Combined effects of multiple prenatal exposure to pollutants on birth weight: The Mothers and Children's Environmental Health (MOCEH) study

Abstract

Background: Increasing evidence shows that prenatal environmental exposures is a risk factor for restricted intrauterine growth. However, only a few studies have examined the effects of multiple environmental exposures on fetal growth. Objective: To investigate the effects of prenatal exposure on multiple environmental pollutants (heavy metals, bisphenol, phthalates, and air pollutants) on birth weight. Methods: The Mothers and Children's Environmental Health study is a prospective birth cohort comprising a total of 719 mother-child pairs, including 466 pairs undergoing early pregnancy exposure and 542 pairs of late pregnancy exposure. The concentrations of three heavy metals (mercury, lead, and cadmium) in the maternal blood samples were measured. The concentrations of three phthalate metabolites [mono(2-ethyl-5-hydroxyhexyl) phthalate, mono(2-ethyl-5-oxohexyl) phthalate, and mono-n-butyl phthalate] and bisphenol A in maternal urine samples were measured. Daily exposure to ambient particulate matter (PM10) and nitrogen dioxide (NO2) exposure was estimated based on residence and averaged by gestational age. To assess the combined effect of multiple pollutants, principal components analysis (PCA) and supervised principal components analysis (SCPA) were conducted. Results: Based on PCA, the components representing PM10 and NO2 exposure during early pregnancy were significantly associated with birth weight of -32.68 g (95% CI: -64.45 g to -0.91 g) per unit increase of the corresponding component. In SCPA model, the components representing NO2 exposure during early pregnancy and the combined exposure to mercury and lead during late pregnancy were negatively associated with birth weight of - 46.63 g (95% CI: -90.65 g to - 2.62 g) and - 55.32 g (95% CI: -99.01 g to -11.64 g), respectively, per unit increase of the corresponding component. Conclusion: Based on our multi-pollutant model, PM10 and NO2 exposure in early pregnancy and the combined effect of Pb and Hg in late pregnancy were associated with reduced birth weight. Our results suggest that exposure to various pollutants during pregnancy has a significant cumulative effect on birth weight, even if each pollutant is at a level below the concentration required for direct effect.