Kim JH, et al. Yonsei Med J. 2022 Aug;63(8):794-798. https://doi.org/10.3349/ymj.2022.63.8.794

Exposure to ambient air pollution is associated with an increased risk of menstrual disorders and infertility. This study examined the relationships between the levels and duration of air pollution exposure and the risk of polycystic ovarian syndrome (PCOS) using Korean population-based cohort data (2015–2019). Real-time data on PM₁₀, PM_2.5, O₃, CO, SO₂, and NO₂ were provided by the Korean Ministry of Environment. The average monthly air pollutant concentration from 1 January 2014 to 31 December 2018 was analyzed. To assess individual-level exposure to air pollutants, a spatial prediction model and an area-averaging approach were used. In total, 237,582 PCOS cases were analyzed. The annual age-adjusted PCOS incidence was 6.70, 8.28, 9.73, 11.58, and 11.97% from 2015–2019, respectively. The PCOS risk increased 1.29–1.32, 1.43–1.52, and 1.32-fold following exposure to the 2-year and 3-year average levels of PM_2.5, O₃, and NO₂, respectively, compared to their 1-year average levels. The PCOS risk increased 1.75-fold (95% confidence interval: 1.66–1.85) in the fourth-quartile for the NO₂ level. Increased SO₂ and CO levels in the second- and third-quartiles were also associated with an increased PCOS risk. Exposure to air pollutants thus increased the risk for PCOS in the Korean population.

Heavy metals (HMs) persist in the environment and enter the human body via various pathways. Once stored in adipose tissue, they can be transferred to breast milk, posing risks to infants. Moreover, maternal diet plays a key role in influencing HM levels in breast milk. The aim of this study was to measure the concentration of HMs, including lead (Pb), cadmium (Cd), mercury (Hg), and arsenic (As), in the breast milk of Korean mothers, assess their potential health risks, and identify maternal dietary factors influencing HM concentration in breast milk. Survey data on maternal–infant pairs and breast milk samples from 209 healthy lactating mothers were collected between January and March 2023. Trained nurses manually expressed the breast milk to prevent external contamination, and maternal dietary intake was systematically assessed using the 24 h recall method. The concentrations of Pb, Cd, Hg, and As were measured, and a risk assessment was conducted using the estimated daily intake hazard quotient. A multiple linear regression model was employed to evaluate the association between the HMs in breast milk and maternal dietary factors. Cd was detected in 99% of the breast milk samples, and high detection rates were observed for Hg (97%), As (89%), and Pb (79%). Arsenic was the largest contributor to the potential health risks of HM-contaminated breast milk. Positive associations were observed between Pb concentration and legume and seaweed consumption, Cd concentration and vegetable and seaweed consumption, Hg concentration and sugar intake, and As concentration and meat intake. This study highlights that maternal dietary intake is closely linked to HM concentrations in breast milk, and elevated As levels potentially pose health risks to infants. These findings underscore the importance of adopting a healthy diet to reduce HM exposure in breast milk and to promote safer breastfeeding practices.

During pregnancy, reproductive hormonal changes could affect the mental health of women, such as depression and anxiety. Previous studies have shown that exposure to endocrine disrupting chemicals (EDCs) is significantly associated with mental health symptoms; however, the results were inconsistent. We aimed to examine the association between 24 endocrine-disrupting chemicals (EDCs) in maternal urine and perinatal depression and their association with dietary and lifestyle factors. Participants were recruited from the “No Environmental Hazards for Mother–Child” cohort in Korea. Structured questionnaires asking dietary and lifestyle factors and evaluation of depressive symptoms were administered during antepartum (14 weeks of gestation) and postpartum (within four weeks after birth) periods. Urine samples were collected from 242 and 119 women during antepartum and postpartum periods, respectively. To assess perinatal depression, we used the Center for Epidemiological Studies-Depression Scale and the Edinburgh Postnatal Depression Scale. Antepartum depression and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) (1.50, 1.01–2.23) and 1-hydroxypyrene (1-OHP) (0.05, 0–0.89) showed significant positive association. Additionally, postpartum depression showed significant associations with mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) (2.78, 1.00–7.70), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (2.79, 1.04–7.46), 2-hydroxynaphthalene (2-NAP) (7.22, 1.43–36.59), and 2-hydroxyfluorene (2-FLU) (<0.01, 0–0.004). Some dietary factors (consumption of fish, fermented foods, cup noodles, and popcorn) and consumer product factors (use of skin care, makeup, perfume, antibiotics, sunscreen, nail polish, new furniture, plastic tableware, detergent, polish, paint, and pesticide) were associated with the concentration level of chemicals. We found that exposure to several EDCs during pregnancy and the postpartum period was associated with perinatal depression and dietary–lifestyle factors. Women in childbirth need to actively seek out information about exposure to EDCs and make efforts to avoid them for their own and fetal health.

Purpose: Heavy metals, which are persistent in the environment and toxic, can accumulate in the body and cause organ damage, which may further negatively affect perinatal women and their fetuses. Therefore, this systematic review was conducted to evaluate the effectiveness of dietary interventions to reduce heavy metal exposure in antepartum and postpartum women.Methods: We searched five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) for randomized controlled trials that provided dietary interventions for antepartum and postpartum women. Quality assessments were conducted independently by two reviewers using the Cochrane Risk-of-Bias tool, a quality assessment tool for randomized controlled trials.Results: A total of seven studies were included. The studies were conducted in six countries, with interventions categorized into “nutritional supplements,” “food supply,” and “educational” strategies. Interventions involving nutritional supplements, such as calcium and probiotics, primarily reduced heavy metal levels in the blood and minimized toxicity. Food-based interventions, including specific fruit consumption, decreased heavy metal concentrations in breast milk. Educational interventions effectively promoted behavioral changes, such as adopting diets low in mercury. The studies demonstrated a low overall risk of bias, supporting the reliability of the findings. These strategies underscore the effectiveness of dietary approaches in mitigating heavy metal exposure and improving maternal and child health.Conclusion: The main findings underscore the importance of dietary interventions in reducing heavy metal exposure. This emphasizes the critical role of nursing in guiding dietary strategies to minimize exposure risks, ultimately supporting maternal and fetal health during pregnancy.