Comparison between the Effects of Maternal Exposure to Natural Fibers and Synthetic Fibers Used In Textiles Industry on Pregnancy Outcomes

INTRODUCTION

Textile manufacturing is one of the world's oldest industries. It's as ancient as civilization itself, and it's becoming bigger every day. Textile goods, like food, are a basic human necessity. For developed nations, the textile chain from seed cotton to cotton-based textile and garment manufacturers is particularly important.. ¹

After farming, the textile is the 2nd largest industry, in terms of number of workers are employed in the industry. In textile industry is classified into 3 sectors: spinning, weaving and finishing. In textile industry there is lot of safety and health problems involved. ²

Because of the diversity of substrates, methods, gear, and materials employed, as well as the finishing procedures conducted, the textile production business is among the most valuable and technically advanced of all industries..³

Textile workers are subjected to a variety of dangers, including physical, chemical, and biological hazards, as well as psychosocial risks such as mental depression and mental instability. ⁴

 According to a research, the most common work - related risks in the textile sector is lungs illness, which is influenced by reproductive organs disorders, noise-induced loss of hearing, heart-related and vision-related diseases, neurotoxicity and other dermal issues, and mental stress.. ⁵

Workers in the textile manufacturing are exposed to a variety of dangers, like noise, chemicals such as dyes, solvents, optical brighteners, finishing additives, and multiple forms of organic and artificial fiber dusts that are harmful to their health, and airborne particles that are harmful to their health.

Regardless of natural or synthetic origin, there is a wide use of chemicals involved already in the production of textile fibers. The textile industry in turn, applies extensive use of chemicals in subsequent processes to manufacture the textile materials, e.g. pretreatment, dyeing, printing, finishing, and coating, as well as washing and drying. ⁶

Phthalates are used to increase flexibility and durability of polyvinylchloride (PVC)-based textile coating used to generate patterns and prints on textiles. ⁷ Several of these chemicals have been related to reproductive toxicity. Textiles are also treated with flame retardants to inhibit ignition. Polybrominateddiphenyl ethers (PBDEs) are used as flame retardants, but19 are persistent environmental pollutants. ⁸

Furthermore, surfactants, such as nonylphenolethoxylates, and biocides, for instance triclosan, are widely used in textile materials. The former are toxic to aquatic life, while the latter has been associated to endocrine disruption. ⁹

Some toxins, such as methylmercury, will ultimately reach levels in the umbilical cord that are higher than those in the mother's blood. In several situations, concentrations of bisphenol A in fetus plasma are greater than in mother's blood, and the rate of clearing of bisphenol A from the blood is slower in fetuses because of enzymes needed to remove it do not appear till after delivery.¹⁰

The study's goal was to compare between the effect of maternal exposure to natural fibers and synthetic fibers used in textiles industry among women textile workers, on pregnancy outcome, at Misr Spinning and Weaving Company in El Mahalla El Kubra and Tanta, Egypt.

PATIENTS AND METHODS

The study deals with, comparison between maternal exposure and its consequences to natural fibers and synthetic fibers used in textiles industry on pregnancy outcomes conducted in Corporation with the Egyptian Ministry of Health, at Textile factories in Al-Mahalah Al-Kubra and Tanta, and Faculty of Medicine, Al-Azhar University (Damietta) during the period from February 2021 to February 2022.

 A cohort prospective study conducted to investigate the current topic, through the following phases:

Preparatory phase:

During this phase the following steps were done:

Survey of literature: A review of literature was conducted to help in understanding comparison between the effect of maternal exposure to natural fibers and synthetic fibers used in textiles industry on pregnancy outcomes that would help to design and prepare the research questionnaire.    

This reviewof literature was implicated to cover the following subjects: Maternal exposure and its consequences to natural fibers in textiles industry on pregnancy outcomes, Maternal exposure and its consequences to synthetic fibers in textiles industry on pregnancy outcomes and the comparison between both of the above topic.

This survey of literature was based on: The periodical medical journals as British medical journal, some sites from internet such as Goggle, world Health Organization Ministry of Health and Population in Egypt, some text books and some previous researches (national and international).

This study was a cohort prospective study among fifty pregnant women will be included and classified into two groups:Group I (Exposed group): Include 25 pregnant women working at Misr Spinning and Weaving Company in Al-Mahalla Al-Kubra and Tanta. Group II (Non-exposed, Control group): Included 25 pregnant women work in non- textile polluted area.

This study was conducted on pregnant females with the following characteristics: Inclusion criteria: Women textile workers, in Al-Mahalla Al-Kubra, Egypt have a history of at Least 2 years of indoor-exposure to occupational pollution during pregnancy, She works eight hours each day, 5 days each week (fourty hours per week),singleton intrauterine gestation, at 20-40 years old. But exclusion criteria:

Presence of consanguinity, multiple pregnancies, 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 and history of drug medication intake during present pregnancy.

