From:  Toxic metals in pregnancy and congenital heart defects. Insights and new perspectives for a technology-driven reduction in food sources

 Clues and pitfalls for the role of toxic metals in the risk of CHD

CluesReferencesPitfallsReferences
As
Associated with developmental and cardiovascular outcomes in humans[40]Few observational studies conducted[13, 22, 45, 46]
Potential teratogen[39–44]Inconsistent results due to differences in the study design, sample size, and methods of exposure assessment[13, 22, 45, 46]
Significant associations with total CHD and septal defects[22, 45, 46]Lack of information on As levels in food and possibility of recall bias on dietary habits[46]
Cd
Associations with outcomes in the cardiovascular system[84]Few and inconsistent data because of heterogeneity between studies[14, 22, 89]
Association with congenital anomalies and other adverse reproductive outcomes[85–88]
Association observed between co-exposure to Cd and other toxic elements and CHD[90]
Pb
Associated with adverse effects at birth and somewhat with certain subgroups of congenital anomalies[107, 108]Heterogeneity among studies due to different measurement sources[22]
Small sample size of studies[109]
Hg
Evidence for an association birth outcomes[132–135]Few studies performed with conflicting results[13, 22]
Association with NTD in human and animal studies[41, 136–139]
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