Possible Risk Factors and Their Potential Associations with Combined Heavy Metal Exposures in Pregnant Women in the Republic of Suriname.

Background: The exposure of pregnant women to multiple environmental pollutants may be more disadvantageous to birth outcomes when compared to single-compound contaminations. Objective: This study investigated the mixed exposures to mercury, manganese, or lead in 380 pregnant Surinamese women. The factors that might be associated with the heavy metal exposures and the relative risk of the potential factors to cause the mixed exposures were explored. The influencing factors of exposures to mixed contaminants assessed were living in Suriname's rural regions, several parts of which are contaminated with heavy metals emitted from artisanal and small-scale gold mining and agricultural activities; the consumption of potentially contaminated foods; advanced maternal age; as well as a relatively low formal educational level and monthly household income. Methods: Descriptive statistics were used to calculate frequency distributions and χ2-contingency analyses to calculate associations and relative risks (RR) with 95% confidence intervals (CI). Findings: Blood levels of two or three of the heavy metals above public health limits were observed in 36% of the women. These women were more often residing in the rural regions, primarily consumed potentially contaminated food items, were 35 years or older, were lower educated, and more often had a lower household income. However, only living in the rural regions (RR = 1.48; 95% CI 1.23-1.77) and a low household income (RR = 1.38; 95% CI 1.15-1.66) significantly increased the risk of exposure exceeding levels of concern to two or three of the heavy metals (by 48% and 38%, respectively). Conclusion: More comprehensive pharmacological, ecological, and epidemiological studies about exposures to mixed heavy metal contaminations in pregnant women are warranted.

Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study.

Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.

The distribution of disease in the Republic of Suriname - A pharmacoepidemiological analysis using the claims database of the State Health Foundation of the year 2017.

The patterns of prescription drug use in Suriname in the year 2017 have been determined with the purpose of obtaining indications about the distribution of disease in the country. The claims database of the State Health Foundation (Staatsziekenfonds, SZF) of Suriname was used for calculations of prescription rates of the fifty most prescribed drugs overall and after stratification according to gender, age, and residence of the insured persons. Information in the database had been de-identified, and the prescribed medicines had been coded according to the Anatomic Therapeutic Chemical Classification System. Statistically significant differences among the prescription rates were assessed with the two samples test of proportions using normal theory method and χ2 Goodness of Fit tests (p < 0.05). Additionally, the Bonferroni adjustment was used to adjust for type 1 error inflation resulting from multiple comparisons. Overall, drugs for the cardiovascular, respiratory, and musculo-skeletal systems had the highest prescription rates (p < 0.001). Furthermore, rates were generally higher in females than in males, in the older age groups than in younger individuals, and in the coastal regions compared to the country's interior (p < 0.001). These findings are largely in line with data found in the literature and support the use of this pharmacoepidemiological approach to assess the distribution of disease in Suriname.

Prevalence and safety of prescription medicine use during pregnancy in the Republic of Suriname in the year 2017: a pharmacoepidemiological analysis.

BACKGROUND: Using the claims database of the State Health Foundation from 2017, the prevalence and safety of prescription medicines given to pregnant women in Suriname (South America) have been determined. METHODS: Prescription rates and proportions of the total number of prescriptions were calculated, overall and stratified for subgroups of age, region of residence, major Anatomical Therapeutic Chemical - and safety classification (Australian categorization system). Data were compared with the Σ2-test and the two samples test of proportions using normal theory method; p-values <0.01 were considered statistically significant differences. RESULTS: Average prescription rates (number of prescriptions by number of patients) were 24.0, 29.7, and 32.5 in age groups 15-29, 30-44, and 45+ years, respectively (p<0.001), and 26.4, 23.0, and 14.0 in the urban-coastal, rural-coastal, and rural-interior region, respectively (p<0.001). CONCLUSIONS: The use of prescription medicines was common (rates up to 40.4), ranged from antibiotics to vitamins, and most were safe. However, 3.2% (some antibiotics and antiepileptics) belonged to safety category D, carrying a definite human fetal risk. However, the potential benefits of these drugs warranted their use in pregnant women. These findings are largely in line with literature data, although future studies must verify their generalizability to the total Surinamese population.