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International Journal of Medical Arts 2020; 2 [1]: 162-172.
Available online at Journal Website
https://ijma.journals.ekb.eg/
Original article
The Effect of Maternal Exposure to Textile Industry-Induced Pollution on Pregnancy and Its
Outcome
Rania El Sayed Abo El Gheita; Abd Elraouf Mohammad Ounb; Alaa Al Arshalb
Resident at Obstetrics and Gynecology Department, Mahalla General Hospital, Ministry of Health and Populations, Egypt[a].
Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt[b].
Corresponding author: Rania El Sayed Abo El Gheit
Email: drrania.aboelgheit@gmail.com
Received at: June 24, Revised at: October 20, 2019; Accepted at: October 23, 2019; Available online at: October 23, 2019
DOI: 10.21608/ijma.2019.13351.1016
ABSTRACT
Background: Inside textile mills, pregnant women employees are inevitably exposed to a huge pollution
that can result in adverse pregnancy outcomes.
Aim of the work: We aimed to evaluate the potential effect of exposure to textile industry induced pollution,
among women textile workers, on pregnancy outcome.
Patients and methods: A case-control study was carried out at Misr Spinning/Weaving Company, El
Mahalla El Kubra, Egypt. The exposed and control group consisted of 142, and 143 eligible
participants respectively. All underwent full history taking, clinical examination and ultrasound
investigations during first, second and third trimesters. Pregnancy outcome was documented.
Results: 64.1% of exposed group’ pregnancies were complicated versus 16.1% of control group. Of which
pregnancy induced hypertension (PIH, 19.0%), preterm birth (23.2%), term low birth weight
(TLBW, 19.7%), and congenital anomalies (2.1%), in contrast to 4.9%, 7.7%, 2.8%, and 0.7%
respectively, in the control group.
Conclusion: We concluded from our results that textile induced pollution exposure was significantly
associated with adverse pregnancy outcomes (OR=1.652, CI: 1.287-1.954), and this risk was
significantly proportional to duration of exposure (OR=2.110, CI: 1.334-3.338).
Keywords: Textile; Pollution; Mahalla Al-Kubra; Congenital anomalies; Low birth weight.
This is an open access article under the Creative Commons license [CC BY] [https://creativecommons.org/licenses/by/2.0/]
Please cite this article as: Abo El Gheit RE, Oun AM, Al Arshal A. The Effect of Maternal Exposure to Textile
Industry-Induced Pollution on Pregnancy and Its Outcome. IJMA 2020; 2[1]: 162-172.
International Journal of Medical Arts
163
INTRODUCTION
Textile industry is considered as one of the
oldest and most complex industries in the world [1].
In spite of the substantial research and
development to minimize pollution potentials of
textile processing, the textile industry is one of the
biggest polluters on our planet. [2]
It has been estimated that between 1.5 and 6.9
kilogram (kg) of chemicals is needed to produce 1
kg of garment, this implying that the weight of the
used chemicals in the textile production process is
larger than the weight of the finished garment itself.
These toxic chemicals are major sources of
pollution[3].
Moreover, the textile manufacturing process
contributes significantly as sources of air emissions,
which is considered as the second greatest
pollution problem in the textile mills. These
emissions include dust, acid vapors, oil mists, odors
and boiler exhausts. Carbon monoxide (CO),
nitrogen dioxides (NO2), sulfur dioxide (SO2), ozone
(O3), lead, and particulate matters (PMS) are well
identified air emissions from textile process [4].
Large scale of epidemiological studies has
reported a critical link between indoor industrial
pollution and an increased incidence, and
aggravated severity of different diseases. Moreover,
occupational noise exposure has been recently
emerged as one of the most influential and a
harmful physical factor at workplaces, linked with a
wide range of negative health effects [5].
The women textile workers are exposed inside
textile mills, to high noise levels exceed those
recommended by the National Institute of
Occupational Safety and Health [6]. So, workers in
textile factories are inevitably exposed to huge
amount of pollution. Fetuses, in particular, are
considered to be highly susceptible to a variety of
toxicants, due to their exposure pattern and
physiologic immaturity, especially during periods of
high cell proliferation, differentiation, and rapid
organ development. Indeed, pregnancy outcome is
determined by the ability of the fetus to thrive, which
depends on a complex combination of genetic,
social, and environmental factors [7].
The daily prenatal maternal exposure to the
textile emitted pollutants, including different
neurotoxic, carcinogenic, and developmental toxic
chemicals, might be associated with more serious,
permanent damage to the fetuses [7].
