{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:41:56Z","timestamp":1784911316811,"version":"3.55.0"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T00:00:00Z","timestamp":1495497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Exposure to arsenic has a number of known detrimental health effects but impact on pregnancy outcomes is not as widely recognized. This narrative review examines existing epidemiological evidence investigating the association between arsenic exposure via drinking water and adverse pregnancy outcomes. We reviewed published epidemiological studies from around the world on impact of chronic arsenic exposure on spontaneous abortion, stillbirth, neonatal death, post neonatal death, low birth weight and preterm baby. Plausible mechanisms of arsenic toxicity causing adverse pregnancy outcomes were also determined through literature review. There is convincing evidence to support the association between high inorganic arsenic exposure (&gt;50 ppb) and spontaneous abortion, stillbirth and low birth weight. Limitations of certain studies include study design, small sample size, recall constraints and exposure assessment. There needs to be further research investigating the dose metered impact of arsenic exposure on pregnancy outcomes. Further research on impact of low\u2013moderate arsenic concentration exposure on pregnancy outcomes will allow for appropriate public health policy recommendations.<\/jats:p>","DOI":"10.3390\/ijerph14060556","type":"journal-article","created":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T11:14:33Z","timestamp":1495538073000},"page":"556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":108,"title":["A Review of the Effects of Chronic Arsenic Exposure on Adverse Pregnancy Outcomes"],"prefix":"10.3390","volume":"14","author":[{"given":"Abul","family":"Milton","sequence":"first","affiliation":[{"name":"Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7116-0691","authenticated-orcid":false,"given":"Sumaira","family":"Hussain","sequence":"additional","affiliation":[{"name":"Mercy Corps, Pak Palace, Murree Road, Rawal Chowk, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnaz","family":"Akter","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mijanur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tafzila","family":"Mouly","sequence":"additional","affiliation":[{"name":"Centre for Health and Development (CHAD), Dhaka 1219, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kane","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Managing Principal, JBS&amp;G, Brisbane 4000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,5,23]]},"reference":[{"key":"ref_1","first-page":"1093","article-title":"Contamination of drinking-water by arsenic in Bangladesh: A public health emergency","volume":"78","author":"Smith","year":"2000","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10653-008-9233-2","article-title":"Arsenic contamination in groundwater in the southeast Asia region","volume":"31","author":"Rahman","year":"2009","journal-title":"Environ. Geochem. Health"},{"key":"ref_3","unstructured":"Singh, P., Zhang, W., Robins, R., and Muir, D. (2001). Arsenic in the Asia-Pacific Region: Managing Arsenic for Our Future, Arris."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1146\/annurev-nutr-080508-141102","article-title":"Effects of arsenic on maternal and fetal health","volume":"29","author":"Vahter","year":"2009","journal-title":"Annu. Rev. Nutr."},{"key":"ref_5","unstructured":"International Agency for Research on Cancer (2012). Arsenic, Metals, Fibres and Dusts. A Review of Human Carcinogens, International Agency for Research on Cancer, World Health Organisation."},{"key":"ref_6","unstructured":"National Toxicology Program (2011). Report on Carcinogens."},{"key":"ref_7","unstructured":"(2017, January 15). World Health Organization\u2019s Arsenic Fact Sheet. Available online: http:\/\/www.who.int\/mediacentre\/factsheets\/fs372\/en\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1289\/ehp.1307894","article-title":"Association of arsenic with adverse pregnancy outcomes\/infant mortality: A systematic review and meta-analysis","volume":"123","author":"Quansah","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_9","unstructured":"Agency for Toxic Substances and Disease Registry (ATSDR) (2007). Toxicological Profile for Arsenic."},{"key":"ref_10","unstructured":"World Health Organization (WHO) (2011). Arsenic in Drinking-Water, Background Document for Development of WHO Guidelines for Drinking-Water Quality, World Health Organization."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.taap.2008.12.016","article-title":"A review on environmental factors regulating arsenic methylation in humans","volume":"235","author":"Tseng","year":"2009","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.reprotox.2010.11.002","article-title":"Arsenic methylation efficiency increases during the first trimester of pregnancy independent of folate status","volume":"31","author":"Gardner","year":"2011","journal-title":"Reprod. Toxicol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.envres.2007.08.011","article-title":"Gender and age differences in the metabolism of inorganic arsenic in a highly exposed population in Bangladesh","volume":"106","author":"Lindberg","year":"2008","journal-title":"Environ. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.etap.2013.10.006","article-title":"A pilot study: The importance of inter-individual differences in inorganic arsenic metabolism for birth weight outcome","volume":"36","author":"Gelmann","year":"2013","journal-title":"Environ. Toxicol. Pharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1289\/ehp.8084","article-title":"Folate, homocysteine, and arsenic metabolism in arsenic-exposed individuals in Bangladesh","volume":"113","author":"Gamble","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.ijheh.2010.09.001","article-title":"Spontaneous pregnancy loss in humans and exposure to arsenic in drinking water","volume":"213","author":"Bloom","year":"2010","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_17","first-page":"190","article-title":"Arsenic in drinking-water and reproductive health outcomes: A study of participants in the Bangladesh Integrated Nutrition Programme","volume":"24","author":"Kwok","year":"2006","journal-title":"J. Health Popul. