1. Is There Any Association Between Fetal Nervous System Anomalies And Heavy Metal/ Trace Element Levels ?
Numan Cim, Harun Egemen Tolunay, Baris Boza, Mustafa Bilici, Orkun Cetin, Erbil Karaman, Recep Yildizhan, Hanim Guler Sahin
Yuzuncu Yil University Faculty of Medicine
Department of Gynecology and Obstetrics/ Van

2. Environmental chemicals, Toxic heavy metals and
INTRODUCTİON
Environmental chemicals,
Toxic heavy metals and
Trace elements are related to
spontan aborts,
premature births,
congenital malformations,
menstrual cycle disorders,
fertility problems and
behavioral problems of offsprings.
(Thompson J,2008)

3. In this study we aimed to evaluate wheather there any causal relationship between heavy metals-trace elements and fetal malformations of CNS (cantral nervous systems).

4. MATERİALS AND METHODS Study group (n=36) Control group (n=30)
Pregnants with fetal congenital nervous system anomaly ( anencephaly, acrania, neural tube defects etc.) in weeks
Control group (n=30)
Pregnants with the same weeks of pregnancy who underwent amniocentesis due to high risk in triple test with the result of normal caryotype were control group.

5. In the both groups we analyzed the heavy metals and trace elements in amniotic fluid.
Metals and elements were measured by using atomic absorption spectro photometer technique with a UNICAM-929 spectro photometer (Unicam Ltd, York Street, Cambridge, UK).
Mann Whitney U test is performed to determine the differences between the groups.

6. Clinical features of the groups
Anomaly group Median
(Min–Max)
N=36
Normal group Median
(Min-Max)
n = 30 P
Age (years)
27,7 (20-40)
27,3 (20-40)
0.846
Parity
2,02 (1-4)
2,03(1-4)
1.000
Hemoglobine (mg/dl)
11,88 (9-15)
11,83(9-15)
0.791
Body Mass İndex(kg/m2)
22,9 (19-28)
22,7 (19-28)
0.461

7. RESULTS Anomaly group Median (Min–Max) N=36 Normal group Median
Fe(μg/100 ml)
0.111
( )
0.072
( )
0.075
Mn (μg/100 ml)
0.009
( )
0.012
( )
0.054
Cu(μg/100 ml)
0.006
( )
0.011
( )
0.005
Pb(μg/100 ml)
0.036
(0, )
0.019
( )
0.000
Zn(μg/100 ml)
0.569
( )
2.916
( )
0.001
Co(μg/100 ml)
0.026
( )
0.029
( )
0.079
Ni(μg/100 ml)
( )
( )
0.918
Cd(μg/100 ml)
0.007
( )
( )
0.020

8. DİSCUSSİON
There are few studies investigating the heayv metals and trace elements in amniotic fluid (AF) of the pregnants with fetal congenital nervous systme anomalies to our knowledge.
In our study we detected low levels of Zn and Cu in amniotic fluid (AF) of pregnants with anomaly compared then healthy group.
İnterestingly finding that zinc (Zn) is reduced in AF of the pregnants with fetal congenital nervous system anomalies has not been reported previously.
Also Pb and Cd levels are increased in AF of pregnants with fetal congenital anomaly group when compared the normal group.

9. Zinc (Zn) is essential for normal fetal growth and development.
Zn is required for transcription, cell division, growth and differentiation. Heavy zinc deficiency is embryotoxic and teratogene, and is a cause of abnormal fetal development
(Cole AC,2002)

10. Lead (Pb) and Cadmium (Cd) is especially neurotoxic.
Disruption of key molecules during neuronal migration and differentiation is probably the mechanism of this neurotoxicity.
Possibly increased lead levels could play role in the pathogenesis of diseases due to the damage in other trace elements metabolism
And in this study we found higher levels of Pb in AF in anomaly group.
This finding can explain a paert of pathogenesis of neural systme anomalies in our study.
(Caban-Holt 2005)

11. Conclusion
This study can contribute benefits to the literature in terms of to clarify the pathogenesis of fetal congenital nervous system anomalies.
We can contribute to decrease the perinatal mortality and morbidity with
avoiding from environmental toxics,
advanced diagnosis/treatment attempts by detection of congenital malformations in early gestational weeks.