Maternal exposure to neighborhood soil Pb and eclampsia risk in new Orleans, Louisiana (USA): Evidence from a natural experiment in flooding

Background: Previous studies link maternal blood lead (Pb) levels and pregnancy-related hypertensive disorders. Objective: Assess the relationship between neighborhood soil Pb and maternal eclampsia risk. Methods: Zip code summarized high density soil survey data of New Orleans collected before and after Hurricanes Katrina and Rita (HKR) were merged with pregnancy outcome data on 75,501 mothers from the Louisiana office of public health. Cross-sectional logistic regression analyses are performed testing the association between pre-HKR accumulation of Pb in soils in thirty-two neighborhoods and eclampsia risk. Then we examine whether measured declines in soil Pb following the flooding of the city resulted in corresponding reductions of eclampsia risk. Results: Cross-sectional analyses show that a one standard deviation increase in soil Pb increases the odds of eclampsia by a factor of 1.48 (95% CI: 131, 1.66). Mothers in zip code areas with soil Pb > 333 mg/kg were 4.00 (95% CI: 3.00, 535) times more likely to experience eclampsia than mothers residing in neighborhoods with soil Pb < 50 mg/kg. Difference-in-differences analyses capturing the exogenous reduction in soil Pb following the 2005 flooding of New Orleans indicate that mothers residing in zip codes experiencing decrease in soil Pb (-387.9 to -33.6 mg/kg) experienced a significant decline in eclampsia risk (OR=0.619; 95% CI: 0397, 0.963). Conclusions: Mothers residing in neighborhoods with high accumulation of Pb in soils are at heightened risk of experiencing eclampsia. (C) 2014 Elsevier Inc. All rights reserved.