and birth weight: A meta-analysis. Reprod.
Toxicol. 79: 21-31. https://doi.org/10.1016/j.reprotox.2018.04.013
Hu, J., Zhao, H., Braun, J.M., Zheng, T.,
Zhang, B., Xia, W., Zhang, W., Li, J., Zhou, Y., Li, H., Li, J., Zhou, A.,
Zhang, Y., Buka, S. L., Liu, S., Peng, Y., Wu, C., Jiang, M., Huo, W., Zhu Y.,
Shi, K., Li, Y., Cai, Z. & Xu, S. 2019. Associations of trimester-specific
exposure to bisphenols with size at birth: A Chinese prenatal cohort study. Environmental
Health Perspectives 127(10): 107001. https://doi.org/10.1289/EHP4664
Kouidhi, W., Thannimalay, L., Soon, C.S. &
Ali Mohd, M. 2017. Occupational exposure to bisphenol A (BPA) in a plastic
injection molding factory in Malaysia. International Journal of Occupational
Medicine and Environmental Health 30(5): 743-750.
https://doi.org/10.13075/ijomeh.1896.00917
Koukoura, O., Sifakis, S. & Spandidos,
D.A. 2012. DNA methylation in the human placenta and fetal growth (review). Molecular
Medicine Reports 5(4): 883-889. https://doi.org/10.3892/mmr.2012.763
Kwintkiewicz, J., Nishi, Y., Yanase, T. &
Giudice, L.C. 2010. Peroxisome proliferator–activated receptor-γ mediates
bisphenol A inhibition of FSH-stimulated IGF-1, aromatase, and estradiol in
human granulosa cells. Environmental Health Perspectives 118(3):
400-406. https://doi.org/10.1289/ehp.0901161
Morice, L., Benaîtreau, D., Dieudonné, M-N.,
Morvan, C., Serazin, V., de Mazancourt, P., Pecquery, R. & Dos Santos, E.
2011. Antiproliferative and proapoptotic effects of bisphenol A on human
trophoblastic JEG-3 cells. Reproductive Toxicology 32(1): 69-76.
https://doi.org/10.1016/j.reprotox.2011.05.003
Mukherjee, R., Pandya, P., Baxi, D. &
Ramachandran, A.V. 2021. Endocrine disruptors-’Food’ for thought. Proceedings
of the Zoological Society 74(4): 432-442.
https://doi.org/10.1007/s12595-021-00414-1
Namat, A., Xia, W., Xiong, C., Xu, S., Wu, C.,
Wang, A., Li, Y., Wu, Y. & Li, J. 2021. Association of BPA exposure during
pregnancy with risk of preterm birth and changes in gestational age: A
meta-analysis and systematic review. Ecotoxicology and Environmental Safety 220: 112400. https://doi.org/10.1016/j.ecoenv.2021.112400
Nobile, S., Di Sipio
Morgia, C. & Vento, G. 2022. Perinatal
origins of adult disease and opportunities for health promotion: A narrative
review. Journal of Personalized Medicine 12(2): 157.
https://doi.org/10.3390/jpm12020157
Pergialiotis, V., Kotrogianni, P.,
Christopoulos-Timogiannakis, E., Koutaki, D., Daskalakis, G. & Papantoniou,
N. 2018. Bisphenol A and adverse pregnancy outcomes: A systematic review of the
literature. The Journal of Maternal-Fetal & Neonatal Medicines 31(24): 3320-3327. https://doi.org/10.1080/14767058.2017.1368076
Pivonello, C.,
Muscogiuri, G., Nardone, A., Garifalos, F., Provvisiero, D.P., Verde, N., de
Angelis, C., Conforti, A., Piscopo, M., Auriemma, R.S., Colao, A. &
Pivonello, R. 2020. Bisphenol
A: An emerging threat to female fertility. Reproductive Biology and
Endocrinology 18: 22. https://doi.org/10.1186/s12958-019-0558-8
Ramirez,
V., Merkel, S., Tietz, T. & Rivas, A. 2023. Risk assessment of food contact
materials. EFSA J. 21(Suppl
1): e211015. https://doi.org/10.2903/j.efsa.2023.e211015
Rolfo, A., Nuzzo, A.M.,
De Amicis, R., Moretti, L., Bertoli, S. & Leone, A. 2020. Fetal–Maternal exposure to endocrine
disruptors: Correlation with diet intake and pregnancy outcomes. Nutrients 12(6): 1744. https://doi.org/10.3390/nu12061744
Rubin, B.S. 2011. Bisphenol A: An endocrine
disruptor with widespread exposure and multiple effects. The Journal of
Steroid Biochemistry and Molecular Biology 127(1-2): 27-34.
