{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:38:02Z","timestamp":1786631882525,"version":"build-2736575974"},"reference-count":45,"publisher":"American Chemical Society (ACS)","issue":"12","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":945,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The assessment of neurodevelopmental effects in children associated with prenatal methylmercury exposure, from contaminated fish and seafood in the maternal diet, has recently been strengthened by adjustment for the negative confounding resulting from co-exposure to beneficial polyunsaturated fatty acids (PUFAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to determine the cost-effectiveness of a periconceptional screening program of blood mercury concentration for women planning to become pregnant in Ontario, Canada. Fish intake recommendations would be provided for those found to have blood mercury levels above the intervention threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Analysis was conducted using a combined decision tree\/Markov model to compare the proposed screening intervention with standard care from a societal perspective over a lifetime horizon. We used the national blood mercury distributions of women 20\u201349 years of age reported in the Canadian Health Measures Survey from 2009 through 2011 to determine the cognitive deficits associated with prenatal methylmercury exposure for successful planned pregnancies. Outcomes modeled included the loss in quality of life and the remedial education costs. Value of information analysis was conducted to assess the underlying uncertainty around the model results and to identify which parameters contribute most to this uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incremental cost per quality-adjusted life year (QALY) gained for the proposed screening intervention was estimated to be Can$18,051, and the expected value for a willingness to pay of Can$50,000\/QALY to be Can$0.61.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that the proposed periconceptional blood mercury screening program for women planning a pregnancy would be highly cost-effective from a societal perspective. The results of a value of information analysis confirm the robustness of the study\u2019s conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Citation<\/jats:title>\n                    <jats:p>Gaskin J, Rennie C, Coyle D. 2015. Reducing periconceptional methylmercury exposure: cost\u2013utility analysis for a proposed screening program for women planning a pregnancy in Ontario, Canada. Environ Health Perspect 123:1337\u20131344;\u2002http:\/\/dx.doi.org\/10.1289\/ehp.1409034<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.1409034","type":"journal-article","created":{"date-parts":[[2015,5,29]],"date-time":"2015-05-29T11:52:55Z","timestamp":1432900375000},"page":"1337-1344","source":"Crossref","is-referenced-by-count":11,"title":["Reducing Periconceptional Methylmercury Exposure: Cost\u2013Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada"],"prefix":"10.1021","volume":"123","author":[{"given":"Janet","family":"Gaskin","sequence":"first","affiliation":[{"name":"Epidemiology and Community Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Rennie","sequence":"additional","affiliation":[{"name":"Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Coyle","sequence":"additional","affiliation":[{"name":"Epidemiology and Community Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2015,5,29]]},"reference":[{"key":"2026080608020642300_micit1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/1476-069X-12-3","article-title":"Economic benefits of methylmercury exposure control in Europe: monetary value of neurotoxicity prevention.","volume":"12","author":"Bellanger","year":"2013","journal-title":"Environmental Health"},{"key":"2026080608020642300_micit2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0378-4274(99)00283-0","article-title":"Benchmark dose calculations of methylmercury-associated neurobehavioural deficits.","volume":"112\u2013113","author":"Budtz-J\u00f8rgensen","year":"2000","journal-title":"Toxicol Lett"},{"key":"2026080608020642300_micit3","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1289\/ehp.9738","article-title":"Separation of risks and benefits of seafood intake.","volume":"115","author":"Budtz-J\u00f8rgensen","year":"2007","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit4","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1111\/j.0006-341X.2001.00698.x","article-title":"Benchmark dose calculation from epidemiological data.","volume":"57","author":"Budtz-J\u00f8rgensen","year":"2001","journal-title":"Biometrics"},{"key":"2026080608020642300_micit5","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1111\/j.0272-4332.2004.00560.x","article-title":"Effects of exposure imprecision on estimation of the benchmark dose.","volume":"24","author":"Budtz-J\u00f8rgensen","year":"2004","journal-title":"Risk Anal"},{"issue":"3","key":"2026080608020642300_micit6","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/humrep\/der465","article-title":"Estimating the prevalence of infertility in Canada.","volume":"27","author":"Bushnik","year":"2012","journal-title":"Hum Reprod"},{"key":"2026080608020642300_micit7","unstructured":"CADTH (Canadian Agency for Drugs and Technologies in Health).\n          \n          2006. 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Fish Consumption Guidelines. Advice for Women who Might Become Pregnant, Women who are Pregnant, Nursing Mothers, and Young Children. EPA-823-R-04-005 Last updated 06\/24\/2013.Available: http:\/\/www.fda.gov\/food\/resourcesforyou\/consumers\/ucm110591.htm [accessed 15 May 2015]."