AIM OF THE WORK
We aimed to evaluate the potential effect of
maternal indoor exposure to textile industry induced
pollution, among women textile workers, on
pregnancy outcome, at Misr Spinning and Weaving
Company in El Mahalla El Kubra, Egypt.
PATIENTS AND METHODS
This case-control study was conducted by
Damietta Faculty of Medicine, Al- Azhar University,
in corporation with the Egyptian Ministry of Health,
at Al-Mahalah Al-Kubra, during the period from
June 2018 to June 2019.
Three hundred pregnant women were included
and classified into two groups. Group 1 (Exposed
group): included 150 pregnant women working at
Misr Spinning and Weaving Company in Al-Mahalla
Al-Kubra. Eight pregnancies were excluded (three
were complicated by gestational diabetes, three
complicated by abortion, while other two were
complicated by intrauterine fetal deaths). Group II
(Non-exposed, Control group): included 150
pregnant women work in non- textile polluted area.
Seven pregnancies were excluded (two underwent
abortion, two of them did not complete antenatal
follow up during the study and three delivered at
their village).
Inclusion criteria: Among women textile
workers, in Al-Mahalla Al-Kubra, Egypt, had a
history of indoor-exposure to occupational pollution
during pregnancy, singleton intrauterine gestation,
at 18-35 years old.
Exclusion criteria: Presence of consanguinity,
multiple pregnancies, and women with history of
chronic medical disorder, obstetric history show
past or recent history of a pregnancy complication,
pervious history of infant with congenital
malformation to exclude other factors that may
affect pregnancy outcome, history of drug
medication intake during present pregnancy.
An informed consent was signed by each
participant, then, the following was done to each
participant: History taking, general and local
examination. In addition, ultrasound was carried out
Abo El Gheit et al.
164
at first, second and third trimesters.
First‐trimester ultrasound scan: It was
performed at (11–14 weeks) by trans-abdominal
ultrasound, soft markers plus the fetal nuchal
translucency, with Screening for chromosomal
anomalies.
Second and third trimester ultrasound scans.
Fetal anomaly scan at 18- 22 week. Uterine artery
Doppler was performed at 20-24 weeks of
gestation. Doppler on umbilical artery to all
suspected cases. Screening for gestational
diabetes and maternal body mass index (BMI) were
performed between 24 –30 weeks of gestation.
Statistical Analysis: The collected data was
organized, tabulated and statistically analyzed
using statistical package for social science (SPSS)
version 22 (SPSS INC, Chicago, USA) Running on
IBM compatible computer. For qualitative data, the
frequency and percent distributions were
calculated, while mean, standard deviation (SD)
were calculated for quantitative data. For
comparison between two groups, the independent
samples (t) test was used. Pearson correlation co-
efficient (r-test) was used for correlating different
variable. For all tests p value ≤0.05 were
considered significant.
RESULTS
Table (1) revealed non-significant differences in
mean intra-pregnancy BMI, and age between
exposed and control groups. Mean duration of
exposure to textile pollution in the exposed group
was 5±1.6 years; 21.8 % exposed less than 3
years; 66.9 % exposed between 3 and 9 years and
11.3% exposed more than 9 years.
Longer maternal hospital stay was significantly
associated with exposed group (35.4±11.6 hour)
when compared to control group (28.9±7.2 hour).
Otherwise, no significant differences were found
regarding gravidity, and delivery mode between
studied groups (Table 2).
Regarding the gestational age, our results
revealed that the exposed group was significantly
associated with younger gestational age (36.8±2.8)
completed weeks of gestation when compared to
control group (38.2±1.3). Similarly, birth weight (g)
data analysis was revealed significantly lowered
birth weight in the exposed group (2835.9±491.4g),
compared to control group (3204.3±322.6 g).Where
28.9% of textile workers delivered babies with LBW
(< 2.500g) in contrast to 4.9% of the age matched
control. 71.1% of exposed group had babies
weights ranged (2.500-4.000g), compared to 95.1%
in the control group (Table 3).
The textile workers in the exposed group were
significantly associated with maternal and neonatal
complications when compared to their controls.
35.9% of textile workers exhibited normal maternal
and neonatal outcomes, while 64.1% revealed
complications with their pregnancies, in contrast to
83.9% and 16.1% in the control group respectively.
PIH was recorded as outcome in 19.0% of
pregnancies in the textile workers versus 4.9% in
the control group. 23.2% of pregnancies in the
exposed group were terminated preterm in contrast
to 7.7% of controls. 19.7% of pregnancies in the
exposed group yielded LBW babies at their term,
compared to only 2.8% of the control group. 2.1%
of exposed group’ pregnancies were complicated
by congenital anomalies; anencephaly,
hydrocephaly, and atrio-ventricular septal defect
(Figures 1, 2, and 4), while only a case of
omphalocele (Figure 3) with a percent of 0.7% of
pregnancy outcomes, was reported among the
control group (Table 4).
