Exposure to metals and congenital anomalies: A biomonitoring study of pregnant Bedouin-Arab women Isabella Karakis a,b,g , Daniella Landau b,c , Maayan Yitshak-Sade b,h , Reli Hershkovitz b,d , Michal Rotenberg e , Batia Sarov b , Itamar Grotto a,b,f , Lena Novack b, ⁎ a Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel b Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel c Department of Neonatology, Soroka University Medical Center, Beer-Sheva, Israel d Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel e Laboratory of Clinical Toxicology and Pharmacology, Sheba Medical Center, Tel-Hashomer, Israel f Public Health Services, Ministry of Health, Jerusalem, Israel g Department of Public Health, The Ashkelon Academic College, Ashkelon, Israel h Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel HIGHLIGHTS • Almost a third of the pregnant women had a detectable metal in their urine. • Aluminum and Arsenic were the most prevalent metals in urine. • The study investigates pregnant women exposed to a hazardous environment. • Household exposure was most highly associated with the detection of metals in urine. • Impact is specific to a metal: Al–anomalies, As - preterm birth and lower weight. abstract article info Article history: Received 4 September 2014 Received in revised form 13 February 2015 Accepted 16 February 2015 Available online xxxx Editor: P. Kassomenos Keywords: Biomonitoring Metals Prenatal exposure Malformations Household environment Background: The Bedouin-Arab population in Israel comprises a low socio-economic society in transition. Smoking among males and consanguineous marriages are frequent. A previous study showed elevated rates of major malformations within groups from this population residing near an industrial park, where high ambient values of arsenic (As) and nickel (Ni) were detected, compared to groups living in remote localities. Objectives: We estimated the extent of exposure to metals in pregnant Bedouin-Arab women in relation to congenital malformations. Methods: We collected maternal urine samples from 140 Bedouin women who gave birth in a local hospital. Patient medical history, type of marriage (consanguineous or non-consanguineous), and parental exposure history were collected by interview and medical records. Results: Aluminum (Al) was detected in 37 women (26.4%), cadmium (Cd) in 2 (1.4%), As in 10 (7.1%), and Ni in 1 woman (0.7%). The detected rate of Cd exposure was low, though more than 92% of the fathers reported smoking. Concentrations of Al were higher for women residing within 10 km of the local industrial park (Prevalence Ratio (PR) = 1.12, p-value = 0.012) or who reported using a wood burning stove (PR = 1.37, p-value = 0.011) and cooking over an open fire (PR = 1.16, p-value = 0.076). Exposure to Al was adversely associated with minor anomalies (OR = 3.8, p-value = 0.046) after adjusting for history of abortions (OR = 6.1, p-value = 0.007). Fetuses prenatally exposed to As were born prematurely (p-value = 0.001) and at lower weights (pv = 0.023). Conclusions: The study population of pregnant women is exposed to high levels of metals mainly of household origin. Our findings may be generalized to similar populations in developing countries. © 2015 Published by Elsevier B.V. 1. Introduction The Bedouin-Arab population in Israel is characterized by a high rate of congenital malformations in comparison to the country's Jewish and Science of the Total Environment 517 (2015) 106–112 ⁎ Corresponding author at: Department of Public Health, Faculty of Health Sciences, POB 653, Ben-Gurion University, Beer-Sheva 84105, Israel. E-mail address: novack@bgu.ac.il (L. Novack). http://dx.doi.org/10.1016/j.scitotenv.2015.02.056 0048-9697/© 2015 Published by Elsevier B.V. Contents lists available at ScienceDirect Science of the Total Environment journal homepage: www.elsevier.com/locate/scitotenv