Long Term Risks to Neonatal Health from Exposure to

Overview

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Key numbers

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1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to
unexplored. Meanwhile exposures to metal delivering weaponry have been and are extensive (24–28),
25% of births of the Gaza Strip. Catchment areas were the Gaza governorate (66% in 2011, and 72% in
less than 0.25% in other areas of the Strip of Gaza. Stability of residence since 2014 was also recorded.
of items from rubble. All analyses were restricted to singleton births (twin births were less than 2%).
Descriptive data of the register in 2018–2019 are reported in Table 1 for each outcome at birth
from this Table, because they had less than 0.5% prevalence in the whole cohort—maternal cigarette or
omitted since it was used by about 100% in each group of outcomes.
Notes: Table 1 Descriptive data of the register 2018–2019. N = number of subjects; % = percentages calculated on
Table 2 shows that the most substantial increase in the prevalence of P, LBW and BD outcomes
Supplementary File 2, Table S1 shows the result of the logistic regression analysis, evaluating
the association of the features in Table 1 with the type of birth outcome. Low weight at birth (LBW),
for LBW by multivariable logistic regression analysis (Table 3).
Table 2. Prevalence of outcomes at birth in the years 2011, 2016 and 2018–2019.
than 28 weeks gestation.* Total live born = 4765, ** total delivered babies = 4830.
of the BD were sporadic and new events. By multivariable logistic regression analysis (Table 3) only
were validated by multivariable logistic regression analysis (Table 3). Univariable and multivariable
analyses were conducted on singletons. Twins represented less than 3% in each year and none of them
Table 3. Association between singleton babies with birth defects, preterm and of low birth weight at
OR = Odds Ratio; 95%CI: 95% confidence intervals. * Forward selection. Only predictors with at least 10 observation
4–5 months. The metals shown in Tables 4 and 5 include 12 of the 23 tested for, and include those
2015 and 2016. The cohort for which metal analysis was done in 2015 was of 502 women (93% mothers
of normal babies, 4% of BD, 3% of preterm; 68% of them were exposed to attacks and related events);
in 2016 the cohort included 78 women (34.6% mothers of normal babies, 33.3% of BD and 32% of
tested (27% mothers of normal babies, 37% BD and 36% preterm; 45% of them exposed to attacks and
related events). Table 4 shows the comparison of the 95th percentile values in ppm of metal load in the
values of the load in metals in the cohorts of mothers (in Table 5) shows a trend of increase in time for
Table 4. Together, they point to high contamination of the environment by heavy metals war-remnants
Table 4. 95th percentile values of metal concentration in ppm in the hair of Gaza mothers at delivery and in reference cohort outside war areas.
Metal N 95th pct 95% CI N 95th pct 95% CI N 95th pct 95% CI * Ref.
N, number of tested samples. 95th pct = 95th percentile; 95%CI: 95% confidence intervals of 95th pct. Ref. = Reference values. * For the 2018–2019 estimates, the upper confidence limit
Table 5. Comparison of the median metal concentration in hair of the cohort of mothers by period.
tested for metal contaminants included in 2015 68% of women that recalled exposure to the 2014
attacks; in the 2016 cohort 40% of women recalled exposure to attacks and in 2018 these were 44%.
photographically documented and 88% of the women in 2018–2019 had remained since these attacks in
and median values are shown in Tables 4 and 5, varied over the years—in 2015 the cohort included
a lesser percentage of BD and preterm (total 7%) than in 2016 (total 65.3% BD and preterm) and in
births with the mother’s recall of exposures to attacks in 2014, stable residence since in the same
than 50% in 2016 to 9% in 2018–2019. Thus, the only environmental associations found for birth defect
had no association with negative outcomes in 2016 and were always in the range of values of reference
About 50% of perinatal deaths in Gaza are due to preterm birth and BD; the rise of prevalence
from a total of 2.2 % in 2011 to 9.5% since 2016, and ongoing, of babies born with these conditions

Methods (brief)

By ICP/MS analysis we determined the content of 23 metals in mothers’ hair. Appropriate statistical
were not well documented and followed up. Since 200, we collected a number of environmental clues
utero to newborns after a mother’s exposure to attacks (22). We collected retrospective evidence of
sample collection has been described before (29,30).
a doctor, in 2016, 2017 and 2018–2019. Data were collected uninterruptedly (24/24 hours and 7/7 days)
2.4. Hair Samples and Metal Load Determination
baby, 23 with BD and 24 with a preterm baby, born in sequence, as much as possible (some samples
same as with previous tastings, using ICP/MS, in 3 runs and with the same protocol for analysis as
a reference (44). We have analyzed a subgroup of the hair collected from women at delivery. In 2015
we could analyze a larger number of samples, while in 2016 and 2018–2019 we analyzed a similar
number of hairs collected sequentially from mothers with normal, BD or preterm babies, being unable
comparison of data collected at different times. The prevalence of low birth at term, preterm and
insufficient sample size.
We analyzed for heavy metal content the hair collected at delivery from mothers each year.
load higher in Gaza than that of the reference sample outside war areas. The comparison of the median
N, number of tested samples. 95th pct = 95th percentile; 95%CI: 95% confidence intervals of 95th pct. Ref. = Reference values. * For the 2018–2019 estimates, the upper confidence limit
held at maximum of sample due to the small sample size. Highlighted in blue, are the values significantly higher than those in the reference samples from area not involved in military
the lack of energy for cryopreservation of the needed fresh bioptic samples, and of supplies for the

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Update history

The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.

Commit	Date	Change	Description
b01ec52c	2026-08-04	major	2 sections added
d49e450f	2026-08-03	major	5 sections added; narrative text revised