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Background:

In utero exposure to heavy metals lead (Pb), mercury (Hg), and cadmium (Cd) may be associated with higher childhood blood pressure (BP), whereas trace elements selenium (Se) and manganese (Mn) may have protective antioxidant effects that modify metal-BP associations.

Objectives:

We examined the individual and joint effects of in utero exposure to Pb, Hg, Cd, Se, and Mn on childhood BP.

Methods:

We used data from the Boston Birth Cohort (enrolled 2002–2013). We measured heavy metals and trace elements in maternal red blood cells collected 24–72 h after delivery. We calculated child BP percentile per the 2017 American Academy of Pediatrics Clinical Practice Guideline. We used linear regression models to estimate the association of each metal, and Bayesian kernel machine regression (BKMR) to examine metal coexposures, with child BP between 3 to 15 years of age.

Results:

Our analytic sample comprised 1,194 mother-infant pairs (61% non-Hispanic Black, 20% Hispanic). Hg and Pb were not associated with child systolic BP (SBP). Se and Mn were inversely associated with child SBP percentiles, which, on average, were 6.23 points lower with a doubling of Se (95% CI: $-11.51$, $-0.96$) and 2.62 points lower with a doubling of Mn (95% CI: $-5.20$, $-0.04$). BKMR models showed similar results. Although Cd was not associated with child SBP overall, the inverse association between Mn and child SBP was stronger at higher levels of Cd ($p\text{-interaction}=0.04$). Consistent with this finding, in utero exposure to cigarette smoke modified the Mn–child SBP association. Among children whose mothers smoked during pregnancy, a doubling of Mn was associated with a 10.09-point reduction in SBP percentile (95% CI: $-18.03$, $-2.15$), compared with a 1.49-point reduction (95% CI: $-4.21$, 1.24) in children whose mothers did not smoke during pregnancy ($p\text{-interaction}=0.08$).

Conclusion:

Se and Mn concentrations in maternal red blood cells collected 24–72 h after delivery were associated with lower child SBP at 3 to 15 years of age. There was an interaction between Mn and Cd on child SBP, whereby the protective association of Mn on child SBP was stronger among mothers who had higher Cd. The association of Mn and child SBP was also modified by maternal cigarette smoking—a source of Cd—during pregnancy. Optimizing in utero Se levels, as well as Mn levels in women who had high Cd or smoked during pregnancy, may protect offspring from developing high BP during childhood. https://doi.org/10.1289/EHP8325