The most potent variables that were associated
with significant increased risk of abnormal
pregnancy outcomes in univariable analysis, were
younger maternal age; OR 0.867 (95% CI, 0.823-
0.912), gestational age OR 0.352 (95% CI, 0.248-
0.499), textile exposure OR 1.434 (95% CI, 1.161-
1.771) and more evidently longer duration of textile
exposure OR 0.894 (95% CI, 0.830-0.964) (Table
5).
Younger maternal age OR 0.522 (95% CI,
0.386-0.707); gestational age, OR 0.356 (95% CI,
0.232-0.547); textile exposure OR 1.652 (95% CI,
1.287-1.954); and longer duration of textile
exposure OR 2.110 (95% CI, 1.334-3.338) were
considered independent prognostic factors for
abnormal pregnancy outcomes (Table 6).
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Table (1): Maternal age, body mass index, and duration of exposure (years), in the studied groups
Characteristics
Control
N=143
Exposed
N=142
p
Age (years)
mean±SD
24.6 ± 4.6
23.8 ± 4.6
0.282T
N
%
N
%
< 20
19
13.3
53
37.3
<0.001C
20-30
102
71.3
74
52.1
> 30
22
15.4
15
10.6
Pregnancy
BMI
mean±SD
30.5 ± 5.1
29.6 ± 5.8
0.153T
N
%
N
%
Underweight
3
2.1
17
12
0.336F
Normal
37
25.9
28
19.7
Overweight / Obese
103
72
97
68.3
Duration of exposure (Years)
Up to 3
31
21.8
3-9
95
66.9
> 9
16
11.3
mean±SD
5±1.6
SD: standard deviation, T: student t test, C: Chi square, F: Fisher exact test. The data was represented as mean±SD, number (N), percent (%).
Table (2): Obstetric data in the studied groups (represented as number, and percent, unless otherwise mentioned).
Control
N=143
Exposed
N=142
p
Parity
Primigravida
N
%
N
%
59
41.3
73
51.4
0.086C
Multigravida
84
49.7
69
48.6
Mode of delivery
CS
64
44.8
63
44.4
1.000C
Vaginal
79
55.2
79
55.6
Maternal hospital stay (hours, mean±SD)
28.9±7.2
35.4±11.6*
<0.001T
SD: standard deviation, T: student t test, C: Chi square. *Denotes statistical significance P≤0.05 compared to the control group.
Table (3). Neonatal data in the studied groups.
Parameters
Control
N=143
Exposed
N=142
p
Gestational age (Completed weeks)
mean±SD
38.2±1.3
36.8±2.8*
<0.001T
Birth weight
(g)
mean±SD
3204.3±322.6
2835.9±491.4*
<0.001T
< 2,500
N, %
7
4.9
41
28.9
<0.001T
2,500–4,000
N, %
136
95.1
101
71.1
SD, standard deviation; the data was represented as mean ± SD, number (N), percent (%).T, student t test. *Denotes statistical significance
P≤0.05 compared to the control group.
Table (4): Maternal and neonatal outcomes (number, percent; N, %) in the studied groups.
Outcome
Control
N=143
Exposed
N=142
p
N
%
N
%
Normal outcome
120
83.9
51
35.9
<0.001F
PIH
7
4.9
27
19.0
Preterm birth
11
7.7
33
23.2
TLBW
SGA
4
2.8
11
7.7
IUGR
0
0
17
12
Congenital anomalies
1
0.7
3
2.1
PIH, Pregnancy induced hypertension; TLBW, Term Low birth weight; F; Fisher exact test. The data was represented as number (N),
percent (%).
Abo El Gheit et al.
166
Table (5): Univariable regression analysis for prediction of abnormal pregnancy outcome.
Maternal variable
p
OR
95% CI
Maternal age
<0.001
0.867
0.823
0.912
BMI
0.078
0.966
0.929
1.004
Gestational age
<0.001
0.352
0.248
0.499
Gravidity
0.068
0.673
0.440
1.030
Delivery mode
0.119
0.595
0.385
1.920
Textile exposure
0.001
1.434
1.161
1.771
Duration of exposure
0.003
0.894
0.830
0.964
OR, odds ratio; CI, confidence interval; BMI, Body mass index. Statistical significance was considered at P≤0.05.
