Prenatal lead exposure: associations with growth and anthropometry in early childhood in a UK observational birth cohort study [version 1; peer review: 2 approved with reservations]

Background: Lead is a neurotoxic metal that crosses the placenta freely. It has adverse effects on a range of birth outcomes. The few studies reporting on the associations of prenatal exposure to lead and child growth have had conflicting results. This study aimed to examine the effect of low-level prenatal exposure to lead on children’s growth from 4 to 61 months old. Methods: Pregnant women were enrolled in the UK Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for pregnancies with a live birth were analysed for lead (n=4140). A 10% subsample of the offspring cohort (Children in Focus) were invited to clinics at 10 time points (4–61 months) at which anthropometric measurements were carried out; z-scores for height, weight and BMI were calculated using the 1990 British Growth Reference Standards. Associations between prenatal log10-lead concentrations and z-scores and other anthropometric measures were modelled using adjusted linear regression models in an imputed dataset for children who attended at least one clinic (n=574). Results: The mean prenatal blood lead concentration was 3.59±1.50 (range 1.22–14.70) µg/dl. There was no evidence for any associations of low-level prenatal lead exposure with z-scores for BMI, height or weight in adjusted models from age 4 to 61 months. There were no associations for other anthropometric measures including mid-upper arm circumference, head circumference and waist circumference. There was some evidence for a weakly positive effect of prenatal lead exposure on head circumference in girls at age 43 and 61 months (at 61 months unstandardised B coefficient 1.59 (95% CI 0.12, 3.16) cm, p=0.048) but not at other ages. Conclusions: There was no consistent evidence of associations between prenatal exposure to lead and measures of growth and anthropometry from age 4 to 61 months in this cohort of children in the UK.