Relation of child birth and breast-feeding burden with cadmium and tubular dysfunction marker levels in urine of adult women in non-polluted areas in Japan.

BACKGROUND AND OBJECTIVES: Cd absorption may be enhanced in association with iron (Fe) deficiency. Women have increased risks of Fe loss at the time of child birth as well as breast-feeding of children. Possible effects of these two factors were investigated in the present study.
METHODS: Data were drawn from previous publications from this group on Cd and tubular dysfunction markers (i.e., α1-microglobulin, β2-microglobulin, and N-acetyl-β-D-glucosaminidase) in urine of adult women in non-polluted areas in Japan. Information including age, smoking, number of children, and types of child feeding was obtained by self-administered questionnaires at the time of urine sampling. In practice, 17,468 cases were available, from which 12,869 cases were employed in the present analyses after exclusion of smokers, former or current patients of anemia or hypertension, and those with incomplete answers. Lactation burden was scored after coding of breast, mixed, and bottle feeding with 2, 1, and 0 for each child followed by summation for all children born to a mother. In order to exclude possible effect of aging, women were stratified by 5 years of age to randomly select equal numbers of cases and controls, followed by summation for all ages for comparison.
RESULTS: The arithmetic mean age and the geometric mean Cd (as observed) were 49.7 years and 1.13 μg/l urine. The number of children was 0-7, and lactation burden score ranged from 0-12. Multiple regression analyses were conducted with age and either number of children or lactation burden scores as independent variables and Cd as a dependent variable. The results showed that age was an influential variable. Comparison after matching for age showed that having 1, 2, or 3 children or lactation burden score up to 2 were associated with a significant increase in Cd. Lactation burden score up to 2 was also associated with increased Cd in urine and such trend persisted up to the highest score of 5-12. The results of trend tests were generally in agreement with these observations. Further comparison after age-matching showed that women having 2 or 3 children but no lactation burden had higher Cd than those with no children. In contrast, Cd was not higher for those having 2 or 3 children with substantial lactation scores (i.e., 2-4 or 3-6) than for those with the same number of children without lactation burden.
CONCLUSIONS: Giving birth to 1-3 children was associated with an increase in urinary Cd, suggesting that child birth might be associated with elevation in Cd body burden. The effect of lactation is probably attributable to that of number of children. Further studies are necessary to examine whether the association is also observable in mothers who have 3 or more children.