Table (6): Multivariable regression analysis for prediction of abnormal pregnancy outcomes.
Variables
p
OR
95% CI
Maternal age
<0.001
0.522
0.386
0.707
Gestational age
<0.001
0.356
0.232
0.547
Textile exposure
0.002
1.652
1.287
1.954
Duration of exposure
0.001
2.110
1.334
3.338
OR, odds ratio; CI, confidence interval. Statistical significance was considered at P≤0.05.
Figure (1): Trans abdominal Ultrasound of anencephaly at gestational age 18 weeks.
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Figure (2): Trans abdominal Ultrasound of hydrocephaly at gestational age 16w+6d.
Figure (3): Trans abdominal Ultrasound of omphalocele at gestational age 22 weeks.
Figure (4 A): Trans vaginal Ultrasound of atrio ventricular septal defect at gestational age 17 week.
Abo El Gheit et al.
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Figure (4 B): A color Doppler of atrio ventricular septal defect at gestational age 17 week.
DISCUSSION
The results of our study revealed significant
association between exposures to the textile
induced pollution among the textile pregnant
women and our adverse pregnancy outcomes, PIH,
preterm birth, TLBW, and congenital anomalies.
Consistent with our results, Mobashera et al.[8],
documented first trimester CO exposure to
pregnant women increased the odds of developing
PIH. A link between CO exposure and PIH has been
further supported by Rudra et al.[9], who ensured a
positive strong association between CO and the
odds of PIH. Vigeh et al. [10] reported twice the rate
of PIH in mothers exposed to higher CO levels than
control mothers (OR= 2.02, 95% CI= 1.35, 3.03).
Earlier studies confirmed increased risk of
developing preeclampsia by about 42%, in women
exposed in the highest PM2.5 during their
pregnancy[9]. Similarly, in a prospective cohort
study in the Netherlands, van den Hooven[11],
explored a positive association between risk of PIH
and PM10 concentrations (OR 1.72 (95% CI 1.12 to
2.63).
In contrast to the strong association between
PIH and first trimester exposure to PM2.5, and
PM10, other lines of evidence addressed significant
link between PIH, and IUFR and ozone (O3)
exposure in the second trimester [8].
A well-documented potential mechanism
whereby pollutant components can increase BP is
superoxide-mediated inhibition of the actions of
nitrous oxide in inducing vasodilatation [12].
Previous reports documented a close relation
between air pollution, and PIH risk, mostly through
systemic/ vascular inflammation. Especially during
the first trimester that represents a critical window
of susceptibility PIH, during which trophoblast
invasion into the maternal decidua takes places to
establish efficient fetal blood supply [13].
The dysregulated autonomic nervous system
(ANS) with an activated sympathetic tone, may
better explain the combined effects of air pollution
and noise on pathogenesis of hypertension [14].
Previous convincing evidence pointed out that
chronic occupational exposure to ≥ 80 – 85 dB, as
typically occurs during daily activities in textile mill,
is associated with significantly higher risk for LBW
and SGA[15].
Yiming et al.[16] in a prevalence study of
hypertension in a group of 1101 female workers in
a textile mill, reported by logistic regression that
exposure to noise is a significant determinant of
prevalence of hypertension, but third in order of
importance behind family history of hypertension
and use of salt.
Our study revealed a significant risk regarding
textile industry exposure and the incidence of
preterm birth, where 23.2% of exposed group, their
pregnancies complicated by preterm birth.
Ritz, and Wilhelm[17] lend support to the
concept of air pollution is a risk preterm birth factor.
Increased risk of preterm birth has been previously
International Journal of Medical Arts
169
recorded to be associated with exposure to air
pollutants particulate matters (PM10) and CO [18]
and (PM2.5), and So2 [19].
Previous work has indicated that pollutants
absorption may induce several pathophysiological
circuits including inflammation, oxidative stress, cell
apoptosis, endothelial dysfunction and hemo-
dynamic responses, which predispose to preterm
birth [20].
In a large study in China suggested that rotating
shift-work and working in a squatting position may
increase the risk of preterm or LBW deliveries [21].
Salam et al. [22]; found that first trimester
exposure to CO was associated with a 20%
increased risk of IUGR. Similarly Liu et al.[23]
reported statistically significant increase in the risk
of IUGR with increased CO exposure in the 1st
trimester.
Previous associations have reported more
consistently the first and third trimesters. Exposures
during first trimester may result in disruption of
placental formation and its function leading to IUGR
while exposures during later pregnancy may
interfere with the fastest period the body mass
accumulation of fetus [24].
