Maternal stress modifies the effect of exposure to lead during pregnancy and 24-month old children's neurodevelopment

Background: Lead and psychosocial stress disrupt similar but not completely overlapping mechanisms. Exposure during the prenatal period to each of these insults singularly has been found to alter normal neurodevelopment; however, longitudinal associations with stress modifying the effect of lead have not been sufficiently analyzed in epidemiologic studies. Objective: To evaluate prenatal stress as an effect modifier of gestational lead neurotoxicity. Methods: We used a structural equations modeling approach with a trivariate response to evaluate cognitive, language and motor scores of the Bayley Scales of Infant Development-III in 24 month-old children (n= 360). Maternal blood lead levels were measured at the 2nd and 3rd trimester and psychosocial stress during pregnancy was assessed using a negative life events (NLE) scale derived from the CRYSIS questionnaire. Results: 3rd trimester lead (mean 3.9 +/- 3.0 SD mu g/dL) and stress (median = 3 NLE) were negatively associated with Bayley III scores. Using the model's results we generated profiles for 0, 2, 4 and 6 NLE across lead levels (up to 10 mu g/dL) and observed a dose-response for the developmental scores when lead levels were below 2 mu g/dL. Each NLE curve had a different shape across increasing lead levels. Higher stress (NLE = 6) resulted in lower cognitive scores for both sexes, in lower language scores in girls but not boys. In the absence of stress we saw a negative association with lead for all scores, however for language and motor scores, higher stress seemed to mask this association. Conclusions: Our work examined and confirmed prenatal stress exposure as amodifier of the well-known neurotoxic effects of prenatal lead. It adds to the existing evidence pointing at the importance of studying the co-exposure of chemical and non-chemical exposures, specifically of considering the emotional environment of children at early developmental stages of life. (C) 2016 Elsevier Ltd. All rights reserved.