A cross sectional study of the relationship between the exposure of pregnant women to military attacks in 2014 in Gaza and the load of heavy metal contaminants in the hair of mothers and newborns

OBJECTIVE Metal contamination of humans in war areas has rarely been investigated. Weaponry's heavy metals become environmentally stable war remnants and accumulate in living things. They also pose health risks in terms of prenatal intake, with potential long term risks for reproductive and children's health. We studied the contribution of military attacks to the load of 23 metals in the hair of Palestinian women in the Gaza Strip, who were pregnant at the time of the military attacks in 2014, and their newborns. We compared the metal load in the mothers with values for adult hair from outside the war area (RHS) as the reference. We investigated heavy metals trans-passing in utero, and assessed if the heavy metal intake could derive from sources unrelated to the war. DESIGN Cross sectional study. PARTICIPANTS AND SETTING Cross sectional convenience sample of 502 mothers delivering in the Gaza Strip and their newborns. MAIN OUTCOME MEASURED Measure of the load of heavy metals in mother and newborn hair by inductively coupled plasma-mass spectrometry (ICP-MS). Comparison of metal loads with the reference RHS, between groups with different exposures to attacks and house/agriculture chemicals, and between mothers and newborns. Data for birth registry and for exposures to war and other known risk factors were obtained at interview with the mothers. Photographic documentation of damage from military attacks was obtained. RESULTS The whole cross sectional convenience sample had a significantly higher load of heavy metals than the reference RHS. Women exposed to military attacks had a significantly higher load of heavy metals than those not exposed; the load in newborns correlated positively with the mothers' load. No significant difference was found between users/non-users of house/agriculture chemicals. No other known confounder was identified. CONCLUSIONS High heavy metal loads in mothers, reflected in those of their newborns, were associated with exposure to military attacks, posing a risk of immediate and long term negative outcomes for pregnancy and child health. Surveillance, biomonitoring and further research are recommended. Implications for general and public health are discussed.