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02307274","article-title":"Epidemiological studies on human subjects exposed to arsenic in drinking water in southeast Hungary","volume":"66","author":"Bereczky","year":"1992","journal-title":"Arch. Toxicol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1289\/ehp.00108667","article-title":"Chronic arsenic exposure and risk of infant mortality in two areas of Chile","volume":"108","author":"Browning","year":"2000","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2188\/jea.13.211","article-title":"The prevalence of subjective symptoms after exposure to arsenic in drinking water in Inner Mongolia, China","volume":"13","author":"Guo","year":"2003","journal-title":"J. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/00039896.1989.9935895","article-title":"Quality of community drinking water and the occurrence of spontaneous abortion","volume":"44","author":"Aschengrau","year":"1989","journal-title":"Arch. Environ. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1289\/ehp.01109629","article-title":"Arsenic in drinking water and pregnancy outcomes","volume":"109","author":"Ahmad","year":"2001","journal-title":"Environ. Health Perspect"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.scitotenv.2006.06.015","article-title":"Arsenic groundwater contamination and its health effects in the state of Uttar Pradesh (UP) in upper and middle Ganga plain, India: A severe danger","volume":"370","author":"Ahamed","year":"2006","journal-title":"Sci. Total Environ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/01.ede.0000147105.94041.e6","article-title":"Chronic arsenic exposure and adverse pregnancy outcomes in Bangladesh","volume":"16","author":"Milton","year":"2005","journal-title":"Epidemiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"172","DOI":"10.2471\/BLT.07.043083","article-title":"Stillbirth in rural Bangladesh: Arsenic exposure and other etiological factors: A report from Gonoshasthaya Kendra","volume":"86","author":"Cherry","year":"2008","journal-title":"Bull. World Health Organ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1093\/aje\/kwm025","article-title":"Association of arsenic exposure during pregnancy with fetal loss and infant death: A cohort study in Bangladesh","volume":"165","author":"Rahman","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_27","first-page":"74N","article-title":"Groundwater arsenic contamination and its health effects in the Ganga-Meghna-Brahmaputra plain","volume":"6","author":"Chakraborti","year":"2004","journal-title":"J. Environ. Monit."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1093\/aje\/kwj089","article-title":"Pregnancy outcomes, infant mortality, and arsenic in drinking water in West Bengal, India","volume":"163","author":"Mazumder","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2478\/10004-1254-59-2008-1871","article-title":"Arsenic exposure through drinking water and its effect on pregnancy outcome in Bengali women","volume":"59","author":"Sen","year":"2008","journal-title":"Arh. Hig. Rada Toksikol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/1476-069X-13-81","article-title":"Consumption of low-moderate level arsenic contaminated water does not increase spontaneous pregnancy loss: A case control study","volume":"13","author":"Bloom","year":"2014","journal-title":"Environ. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.chemosphere.2016.02.119","article-title":"Arsenic groundwater contamination and its health effects in Patna district (capital of Bihar) in the middle Ganga plain, India","volume":"152","author":"Chakraborti","year":"2016","journal-title":"Chemosphere"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.reprotox.2015.10.012","article-title":"Low level arsenic contaminated water consumption and birth outcomes in Romania\u2014An exploratory study","volume":"59","author":"Bloom","year":"2016","journal-title":"Reprod. Toxicol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1289\/ehp.1510065","article-title":"Relation between in utero arsenic exposure and birth outcomes in a cohort of mothers and their newborns from new hampshire","volume":"124","author":"Emond","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.envres.2015.01.008","article-title":"Birth outcomes and background exposures to select elements, the Longitudinal Investigation of Fertility and the Environment (LIFE)","volume":"138","author":"Bloom","year":"2015","journal-title":"Environ. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.scitotenv.2016.10.044","article-title":"Evaluation of in utero exposure to arsenic in South Africa","volume":"575","author":"Channa","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/01.ede.0000072104.65240.69","article-title":"Arsenic exposure from drinking water and birth weight","volume":"14","author":"Hopenhayn","year":"2003","journal-title":"Epidemiology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s12011-012-9396-7","article-title":"Prenatal exposure to arsenic and its effects on fetal development in the general population of Dalian","volume":"149","author":"Guan","year":"2012","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_38","first-page":"89","article-title":"Decrease in birth weight and gestational age by arsenic among the newborn in Shanghai, China","volume":"58","author":"Xu","year":"2011","journal-title":"Nihon Koshu Eisei Zasshi"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0013-9351(02)00015-4","article-title":"Arsenic in drinking water and adverse pregnancy outcome in an arseniasis-endemic area in northeastern Taiwan","volume":"91","author":"Yang","year":"2003","journal-title":"Environ. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1097\/JOM.0b013e3181566ba0","article-title":"Maternal arsenic exposure associated with low birth weight in Bangladesh","volume":"49","author":"Huyck","year":"2007","journal-title":"J. Occup. Environ. Med."},{"key":"ref_41","first-page":"173","article-title":"Estimating effects of arsenic exposure during pregnancy on perinatal outcomes in a Bangladeshi cohort","volume":"27","author":"Kile","year":"2016","journal-title":"Epidemiology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1289\/ehp.1510070","article-title":"Prenatal arsenic exposure and birth outcomes among a population residing near a mining-related Superfund site","volume":"124","author":"Henn","year":"2016","journal-title":"Environ. Health Perspect."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/556\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:36:44Z","timestamp":1760207804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,23]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,6]]}},"alternative-id":["ijerph14060556"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14060556","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,23]]}}}