https://doi.org/10.1016/j.jsbmb.2011.05.002
Samardzija, D., Pogrmic-Majkic, K., Fa, S.,
Stanic, B., Jasnic, J. & Andric, N. 2018. Bisphenol A decreases
progesterone synthesis by disrupting cholesterol homeostasis in rat granulosa
cells. Molecular and Cellular Endocrinology 461: 55-63.
https://doi.org/10.1016/j.mce.2017.08.013
Sengupta, S., Carrion, V., Shelton, J., Wynn,
R.J., Ryan, R.M., Singhal, K. & Lakshminrusimha, S. 2013. Adverse neonatal
outcomes associated with early-term birth. JAMA Pediatrics 167(11):
1053-1059. https://doi.org/10.1001/jamapediatrics.2013.2581
Sol, C.M., van Zwol-Janssens, C., Philips,
E.M., Asimakopoulos, A.G., Martinez-Moral, M-P., Kannan, K., Jaddoe, V.W.V.,
Trasande, L. & Santos, S. 2021. Maternal bisphenol urine concentrations,
fetal growth and adverse birth outcomes: A population-based prospective cohort. Environmental Health 20: 60. https://doi.org/10.1186/s12940-021-00747-6
Steinthorsdottir, V., McGinnis, R., Williams,
N.O., Stefansdottir, L., Thorleifsson, G., Shooter, S., Fadista, J.,
Sigurdsson, J.K., Auro, K.M., Berezina, G., Borges, M-C., Bumpstead, S.,
Bybjerg-Grauholm, J., Colgiu, I., Dolby, V.A., Dudbridge, F., Engel, S.M.,
Franklin, C.S., Frigge, M.L., Frisbaek, Y., Geirsson,
R.T., Geller, F., Gretarsdottir, S., Gudbjartsson, D.F., Harmon, Q., Hougaard,
D.M., Hegay, T., Helgadottir, A., Hjartardottir, S., Jääskeläinen, T.,
Johannsdottir, H., Jonsdottir, I., Juliusdottir, T., Kalsheker, N., Kasimov,
A., Kemp, J.P., Kivinen, K., Klungsøyr, K., Lee, W.K., Melbye, M.,
Miedzybrodska, Z., Moffett, A., Najmutdinova, D., Nishanova, F., Olafsdottir,
T., Perola, M., Pipkin, F.B., Poston, L., Prescott, G., Saevarsdottir, S., Salimbayeva,
D., Scaife, P.J., Skotte, L., Staines-Urias, E., Stefansson, O.A., Sørensen,
K.M., Thomsen, L.C.V., Tragante, V., Trogstad, L., Simpson, N.A.B., FINNPEC
Consortium, GOPEC Consortium, Aripova, T., Casas, J.P., Dominiczak, A.F.,
Walker, J.J., Thorsteinsdottir, U., Iversen, A.C., Feenstra, B., Lawlor, D.A.,
Boyd, H.A., Magnus, P., Laivuori, H., Zakhidova, N., Svyatova, G., Stefansson,
K. & Morgan, L. 2020. Genetic
predisposition to hypertension is associated with preeclampsia in European and
Central Asian women. Nature Communications 11(1): 5976.
https://doi.org/10.1038/s41467-020-19733-6
Sutan, R., Aminuddin, N.A. & Mahdy, Z.A.
2022. Prevalence, maternal characteristics, and birth outcomes of preeclampsia:
A cross-sectional study in a single tertiary healthcare center in greater Kuala
Lumpur Malaysia. Frontiers in Public Health 10: 973271.
https://www.frontiersin.org/articles/10.3389/fpubh.2022.973271
Tamschick, S., Rozenblut-Kościsty, B.,
Ogielska, M., Kekenj, D., Gajewski, F., Krüger, A., Kloas, W. & Stöck, M.
2016. The plasticizer bisphenol A affects somatic and sexual development, but
differently in pipid, hylid and bufonid anurans. Environmental Pollution
(Barking, Essex: 1987) 216: 282-291.
https://doi.org/10.1016/j.envpol.2016.05.091
Tita, A.T.N., Landon, M.B., Spong, C.Y., Lai,
Y., Leveno, K.J., Varner, M.W., Moawad, A.H., Caritis, S.N., Meis, P.J.,
Wapner, R.J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A.M.,
O’Sullivan, M.J., Sibai, B.M., Langer, O., Thorp, J.M., Ramin, S.M. &
Mercer, B.M. for Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units
Network. 2009. Timing of elective repeat cesarean delivery at term and neonatal
outcomes. The New England Journal of Medicine 360(2): 111-120.
https://doi.org/10.1056/NEJMoa0803267
United Nations International Children's
Emergency Fund (UNICEF). 2023. Maternal Mortality Rates and Statistics. https://data.unicef.org/topic/maternal-health/maternal-mortality/
(Accessed on December 28, 2023).
