ASSOCIATIONS OF GESTATIONAL EXPOSURE TO TOXIC METALS AND ALLERGIC OUTCOMES IN CHILDREN: A META-ANALYSIS
- Авторы: Fakhr Ghasemi N.1, Tayari N.2, Mohammad Hashem S.3, Yadegarifard E.2, Molavi A.4, Ansari A.5, Ayati M.6, Deravi N.7, Keikha E.7
-
Учреждения:
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- University of Medical Sciences, Bandar Abbas, Iran
- University of Medical Science, Qazvin, Iran
- Ilam University of Medical Science, Ilam, Iran
- Shantou Univercity MedicL College, Shantou, Guangdong
- University of Szeged, Szeged, Hungary
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Раздел: ОБЗОРЫ
- Дата подачи: 01.10.2025
- Дата принятия к публикации: 25.11.2025
- URL: https://rusimmun.ru/jour/article/view/17316
- DOI: https://doi.org/10.46235/1028-7221-17316-AOJ
- ID: 17316
Цитировать
Полный текст
Аннотация
Objective: Because of their immunotoxic qualities and capacity to cross the placental barrier, exposure to toxic metals during pregnancy may have an impact on the development of allergy disorders in offspring. However, results from different research continue to be conflicting. The purpose of this meta-analysis was to determine the associations between gestational exposure to certain heavy metals and the risk of allergic outcomes to the child.
Methods: This systematic literature review was run through six databases, that is, Embase, PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, up to February 2025. Included were observational studies on prenatal exposures to heavy metals and allergic conditions later in life. The pooled odds, risk, and hazard ratios, as well as standardized mean differences in body weight, were computed using the random-effects model. Systematic assessment was performed on heterogeneity, publication bias, and study quality.
Results: The meta-analysis that embodied 14 cohort studies with a composite sample of 292,057 participants from Korea, Taiwan, Japan, China, Mexico, France, Spain, and Sweden looked at the relationship between the prenatal exposure of distinct heavy metals most associated with lead (Pb), mercury (Hg), cadmium (Cd), chromium (Cr), and nickel (Ni), and allergic conditions during early childhood, such as asthma, atopic dermatitis, rhinitis, wheezing and food allergy. Across the metals investigated, none presented statistically significant evidence of relationship with any allergic outcome. The pooled odds ratio (ORs) for prenatal lead exposure and asthma, OR were 1.05 (95% CI: 0.85-1.24); for mercury exposure and atopic dermatitis, the OR of 1.00 (95% CI: 0.97-1.04); while for cadmium exposure and atopic dermatitis, it was 1.06 (95%CI: 0.87-1.25), respectively. Heterogeneity in studies was low to moderate, while funnel plot analyses did not reveal significant evidence for publication bias.
Conclusion: This meta-analysis found no definitive evidence for an association between prenatal exposure to selected toxic metals and allergic diseases in children. While biologically plausible mechanisms exist, current observational data do not substantiate a clear link. Future studies need to resolve these methodological limitations and investigate interactions between metals, timing of exposure, and genetic susceptibility.
Ключевые слова
Об авторах
Neda Fakhr Ghasemi
Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Email: FakhrghasemiN4021@mums.ac.ir
Researcher, Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;
Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;
ИранNarges Tayari
University of Medical Sciences, Bandar Abbas, Iran
Email: Narges.tayari@yahoo.com
Student research committee, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran;
Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran;
ИранSourena Mohammad Hashem
University of Medical Science, Qazvin, Iran
Email: sourena8181@gmail.com
Student Research Committee, Faculty of Medicine, Qazvin University of Medical Science, Qazvin, Iran;
ИранElham Yadegarifard
University of Medical Sciences, Bandar Abbas, Iran
Email: Iranemydf99@gmail.com
Student Research Committee, Faculty of Medicine;
Hormozgan University of Medical Sciences, Bandar Abbas, Iran;
ИранAli Molavi
Ilam University of Medical Science, Ilam, Iran
Email: ali.re.mo.1382@gmail.com
Medical Student;
Ilam University of Medical Science, Ilam, Iran;
ИранAkram Ansari
Shantou Univercity MedicL College, Shantou, Guangdong
Email: China22Akramansari@stu.edu.cn
Student Research Committee, Shantou Univercity MedicL College, Shantou, Guangdong China;
Shantou Univercity MedicL College, Shantou, Guangdong;
КитайMojan Ayati
University of Szeged, Szeged, Hungary
Email: mojn.ayati@gmail.com
Student Research Committee, School of Medicine, University of Szeged, Szeged, Hungary;
School of Medicine, University of Szeged, Szeged, Hungary;
ВенгрияNiloofar Deravi
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Email: niloofar.deravi@gmail.com
Researcher, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
ИранElham Keikha
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Автор, ответственный за переписку.
