Prevalence and Multi-Domain Determinants of Elevated Blood Lead Levels Among Pregnant Women in Bangladesh: Evidence from the 2025 Multiple Indicator Cluster Survey
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
Abstract
BackgroundLead is a cumulative environmental toxicant for which no safe level of exposure has been identified, and pregnant women and their fetuses are particularly vulnerable because lead readily crosses the placenta and can be mobilised from maternal bone stores. Bangladesh conducted its first nationally representative blood lead testing among pregnant women through the 2025 Multiple Indicator Cluster Survey (MICS), but a detailed, multi-domain analysis of the determinants of elevated blood lead level (BLL) among this population has not yet been reported.
MethodsWe conducted a secondary cross-sectional analysis of 1,928 pregnant women aged 15- 49 years with complete data from the womens dataset of Bangladesh MICS 2025. Elevated BLL was defined as [≥]5 g/dL. Survey-weighted logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) for co-exposure to arsenic, cadmium and mercury and sociodemographic and socioeconomic covariates. Slope Index of Inequality (SII) as well as Relative Index of Inequality (RII) were used to quantify wealth-related inequality. Population attributable fractions (PAF) were estimated for three counterfactual scenarios, and adaptive least absolute shrinkage and selection operator (LASSO) regression was used as a sensitivity analysis.
ResultsElevated BLL was present among 6.2% of participants. In the adjusted model, a 2-fold rise in blood cadmium was associated with higher odds of elevated BLL (aOR: 1.54; 95% CI: 1.21-1.96), whereas a 2-fold rise in blood mercury (aOR: 0.63; 95% CI: 0.48-0.83), rural residence (aOR: 0.55; 95% CI: 0.32-0.94), secondary education (aOR: 0.49; 95% CI: 0.28-0.85) and post-secondary education (aOR: 0.22; 95% CI: 0.11-0.46) were associated with lower odds. Belonging to progressively wealthier quintiles was associated with markedly higher odds, BLL rising to an aOR of 10.32 (95% CI: 4.41-24.15) for the richest versus poorest quintile. The RII was 8.59 (95% CI: 4.24-17.40) and the SII was 0.159 (95% CI: 0.101-0.218), indicating a substantial pro-rich gradient in elevated BLL. Counterfactual scenarios suggested that shifting the population to secondary-level education could reduce the prevalence of elevated BLL by 52.9% (95% CI: 20.6-72.0) and shifting to rural residence by 24.3% (95% CI: 1.4-41.9). Adaptive LASSO variable selection produced estimates consistent in direction and magnitude with the fully adjusted model.
ConclusionIn this national sample, approximately one out of every 16 pregnant women had blood lead levels that met or exceeded the action threshold set by the World Health Organization, with this issue being particularly prevalent among wealthier, urban, and less-educated women, and was compounded by co-exposure to cadmium. In Bangladesh, the typical pattern observed for maternal and child health indicators does not align with the inverse relationship found between household wealth and lead exposure. This suggests that the sources of exposure are not merely indicators of material poverty. Antenatal blood lead screening, source investigation, and equity-informed lead-reduction strategies that specifically reach wealthier and urban households are warranted.
Related
- Knowledge of gestational diabetes mellitus and its sociodemographic determinants among pregnant women in Bangladesh: a nationwide facility-based cross-sectional study.