During his a cohort on 14000 pregnant women,
Farrow et al.[25] reported working in the textile
trade, was recorded among the major job groups
with the LBWS. The oxidative stress induced by
pollution could result DNA damage, disrupting DNA
transcription, resulting in decreased capacity of the
feto–placental exchange of nutrients and oxygen
and compromised fetal growth [26].
Ritz et al. [24] suggested a possible gene–
environment interaction enhancing risk of
congenital malformation. The continuous exposure
to multiple air pollutants especially PM2.5, 10, was
associated with immediate vasoconstriction and
endothelial functions could be considered as an
intervening pathway in subsequent impact on fetal
growth [12].
Our results revealed higher prevalence of
anomalies among new-borns to textile worker, with
higher proportions of malformations in the nervous
and circulatory systems.
A significant association was detected among
cases with congenital birth defects whose mothers
had been exposed textile occupation [27].
A significant risk of multiple fetal anomalies was
closely linked with textile dye workers with
hydrocephaly, ventricular septal defect and
congenital heart diseases, among the most
frequently encountered defects of the twenty cases
with multiple birth defects recorded in the textile dye
workers, through registry based case-control study
carried out by [28].
Shi and Chia[29] identified a significant risk
between textile dye workers and multiple anomalies
(adjusted OR 1.9, 99% CI 1.0–3.8). Khattak et
al.[30], ranked working women in textile and clothing
industries among the most important women-
dominated occupations with potential chemical
exposures, involving exposure to organic solvents,
with its deleterious health effects, including the well
documented teratogenicity and an increased risk of
major fetal anomalies.
Pregnant women working under persistent
occupational exposure to organic solvents, as did
the textile workers [31], have been reported to be at
high risk for delivering baby with congenital
malformations, most frequently, central nervous
system, coronary disorders, and congenital
deafness [32].
McMartin et al.[33] documented an overall
average value (OR=1.64 95% CI=1.16-2.30) during
evaluating maternal occupational organic solvents
exposure and the associated risk of major
congenital anomalies. Higher risk of anencephaly,
NTDs and spina bifida subtypes was reported in
pregnant women from counties with textile industrial
development than in those from other counties, with
released solvents have been accused [32, 34].
Castilla et al.[34] declared that the textile
industry was ranked as industry uses diverse
potentially teratogenic pollutants with increased risk
of congenital anomalies; especially anomalies
related the central nervous system on top of which
anencephaly and microcephaly.
Bianchi et al.[28], reported hydrocephaly , cleft
palate and lip , absent diaphragm, oesophageal
atresia, absent auditory canal, spina bifida, low set
Abo El Gheit et al.
170
ears, and ventricular septal defect, among the
multiple congenital anomalies that have been
previously recorded in textile dye-workers.
Unfortunately the chemical substances could be
transferred directly to fetal circulation if they are not
metabolized either by placental or maternal
metabolism. The fetus attempt to metabolize these
chemical pollutants, by enzyme activity, mainly
through fetal liver, however other organs such as
kidneys, adrenal glands, lungs, and brain may also
be involved [39].
The lowered capacity of the fetus for
detoxification and excretion with much weaker
enzyme system, may lead to excessively higher
levels of these harmful pollutants in fetal blood as
compared to those in the maternal circulation. The
condition is much worsened by the fact that fetal
blood-brain barrier is also immature, leading to
enhanced vulnerability of the fetal brain to
damaging effects of these toxic chemicals [36].
Maternal exposure to dyes has been reported to
be a significant risk factor for congenital septal
defects [37]. Khattak [30] declared in his study that
pregnant women exposed occupationally to organic
solvents, especially those in the textile industries,
had a 13-fold risk of major malformations as well
increased risk for miscarriages in their previous
pregnancies while working with organic solvents.
In a previous study performed in China on 10
542 women between 2010–2012, Jin et al.[38]
documented a positive associations for congenital
malformations and the maternal exposures to
(PM10), (NO2), and (SO2) (OR 1st trimester 3.96, (CI):
1.36 - 11.53; OR 2nd trimester 3.59, CI: 1.57, 8.22; OR
entire pregnancy 2.09, 95% CI: 1.21- 3.62)
Conclusion: The findings reported in this study
indicated that pregnant women exposed to textile
induced pollutions inside Misr Spinning and
Weaving Company at Al Mahalla Al Kubra, at
increased risk of the adverse pregnancy outcomes
with a particular TLBW, preterm birth, hypertension,
and congenital anomalies.
Acknowledgments
The authors gratefully acknowledge working
staff team at Ghazal Al Mahalla and at Al Mahalla
General Hospitals for their great support and
assistance.
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