Email: Keykha6454@yahoo.com
Student Research Committee, Department of Internal Medicine Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
Department of Internal Medicine Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
ИранСписок литературы
- Ashley-Martin, J., Levy, A. R., Arbuckle, T. E., Platt, R. W., Marshall, J. S., & Dodds, L. (2015). Maternal exposure to metals and persistent pollutants and cord blood immune system biomarkers. Environmental health : a global access science source, 14, 52. - https://doi.org/10.1186/s12940-015-0046-3
- Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M. R., & Sadeghi, M. (2021). Toxic Mechanisms of Five Heavy Metals: Mercury, Lead, Chromium, Cadmium, and Arsenic. Frontiers in pharmacology, 12, 643972. - https://doi.org/10.3389/fphar.2021.643972
- Barouki, R., Melén, E., Herceg, Z., Beckers, J., Chen, J., Karagas, M., Puga, A., Xia, Y., Chadwick, L., Yan, W., Audouze, K., Slama, R., Heindel, J., Grandjean, P., Kawamoto, T., & Nohara, K. (2018). Epigenetics as a mechanism linking developmental exposures to long-term toxicity. Environment international, 114, 77–86. - https://doi.org/10.1016/j.envint.2018.02.014
- Brooker, I. A., Fisher, J. J., Sutherland, J. M., & Pringle, K. G. (2024). Understanding the impact of placental oxidative and nitrative stress in pregnancies complicated by fetal growth restriction. Placenta, 158, 318–328. - https://doi.org/10.1016/j.placenta.2024.11.005
- Calvo, M. J., Parra, H., Santeliz, R., Bautista, J., Luzardo, E., Villasmil, N., Martínez, M. S., Chacín, M., Cano, C., Checa-Ros, A., D'Marco, L., Bermúdez, V., & De Sanctis, J. B. (2024). The Placental Role in Gestational Diabetes Mellitus: A Molecular Perspective. TouchREVIEWS in endocrinology, 20(1), 10–18. - https://doi.org/10.17925/EE.2024.20.1.5
- Carrasco, P., Estarlich, M., Iñiguez, C., Ferrero, A., Murcia, M., Esplugues, A., Vioque, J., Marina, L. S., Zabaleta, C., Iriarte, G., Fernández-Somoano, A., Tardon, A., Vrijheid, M., Sunyer, J., Ballester, F., & Llop, S. (2021). Pre and postnatal exposure to mercury and respiratory health in preschool children from the Spanish INMA Birth Cohort Study. The Science of the total environment, 782, 146654. - https://doi.org/10.1016/j.scitotenv.2021.146654
- Chandrasekaran, P., Weiskirchen, S., & Weiskirchen, R. (2024). Effects of Probiotics on Gut Microbiota: An Overview. International journal of molecular sciences, 25(11), 6022. - https://doi.org/10.3390/ijms25116022
- Chen, X., Zhang, S., Jiang, D., Li, Y., Yin, M., Fang, C., Lv, Z., Huang, Y., Yang, H., Zhang, H., Zhang, J., Fu, Q., Wang, H., Jiang, W., Chen, Y., & Li, X. (2024). Prenatal heavy metal exposure and pediatric asthma, allergic rhinitis, atopic dermatitis: a systematic review and meta-analysis. Expert review of clinical immunology, 20(11), 1401–1409. - https://doi.org/10.1080/1744666X.2024.2390024
- Dietert, R. R., & Zelikoff, J. T. (2008). Early-life environment, developmental immunotoxicology, and the risk of pediatric allergic disease including asthma. Birth defects research. Part B, Developmental and reproductive toxicology, 83(6), 547–560. - https://doi.org/10.1002/bdrb.20170
- Dow, C., Kadawathagedara, M., Ghozal, M., Charles, M. A., Adel-Patient, K., Dereumeaux, C., & de Lauzon-Guillain, B. (2025). Prenatal exposure to heavy metals and childhood atopic disease. Environmental research, 270, 121062. - https://doi.org/10.1016/j.envres.2025.121062
- Du, G., Zhou, F., Ouyang, L., Wang, K., Rao, S., Su, R., Zhu, Y., Guo, K., Xiao, J., Xie, J., Li, Q., Feng, C., & Fan, G. (2023). Pregnancy and lactation mixed exposure to lead, cadmium, and mercury alters maternal-offspring single heavy metal load: A factorial design. International journal of hygiene and environmental health, 248, 114113. - https://doi.org/10.1016/j.ijheh.2023.114113
- Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. - https://doi.org/10.1111/j.0006-341x.2000.00455.x
- Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed.), 315(7109), 629–634. - https://doi.org/10.1136/bmj.315.7109.629
- Ga, W. (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. In 3rd Symposium on Systematic Reviews: Beyond the Basics, Oxford, UK, 3-5 July 2000. - The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses | CiNii Research
- Gensollen, T., & Blumberg, R. S. (2017). Correlation between early-life regulation of the immune system by microbiota and allergy development. The Journal of allergy and clinical immunology, 139(4), 1084–1091. - https://doi.org/10.1016/j.jaci.2017.02.011
- Grijincu, M., Buzan, M. R., Zbîrcea, L. E., Păunescu, V., & Panaitescu, C. (2024). Prenatal Factors in the Development of Allergic Diseases. International journal of molecular sciences, 25(12), 6359. - • https://doi.org/10.3390/ijms25126359
- •
- Heo, Y., Parsons, P. J., & Lawrence, D. A. (1996). Lead differentially modifies cytokine production in vitro and in vivo. Toxicology and applied pharmacology, 138(1), 149–157. - https://doi.org/10.1006/taap.1996.0108
- Ho, J. C., Wen, H. J., Sun, C. W., Tsai, S. F., Su, P. H., Chang, C. L., Sun, H. L., Wang, S. L., & Lee, C. H. (2022). Prenatal exposure to nickel and atopic dermatitis at age 3 years: a birth cohort study with cytokine profiles. Journal of the European Academy of Dermatology and Venereology : JEADV, 36(12), 2414–2422. - https://doi.org/10.1111/jdv.18425
- Hsieh, C. Y., Jung, C. R., Lin, C. Y., & Hwang, B. F. (2021). Combined exposure to heavy metals in PM2.5 and pediatric asthma. The Journal of allergy and clinical immunology, 147(6), 2171–2180.e13. - https://doi.org/10.1016/j.jaci.2020.12.634
- Huang, Z., Chu, M., Chen, X., Wang, Z., Jiang, L., Ma, Y., & Wang, Y. (2022). Th2A cells: The pathogenic players in allergic diseases. Frontiers in immunology, 13, 916778. - https://doi.org/10.3389/fimmu.2022.916778
- Ijomone, O. M., Ijomone, O. K., Iroegbu, J. D., Ifenatuoha, C. W., Olung, N. F., & Aschner, M. (2020). Epigenetic influence of environmentally neurotoxic metals. Neurotoxicology, 81, 51–65. - https://doi.org/10.1016/j.neuro.2020.08.005
- Jedrychowski, W., Perera, F., Maugeri, U., Miller, R. L., Rembiasz, M., Flak, E., Mroz, E., Majewska, R., & Zembala, M. (2011). Intrauterine exposure to lead may enhance sensitization to common inhalant allergens in early childhood: a prospective prebirth cohort study. Environmental research, 111(1), 119–124. - https://doi.org/10.1016/j.envres.2010.11.002
- Kampouri, M., Gustin, K., Stråvik, M., Barman, M., Sandin, A., Sandberg, A. S., Wold, A. E., Vahter, M., & Kippler, M. (2023). Associations of gestational and early-life exposure to toxic metals and fluoride with a diagnosis of food allergy or atopic eczema at 1 year of age. Environment international, 178, 108071. - https://doi.org/10.1016/j.envint.2023.108071
- Kim, J. H., Jeong, K. S., Ha, E. H., Park, H., Ha, M., Hong, Y. C., Lee, S. J., Lee, K. Y., Jeong, J., & Kim, Y. (2013). Association between prenatal exposure to cadmium and atopic dermatitis in infancy. Journal of Korean medical science, 28(4), 516–521. - https://doi.org/10.3346/jkms.2013.28.4.516
- Kim, J., Kim, S., Woo, S. Y., Chung, J. Y., Hong, Y. S., Oh, S. Y., Choi, S. J., Oh, S. Y., Kim, K. W., Shin, Y. H., Won, H. S., Lee, K. J., Kim, S. H., Kwon, J. Y., Lee, S. H., Hong, S. J., & Ahn, K. (2019). Prenatal Exposure to Lead and Chromium is Associated with IL-13 Levels in Umbilical Cord Blood and Severity of Atopic Dermatitis: COCOA Study. Immune network, 19(6), e42. - https://doi.org/10.4110/in.2019.19.e42