A non-probability (convenient) sample technique will be done to investigate the study. All study subjects matching the inclusion criteria was recruited to participate in this study after take the informed consent until the total target sample size is reached.

The following was done to each participant: history taking, general and local examination and ultrasound will be carried out at first, second and third trimesters.

First‐trimester ultrasound scan: It was performed at (11–14eeks): Fetal viability was assessed; fetal crown rump length was measured and anatomical survey.

Second and third trimester ultrasound scans: Fetal anomaly scans 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) performed between 24 –30 weeks of gestation

We were study the potential effect of maternal indoor exposure to textile industry in pregnancy and the frequency outcome variables among our two groups which were include the following: abortion, low birth weight (>2500 g), foetal macrosomia (>4000 g), tiny for stage of pregnancy (less than the sex-specific 10%ile), premature birth (>37 weeks' gestation), extremely premature delivery (>32 weeks'gestation), cesarean section, neonatal mortality (within the first year), Our two groups were analysed in terms of obstetric difficulties, neonatal sickness, and perinatal mortality. Any obstetrics problems were characterised as having several of the following conditions: Pre-eclampsia, prenatal diabetes mellitus, pregnancy-induced high blood pressure, pre-labor rupture of membranes of >24 hours, threatening preterm labour, and postpartum haemorrhage and third-degree tear.

Implementation phase: During this phase the following step were done: Data collection: The data were collected through (50) visits. The researcher carries out three visits / week. The methods used for data collection through the clinical and laboratory investigations lasted about (10) minute for each one. After taking a formal consent from each participant, assuring confidentiality of the study results, all participants were interviewed to fulfill clinical examination.

Evaluation Phase (Data management phase): During this phase the following activities were done.

Ethical consideration: Consent: Informed consent was taken from all patients and includes:The aim of research and what steps was done.All data was confidential.All data was used in research only and an identified person to whom the relatives were return to at any time for explanations.

Data entry and analysis: Statistical analysis of data was performed including coding, data entering and sorting by Microsoft office 2010 and statistical analysis program IBM Statistical package for social studies (SPSS) version 16.

RESULTS

S*: P

CD: standard deviation, BMI; body mass index

Table 1: Socio- demographic data of the studied groups

Table (1) showed that there is 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 (8.3±0.6) years; (20 %) exposed between 2 and 6 years; (44 %) exposed between 6 and 10 years and (36%) exposed more than 10 years.

*: P

CD: standard deviation,  CS; cesarean section

Table 2: Obstetric data of the studied groups

Table (2) showed that longer maternal hospital stay was significantly associated with case group (34.8±9.1 hour) when compared to control group (27.9±6.3 hour). Otherwise, no significant differences were found regarding gravidity, and delivery mode between studied groups.

*: P

PIH, Pregnancy induced hypertension; TLBW, Term Low birth weight; SGA; Small for gestational age; IUGR; intrauterine growth retardation 

Table 3: Maternal and neonatal outcomes of the studied groups

Table (3) showed that PIH was recorded as outcome in (8%) of pregnancies exposed to Natural fibers versus (23%) pregnancies exposed to Synthetic fibers in contrast to (4%) in the control group.  Only 8% of pregnancies exposed to synthetic fibers ended in miscarriage, compared to no statistically important increases in risks for women exposed to natural fibres and none among the control group. (16%) of pregnancies exposed to Natural fibers in the case group were terminated preterm versus (35%) pregnancies exposed to Synthetic fibers in the case group in contrast to (8%) of controls. (16%) of pregnancies exposed to Natural fibers yielded LBW babies at their term, versus (25%) pregnancies exposed to Synthetic fibers compared to (4%) of the control group. It was also noticed that there was marked improvement in neonatal outcome in group exposed to natural fibers in comparison to synthetic fibers group.

Fig. 1: Trans vaginal Ultrasound of atrio ventricular septal defect at gestational age 17 week

*: P

OR, odds ratio; CI, confidence interval; BMI; body mass index

Table 4: Univar-able regression analysis for prediction of abnormal pregnancy outcome

Table (4) showed that the most potent variables that were linked to a significantly higher chances of having an abnormal pregnancy outcome in uni variable analysis, were younger maternal age; OR 0.832 (95% CI, 0.812-0.902), gestational age OR 0.315 (95% CI, 0.228-0.427), textile exposure OR 1.469 (95% CI, 1.263-1.721) and more evidently longer duration of textile exposure OR 0.847 (95% CI, 0.822-0.967).