- Blood lead and other metals among pregnant women in Bangladesh: national prevalence, geographic variation and household child exposure
- Prevalence and determinants of hepatitis B vaccination uptake among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis
- Socioeconomic determinants of elevated blood lead among children aged 12-59 months in Bangladesh: a nationally representative survey
- National Prevalence and Determinants of Concurrent Wasting and Stunting among Under-Five Children in Yemen: Evidence from the 2022-2023 Multiple Indicator Cluster Survey
BibTeX
@misc{bashar2026prevalence,
title = {{Prevalence and Multi-Domain Determinants of Elevated Blood Lead Levels Among Pregnant Women in Bangladesh: Evidence from the 2025 Multiple Indicator Cluster Survey}},
author = {S. J. J. Bashar and M. F. Al Fidah and M. R. Islam and A. K. Roy and R. Raqib and T. Ahmed and M. Mahfuz},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.12.26365283},
url = {https://www.medrxiv.org/content/10.64898/2026.10.12.26365283v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Prevalence and Multi-Domain Determinants of Elevated Blood Lead Levels Among Pregnant Women in Bangladesh: Evidence from the 2025 Multiple Indicator Cluster Survey
AU - S. J. J. Bashar
AU - M. F. Al Fidah
AU - M. R. Islam
AU - A. K. Roy
AU - R. Raqib
AU - T. Ahmed
AU - M. Mahfuz
PY - 2026
DA - 2026/10/12
PB - medRxiv
DO - 10.64898/2026.10.12.26365283
UR - https://www.medrxiv.org/content/10.64898/2026.10.12.26365283v1
AB - BackgroundLead is a cumulative environmental toxicant for which no safe level of exposure has been identified, and pregnant women and their fetuses are particularly vulnerable because lead readily crosses the placenta and can be mobilised from maternal bone stores. Bangladesh conducted its first nationally representative blood lead testing among pregnant women through the 2025 Multiple Indicator Cluster Survey (MICS), but a detailed, multi-domain analysis of the determinants of elevated blood lead level (BLL) among this population has not yet been reported. MethodsWe conducted a secondary cross-sectional analysis of 1,928 pregnant women aged 15- 49 years with complete data from the womens dataset of Bangladesh MICS 2025. Elevated BLL was defined as [≥]5 g/dL. Survey-weighted logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) for co-exposure to arsenic, cadmium and mercury and sociodemographic and socioeconomic covariates. Slope Index of Inequality (SII) as well as Relative Index of Inequality (RII) were used to quantify wealth-related inequality. Population attributable fractions (PAF) were estimated for three counterfactual scenarios, and adaptive least absolute shrinkage and selection operator (LASSO) regression was used as a sensitivity analysis. ResultsElevated BLL was present among 6.2% of participants. In the adjusted model, a 2-fold rise in blood cadmium was associated with higher odds of elevated BLL (aOR: 1.54; 95% CI: 1.21-1.96), whereas a 2-fold rise in blood mercury (aOR: 0.63; 95% CI: 0.48-0.83), rural residence (aOR: 0.55; 95% CI: 0.32-0.94), secondary education (aOR: 0.49; 95% CI: 0.28-0.85) and post-secondary education (aOR: 0.22; 95% CI: 0.11-0.46) were associated with lower odds. Belonging to progressively wealthier quintiles was associated with markedly higher odds, BLL rising to an aOR of 10.32 (95% CI: 4.41-24.15) for the richest versus poorest quintile. The RII was 8.59 (95% CI: 4.24-17.40) and the SII was 0.159 (95% CI: 0.101-0.218), indicating a substantial pro-rich gradient in elevated BLL. Counterfactual scenarios suggested that shifting the population to secondary-level education could reduce the prevalence of elevated BLL by 52.9% (95% CI: 20.6-72.0) and shifting to rural residence by 24.3% (95% CI: 1.4-41.9). Adaptive LASSO variable selection produced estimates consistent in direction and magnitude with the fully adjusted model. ConclusionIn this national sample, approximately one out of every 16 pregnant women had blood lead levels that met or exceeded the action threshold set by the World Health Organization, with this issue being particularly prevalent among wealthier, urban, and less-educated women, and was compounded by co-exposure to cadmium. In Bangladesh, the typical pattern observed for maternal and child health indicators does not align with the inverse relationship found between household wealth and lead exposure. This suggests that the sources of exposure are not merely indicators of material poverty. Antenatal blood lead screening, source investigation, and equity-informed lead-reduction strategies that specifically reach wealthier and urban households are warranted.
ER -