- Lamiable, O., Mayer, J. U., Munoz-Erazo, L., & Ronchese, F. (2020). Dendritic cells in Th2 immune responses and allergic sensitization. Immunology and cell biology, 98(10), 807–818. - https://doi.org/10.1111/imcb.12387
- Lee, S., Park, S. K., Park, H., Lee, W., Kwon, J. H., Hong, Y. C., Ha, M., Kim, Y., Lee, B., & Ha, E. (2021). Prenatal heavy metal exposures and atopic dermatitis with gender difference in 6-month-old infants using multipollutant analysis. Environmental research, 195, 110865. - https://doi.org/10.1016/j.envres.2021.110865
- León B. (2023). Understanding the development of Th2 cell-driven allergic airway disease in early life. Frontiers in allergy, 3, 1080153. - https://doi.org/10.3389/falgy.2022.1080153
- Liao, J., Wen, J., Wei, C., Zhuang, R., Giri, M., & Guo, S. (2024). Association between blood heavy metal element and all-cause mortality in asthmatic adults: a cohort study. Scientific reports, 14(1), 20457. - https://doi.org/10.1038/s41598-024-70250-8
- Luo, D., Wan, X., Liu, J., & Tong, T. (2018). Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Statistical methods in medical research, 27(6), 1785–1805. - https://doi.org/10.1177/0962280216669183
- Mansoor, S., Ali, A., Kour, N., Bornhorst, J., AlHarbi, K., Rinklebe, J., Abd El Moneim, D., Ahmad, P., & Chung, Y. S. (2023). Heavy Metal Induced Oxidative Stress Mitigation and ROS Scavenging in Plants. Plants (Basel, Switzerland), 12(16), 3003. - https://doi.org/10.3390/plants12163003
- McRae, N., Gennings, C., Rivera Rivera, N., Tamayo-Ortiz, M., Pantic, I., Amarasiriwardena, C., Schnaas, L., Wright, R., Tellez-Rojo, M. M., Wright, R. O., & Rosa, M. J. (2022). Association between prenatal metal exposure and adverse respiratory symptoms in childhood. Environmental research, 205, 112448. - https://doi.org/10.1016/j.envres.2021.112448
- Mijač, S., Banić, I., Genc, A. M., Lipej, M., & Turkalj, M. (2024). The Effects of Environmental Exposure on Epigenetic Modifications in Allergic Diseases. Medicina (Kaunas, Lithuania), 60(1), 110. - https://doi.org/10.3390/medicina60010110
- Miko, E., Csaszar, A., Bodis, J., & Kovacs, K. (2022). The Maternal-Fetal Gut Microbiota Axis: Physiological Changes, Dietary Influence, and Modulation Possibilities. Life (Basel, Switzerland), 12(3), 424. - https://doi.org/10.3390/life12030424
- Mishra K. P. (2009). Lead exposure and its impact on immune system: a review. Toxicology in vitro: an international journal published in association with BIBRA, 23(6), 969–972. - https://doi.org/10.1016/j.tiv.2009.06.014
- Miyazaki, J., Ikehara, S., Tanigawa, K., Kimura, T., Ueda, K., Ozono, K., Kimura, T., Kobayashi, Y., Yamazaki, S., Kamijima, M., Sobue, T., Iso, H., & Japan Environment, Children's Study JECS Group (2023). Prenatal exposure to selenium, mercury, and manganese during pregnancy and allergic diseases in early childhood: The Japan Environment and Children's study. Environment international, 179, 108123. - https://doi.org/10.1016/j.envint.2023.108123
- Mousa, W. K., Chehadeh, F., & Husband, S. (2022). Microbial dysbiosis in the gut drives systemic autoimmune diseases. Frontiers in immunology, 13, 906258. - https://doi.org/10.3389/fimmu.2022.906258
- Naspolini, N. F., Meyer, A., Moreira, J. C., Sun, H., Froes-Asmus, C. I. R., & Dominguez-Bello, M. G. (2022). Environmental pollutant exposure associated with altered early-life gut microbiome: Results from a birth cohort study. Environmental research, 205, 112545. - https://doi.org/10.1016/j.envres.2021.112545
- Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed.), 372, n71. - https://doi.org/10.1136/bmj.n71
- Paithankar, J. G., Saini, S., Dwivedi, S., Sharma, A., & Chowdhuri, D. K. (2021). Heavy metal associated health hazards: An interplay of oxidative stress and signal transduction. Chemosphere, 262, 128350. - https://doi.org/10.1016/j.chemosphere.2020.128350