Vandenberg, L.N., Colborn,
T., Hayes, T.B., Heindel, J.J., Jacobs, D. R., Jr., Lee, D. H., Shioda,
T., Soto, A.M., vom Saal, F.S., Welshons, W.V., Zoeller, R.T. & Myers, J.P. 2012. Hormones and
endocrine-disrupting chemicals: Low-dose effects and nonmonotonic dose
responses. Endocr. Rev. 33(3):
378-455. https://doi.org/10.1210/er.2011-1050
Veiga-Lopez, A., Moeller, J., Sreedharan, R.,
Singer, K., Lumeng, C., Ye, W., Pease, A. & Padmanabhan, V. 2016.
Developmental programming: Interaction between prenatal BPA exposure and
postnatal adiposity on metabolic variables in female sheep. American Journal
of Physiology. Endocrinology and Metabolism 310(3): E238-247.
https://doi.org/10.1152/ajpendo.00425.2015
Vrachnis, N., Loukas, N., Vrachnis, D.,
Antonakopoulos, N., Zygouris, D., Kοlialexi, A., Pergaliotis, V., Iavazzo,
C., Mastorakos, G. & Iliodromiti, Z. 2021. A systematic review of bisphenol
A from dietary and non-dietary sources during pregnancy and its possible
connection with fetal growth restriction: Investigating its potential effects
and the window of fetal vulnerability. Nutrients 13(7): 2426.
https://doi.org/10.3390/nu13072426
Warembourg, C., Basagaña, X., Seminati, C., de
Bont, J., Granum, B., Lyon-Caen, S., Manzano-Salgado, C.B., Pin, I., Sakhi,
A.K., Siroux, V., Slama, R., Urquiza, J., Vrijheid, M., Thomsen, C. &
Casas, M. 2019. Exposure to phthalate metabolites, phenols and organophosphate
pesticide metabolites and blood pressure during pregnancy. International
Journal of Hygiene and Environmental Health 222(3): 446-454.
https://doi.org/10.1016/j.ijheh.2018.12.011
Wee, S.Y., Aris, A.Z., Yusoff, F.M. &
Praveena, S.M. 2020. Occurrence of multiclass endocrine disrupting compounds in
a drinking water supply system and associated risks. Scientific Reports 10: 17755. https://doi.org/10.1038/s41598-020-74061-5
Wilmink, F.A., Hukkelhoven, C.W.P.M., Lunshof,
S., Mol, B.W.J., van der Post, J.A.M. & Papatsonis, D.N.M. 2010. Neonatal
outcome following elective cesarean section beyond 37 weeks of gestation: A
7-year retrospective analysis of a national registry. American Journal of
Obstetrics and Gynecology 202(3): 250.e1-8.
https://doi.org/10.1016/j.ajog.2010.01.052
Wiraagni, I.A., Mohd, M.A., Rashid, R. bin A.
& Haron, D.E. bin M. 2019. Validation of a simple extraction procedure for
bisphenol A identification from human plasma. PLoS ONE 14(10): e0221774.
https://doi.org/10.1371/journal.pone.0221774
World Health Organization (WHO). 2023. Newborn
Mortality.
https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report-2021
(Accessed on December 28, 2023).
Zhang, Z., Alomirah, H., Cho, H-S., Li, Y-F.,
Liao, C., Minh, T.B., Mohd, M.A., Nakata, H., Ren, N. & Kannan, K. 2011.
Urinary bisphenol A concentrations and their implications for human exposure in
several Asian countries. Environmental Science & Technology 45(16):
7044-7050. https://doi.org/10.1021/es200976k
Zhong, Q., Peng, M.,
He, J., Yang, W. & Huang, F. 2020. Association of prenatal exposure to
phenols and parabens with birth size: A systematic review and meta- analysis. Sci.
Total Environ. 703: 134720. https://doi.org/10.1016/j.
scitotenv.2019.134720
Zhou, Z., Lei, Y., Wei, W., Zhao, Y., Jiang,
Y., Wang, N., Li, X. & Chen, X. 2019. Association between prenatal exposure
to bisphenol a and birth outcomes. Medicine 98(44): e17672.
https://doi.org/10.1097/MD.0000000000017672
*Corresponding author;
email: sitih587@uitm.edu.my
|
|||
|
