ArticleBMC public health2014
Association between arsenic, cadmium, manganese, and lead levels in private wells and birth defects prevalence in North Carolina: a semi-ecologic study.
Article in BMC public health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Exposure to drinking water pollutants and non-syndromic birth defects: a systematic review and meta-analysis synthesis.BMJ open · 2024Pooled it
- Prenatal Exposure to Toxic Metals and Neural Tube Defects: A Systematic Review of the Epidemiologic Evidence.Environmental health perspectives · 2023Pooled it
- Association of maternal multiple serum metal/metalloid concentrations and metabolic gene polymorphisms with offspring skeletal defects: a multicenter case-control study.BMC pregnancy and childbirth · 2026Article
- Multiple-element exposure in early pregnancy and birth defects: a nested case-control study based on the China birth cohort study.Frontiers in nutrition · 2026Article
- Article
- The effects of developmental cadmium exposure on health and disease.Disease models & mechanisms · 2025Review
- Associations of Environmental Exposure to Arsenic, Manganese, Lead, and Cadmium with Alzheimer's Disease: A Review of Recent Evidence from Mechanistic Studies.Journal of xenobiotics · 2025Review
- Using transcriptomic signatures to elucidate individual and mixture effects of inorganic arsenic and manganese in human placental trophoblast HTR-8/SVneo cells.Toxicological sciences : an official journal of the Society of Toxicology · 2025Article
- Exploring Demographic Disparities in Private Well Water Testing in North Carolina.Environmental science & technology · 2025Article
- Testing for heavy metals in drinking water collected from Dog Aging Project participants.PLOS water · 2025Article
- Parental arsenic exposure and tissue-specific DNA methylation in Bangladeshi infants with spina bifida.Epigenetics · 2024Article
- Lead brownfields and birth defects in North Carolina 2003-2015: A cross-sectional case-control study.Birth defects research · 2024Article
- Environmental causes of birth defects: challenges and opportunities.Pediatric research · 2024Article
- Prenatal metal concentrations and physical abnormalities in the Japan Environment and Children's Study.Pediatric research · 2024Article
- Manganese exposure from spring and well waters in the Shenandoah Valley: interplay of aquifer lithology, soil composition, and redox conditions.Environmental geochemistry and health · 2024Article
- Heavy metals and trace elements in maternal blood and prevalence of congenital limb abnormalities among newborns: the Japan Environment and Children's Study.Environmental health and preventive medicine · 2024Article
- Knowledge assessment of women of reproductive age on birth defects: a descriptive cross-sectional study in Kenya.The Pan African medical journal · 2024Article
- Drinking Water Contaminant Concentrations and Birth Outcomes.Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management] · 2024Article
- Update of the risk assessment of inorganic arsenic in food.EFSA journal. European Food Safety Authority · 2024Article
- Factors by which global warming worsens allergic disease.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2023Review
1 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundToxic metals including arsenic, cadmium, manganese, and lead are known human developmental toxicants that are able to cross the placental barrier from mother to fetus. In this population-based study, we assess the association between metal concentrations in private well water and birth defect prevalence in North Carolina.
methodsA semi-ecologic study was conducted including 20,151 infants born between 2003 and 2008 with selected birth defects (cases) identified by the North Carolina Birth Defects Monitoring Program, and 668,381 non-malformed infants (controls). Maternal residences at delivery and over 10,000 well locations measured for metals by the North Carolina Division of Public Health were geocoded. The average level of each metal was calculated among wells sampled within North Carolina census tracts. Individual exposure was assigned as the average metal level of the census tract that contained the geocoded maternal residence. Prevalence ratios (PR) with 95% confidence intervals (CI) were calculated to estimate the association between the prevalence of birth defects in the highest category (≥90th percentile) of average census tract metal levels and compared to the lowest category (≤50th percentile).
resultsStatewide, private well metal levels exceeded the EPA Maximum Contaminant Level (MCL) or secondary MCL for arsenic, cadmium, manganese, and lead in 2.4, 0.1, 20.5, and 3.1 percent of wells tested. Elevated manganese levels were statistically significantly associated with a higher prevalence of conotruncal heart defects (PR: 1.6 95% CI: 1.1-2.5).
conclusionsThese findings suggest an ecologic association between higher manganese concentrations in drinking water and the prevalence of conotruncal heart defects.
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