- Pesce, G., Sesé, L., Calciano, L., Travert, B., Dessimond, B., Maesano, C. N., Ferrante, G., Huel, G., Prud'homme, J., Guinot, M., Soomro, M. H., Baloch, R. M., Lhote, R., & Annesi-Maesano, I. (2021). Foetal exposure to heavy metals and risk of atopic diseases in early childhood. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 32(2), 242–250. - https://doi.org/10.1111/pai.13397
- Rault, P., Fortier, M., Pédelucq, J., Lacaze, E., Brousseau, P., Auffret, M., & Fournier, M. (2013). Immunotoxicity of heavy metals (silver, cadmium, mercury and lead) on marine bivalve Mytilus edulis: in vitro exposure of hemocytes. Journal of Xenobiotics, 3(s1), e8. - https://doi.org/10.4081/xeno.2013.s1.e8
- Ruan, F., Zhang, J., Liu, J., Sun, X., Li, Y., Xu, S., & Xia, W. (2022). Association between prenatal exposure to metal mixtures and early childhood allergic diseases. Environmental research, 206, 112615. - https://doi.org/10.1016/j.envres.2021.112615
- Sajdel-Sulkowska E. M. (2023). The Impact of Maternal Gut Microbiota during Pregnancy on Fetal Gut-Brain Axis Development and Life-Long Health Outcomes. Microorganisms, 11(9), 2199. - https://doi.org/10.3390/microorganisms11092199
- Shin, J., Kim, B. M., Ha, M., Park, H. S., Hong, Y. C., Kim, Y., Hyun Kwon, J., & Ha, E. H. (2019). The Association Between Mercury Exposure and Atopic Dermatitis in Early Childhood: A Mothers and Children's Environmental Health Study. Epidemiology (Cambridge, Mass.), 30 Suppl 1, S3–S8. - https://doi.org/10.1097/EDE.0000000000001002
- Soomro, M. H., Baiz, N., Huel, G., Yazbeck, C., Botton, J., Heude, B., Bornehag, C. G., Annesi-Maesano, I., & EDEN mother-child cohort study group (2019). Exposure to heavy metals during pregnancy related to gestational diabetes mellitus in diabetes-free mothers. The Science of the total environment, 656, 870–876. - https://doi.org/10.1016/j.scitotenv.2018.11.422
- Sutton, A. J., Abrams, K. R., Jones, D. R., Sheldon, T. A., & Song, F. (2000). Methods for meta-analysis in medical research (Vol. 348). Chichester: Wiley. - Methods-for-Meta-Analysis-in-Medical-Research.pdf
- Swagatika, S., & Tomar, R. S. (2016). Modulation of epigenetics by environmental toxic molecules. Advances in Molecular Toxicology, 10, 361-389. - https://doi.org/10.1016/B978-0-12-804700-2.00008-8
- To, T., Borkhoff, C. M., Anderson, L. N., Birken, C. S., Dell, S. D., Janus, M., Maguire, J. L., Moraes, T. J., Parkin, P. C., Subbarao, P., Van Dam, A., Guttman, B., Terebessy, E., Zhang, K., & Zhu, J. (2024). Association of factors with childhood asthma and allergic diseases using latent class analysis. Scientific reports, 14(1), 6874. - https://doi.org/10.1038/s41598-024-56805-9
- Tokura, Y., & Hayano, S. (2022). Subtypes of atopic dermatitis: From phenotype to endotype. Allergology international : official journal of the Japanese Society of Allergology, 71(1), 14–24. - https://doi.org/10.1016/j.alit.2021.07.003
- Tsai, T. L., Wang, S. L., Hsieh, C. J., Wen, H. J., Kuo, C. C., Liu, H. J., Sun, C. W., Chen, M. L., Wu, M. T., & TMICS Study Group (2021). Association Between Prenatal Exposure to Metals and Atopic Dermatitis Among Children Aged 4 Years in Taiwan. JAMA network open, 4(10), e2131327. - https://doi.org/10.1001/jamanetworkopen.2021.31327
- Wan, X., Wang, W., Liu, J., & Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology, 14, 135. - https://doi.org/10.1186/1471-2288-14-135
- Zinia, S. S., Yang, K. H., Lee, E. J., Lim, M. N., Kim, J., Kim, W. J., & Ko-CHENS Study group (2023). Effects of heavy metal exposure during pregnancy on birth outcomes. Scientific reports, 13(1), 18990. - https://doi.org/10.1038/s41598-023-46271-0
Дополнительные файлы