},{"key":"2026080608020642300_micit16","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/j.contraception.2011.07.013","article-title":"Unintended pregnancy in the United States: incidence and disparities.","volume":"84","author":"Finer","year":"2011","journal-title":"Contraception"},{"key":"2026080608020642300_micit17","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1289\/ehp.11368","article-title":"Quantitative approach for incorporating methylmercury risks and omega-3 fatty acid benefits in developing species-specific fish consumption advice.","volume":"117","author":"Ginsberg","year":"2009","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/0272989X9501500104","article-title":"Management of childhood lead poisoning: clinical impact and cost-effectiveness.","volume":"15","author":"Glotzer","year":"1995","journal-title":"Med Decis Making"},{"key":"2026080608020642300_micit19","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1006\/enrs.1997.3804","article-title":"Cognitive performance of children prenatally exposed to \u201csafe\u201d levels of methylmercury.","volume":"77","author":"Grandjean","year":"1998","journal-title":"Environ Res"},{"issue":"6","key":"2026080608020642300_micit20","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0892-0362(97)00097-4","article-title":"Cognitive deficits in 7-year-old children with prenatal exposure to methylmercury.","volume":"19","author":"Grandjean","year":"1997","journal-title":"Neurotoxicol Teratol"},{"key":"2026080608020642300_micit21","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1367\/1539-4409(2003)003&lt;0018:NRCBSA&gt;2.0.CO;2","article-title":"Neurotoxic risk caused by stable and variable exposure to methylmercury from seafood.","volume":"3","author":"Grandjean","year":"2003","journal-title":"Ambul Pediatr"},{"key":"2026080608020642300_micit22","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1289\/ehp.1104494","article-title":"Evidence on the human health effects of low-level methylmercury exposure.","volume":"120","author":"Karagas","year":"2012","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit23","doi-asserted-by":"crossref","first-page":"626","DOI":"10.3349\/ymj.2006.47.5.626","article-title":"The effect of fish consumption on blood mercury levels of pregnant women.","volume":"47","author":"Kim","year":"2006","journal-title":"Yonsei Med J"},{"key":"2026080608020642300_micit24","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1289\/ehp.10831","article-title":"Relationship between cord blood mercury levels and early child development in a World Trade Center cohort.","volume":"116","author":"Lederman","year":"2008","journal-title":"Environ Health Perspect"},{"issue":"1","key":"2026080608020642300_micit25","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/BF03405557","article-title":"Methylmercury blood guidance values for Canada.","volume":"101","author":"Legrand","year":"2010","journal-title":"Can J Public Health"},{"key":"2026080608020642300_micit26","unstructured":"MOHLTC (Ministry of Health and Long-Term Care).\n          \n          2012. 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Mercury: Assessing the Environmental Burden of Disease at National and Local Levels (Pr\u00fcss-\u00dcst\u00fcn A, ed). Environmental Burden of Disease Series No. 16. Geneva:World Health Organization.Available: http:\/\/whqlibdoc.who.int\/publications\/2008\/9789241596572_eng.pdf [accessed 15 May 2015]."},{"key":"2026080608020642300_micit37","doi-asserted-by":"publisher","first-page":"5216","DOI":"10.1021\/es903359u","article-title":"A probabilistic characterization of the health benefits of reducing methyl mercury intake in the United States.","volume":"44","author":"Rice","year":"2010","journal-title":"Environ Sci Technol"},{"key":"2026080608020642300_micit38","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1289\/ehp.1003012","article-title":"Evaluation of the cardiovascular effects of methylmercury exposures: current evidence supports development of a dose\u2013response function for regulatory benefits analysis.","volume":"119","author":"Roman","year":"2011","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit39","unstructured":"StatCan (Statistics Canada).\n          \n          2009. Table 102-0504. 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Ottawa, Ottawa, Canada:Minister of Industry.Available: http:\/\/www5.statcan.gc.ca\/bsolc\/olc-cel\/olc-cel?catno=82-626-X&lang=eng [accessed 15 August 2015]."},{"key":"2026080608020642300_micit42","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1289\/ehp.6187","article-title":"An assessment of the cord blood:maternal blood methylmercury ratio: implications for risk assessment.","volume":"111","author":"Stern","year":"2003","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit43","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/j.neuro.2008.06.002","article-title":"Associations of maternal long-chain polyunsaturated fatty acids, methyl mercury, and infant development in the Seychelles Child Development Nutrition Study.","volume":"29","author":"Strain","year":"2008","journal-title":"Neurotoxicology"},{"key":"2026080608020642300_micit44","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1289\/ehp.7743","article-title":"Public health and economic consequences of methyl mercury toxicity to the developing brain.","volume":"113","author":"Trasande","year":"2005","journal-title":"Environ Health Perspect"},{"key":"2026080608020642300_micit45","unstructured":"UNEP (United Nations Environment Programme).\n          \n          2015. 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