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A cross sectional study of the relationship between the exposure of pregnant women to military attacks in 2014 in Gaza and the load of heavy metal contaminants in the hair of mothers and newborns
  1. Paola Manduca1,
  2. Safwat Y Diab2,
  3. Samir R Qouta3,
  4. Nabil MA Albarqouni3,
  5. Raiija-Leena Punamaki4
  1. 1 DISTAV, University of Genoa, Genova, Italy
  2. 2 Al-Quds Open University-Gaza Branch, Gaza, Gaza Strip, Palestine
  3. 3 Islamic University of Gaza, Gaza, Palestine
  4. 4 University of Tampere, School of Social Sciences and Humanities/Psychology, Tampere, Finland
  1. Correspondence to Prof. Paola Manduca; paolamanduca{at}


Objective Metal contamination of humans in war areas has rarely been investigated. Weaponry’s heavy metals become environmentally stable war remnants and accumulate in living things. They also pose health risks in terms of prenatal intake, with potential long term risks for reproductive and children’s health. We studied the contribution of military attacks to the load of 23 metals in the hair of Palestinian women in the Gaza Strip, who were pregnant at the time of the military attacks in 2014, and their newborns. We compared the metal load in the mothers with values for adult hair from outside the war area (RHS) as the reference. We investigated heavy metals trans-passing in utero, and assessed if the heavy metal intake could derive from sources unrelated to the war.

Design Cross sectional study.

Participants and setting Cross sectional convenience sample of 502 mothers delivering in the Gaza Strip and their newborns.

Main outcome measured Measure of the load of heavy metals in mother and newborn hair by inductively coupled plasma-mass spectrometry (ICP-MS). Comparison of metal loads with the reference RHS, between groups with different exposures to attacks and house/agriculture chemicals, and between mothers and newborns. Data for birth registry and for exposures to war and other known risk factors were obtained at interview with the mothers. Photographic documentation of damage from military attacks was obtained.

Results The whole cross sectional convenience sample had a significantly higher load of heavy metals than the reference RHS. Women exposed to military attacks had a significantly higher load of heavy metals than those not exposed; the load in newborns correlated positively with the mothers’ load. No significant difference was found between users/non-users of house/agriculture chemicals. No other known confounder was identified.

Conclusions High heavy metal loads in mothers, reflected in those of their newborns, were associated with exposure to military attacks, posing a risk of immediate and long term negative outcomes for pregnancy and child health. Surveillance, biomonitoring and further research are recommended. Implications for general and public health are discussed.


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  • Contributors Contributorship statement. PM developed the questionnaire used to collect the data, directed the analytical work and elaboration of the data with statisticians, wrote the manuscript, and prepared the figures and reference list. SYD directed the organised field work in three hospitals, and the follow-up objective assessment of damages, and contributed to the definition of the work and review of the manuscript. NMAA directed the organised field work in one hospital and contributed to the definition of the work and review of the manuscript. SRQ partecipated in the planning of the study and review of the manuscript. R-LP launched the idea of the study and participated in the planning of the work and first draft and review of the manuscript. All contributed authors had access to and revised the data.

  • Competing interests None declared.

  • Patient consent Yes.

  • Ethics approval The Palestinian Health Research Council and the Helsinki C’ommittee for Ethical Approval approved the study, and the Research Board of the Islamic University of Gaza, Palestinine, reviewed and accepted the research tools and procedures. The women provided written informed consent for their own and their newborns’ participation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at the doi:10.5061/dryad.kr846.

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