BACKGROUND : Prenatal exposure to lead (Pb) has been shown to have negative and irreversible health
impacts on foetal and early childhood development, affecting morbidity and mortality in
adulthood. This study aimed to assess in utero Pb exposure, examine birth outcomes, and
identify confounding factors in the large cohort of South African population, following the legislated
removal of Pb from petrol.
METHODS : Lead was measured in the maternal blood, urine and cord blood using Inductive Coupled
Plasma Mass spectrometry (ICP-MS). The statistical analyses included Spearman's correlation,
Wilcoxon rank sum (Mann Whitney), Kruskal-Wallis rank tests and multivariate linear
RESULTS : Overall, the geometric mean (GM) of Pb in maternal blood (PbB) was 1.32 μg/dL (n = 640;
95% CI, 1.24±1.40). In the subset cohort, the GM of paired maternal PbB and cord blood
(PbC) was 1.73 μg/dL (n = 350; 95% CI, 1.60±1.86) and 1.26 μg/dL (n = 317; 95% CI, 1.18±
1.35), respectively with a positive correlation between the log PbB and the log PbC (rho =
0.65, p = <0.001). Birth outcomes showed geographical differences in the gestational age
(p<0.001), birth length (p = 0.028) and head circumference (p<0.001), Apgar score at 5 min
(p<0.001) and parity (p<0.002). In female neonates, a positive association was found
between PbC and head circumference (rho = 0.243; p<0.016). The maternal PbB levels
were positively correlated with race, educational status, water sources, cooking fuels and
use of pesticides at home.
CONCLUSIONS : This study has demonstrated not only the positive impact that the introduction of unleaded
petrol and lead-free paint has had on in utero exposure to Pb in South Africa, but has also
contributed new data on the topic, in a region where such data and scientific investigations
in this field are lacking. Future research should evaluate if similar effects can be detected in
young children and the adult population.