环境与职业医学2026，Vol.43Issue(4)：475-484,10.DOI:10.11836/JEOM25403
妊娠早期金属锂、钒、铀、铋混合暴露与孕妇体重增长的关联
Association of mixed exposure to lithium,vanadium,uranium,and bismuth in early pregnancy with gestational weight gain
摘要
Abstract
[Background]Gestational weight gain is closely related to maternal and infant health outcomes.Pregnant women are simultaneously ex-posed to four metals—lithium(Li),vanadium(V),uranium(U),and bismuth(Bi)—through inhalation of fine particulate matter and con-sumption of contaminated food and water.Existing studies suggest that exposure to these metals may be associated with gestational weight gain.However,no study has yet explored the complex relationships between exposure to mixtures of these four metals and weight gain at different stages of pregnancy. [Objective]To investigate the associations between mixed exposure to Li,V,U,and Bi in early pregnancy and the average weekly gestational weight gain during both early pregnancy and mid-to-late pregnancy. [Methods]This prospective study recruited eligible women in early pregnancy from an obstetrics clinic of a tertiary hospital in Jinan,Chi-na,between September 2021 and July 2023.Pre-pregnancy weight,current weight(at 11+0 to 13+6 weeks of gestation),and spot urine samples(≥5.0 mL)were collected at enrollment.Urinary concentrations of Li,V,Bi,and U were determined using inductively coupled plasma mass spectrometry.Participants were followed up in late pregnancy(≥28 weeks of gestation)to collect information on physical activity via questionnaire;weight measurements at the last antenatal visit(35+0 to 37+6 weeks of gestation)were obtained from the hospital information system.After adjusting for covariates,multiple linear regression and generalized additive models were used to assess the as-sociations of individual metals with weekly weight gain in early pregnancy and in mid-to-late pregnancy.Bayesian kernel machine regression(BKMR)and quantile-based g-computation(Qgcomp)were applied to evaluate the joint effects of the metal mixture exposure on weekly weight gain at the two gestational stages. [Results]A total of 313 pregnant women were included.The geometric means of urinary Li,V,U,and Bi concentrations were 37.07,0.20,0.06,and 0.04 μg·L-1,respectively;after creatinine adjustment,the corresponding values were 46.82,0.25,0.07,and 0.05 μg·g-1(Cr).The mean weekly gestational weight gain was(0.19±0.25)kg in early pregnancy and(0.53±0.18)kg in mid-to-late pregnancy.Both multiple linear regression and generalized additive models showed that urinary V concentration was positively associated with average weekly gestational weight gain in early pregnancy,while no significant associations were found for other metals or for gestational weight gain in mid-to-late pregnancy.In the BKMR model with early-pregnancy weight gain as the outcome,V had the strongest association[posterior inclusion probability(PIP)=0.773].When other metals were fixed at their medians,V showed a positive non-linear association with the outcome.A significant single-metal effect of V and its interaction with Li were observed.Compared with the 50th percentile of the metal mixture,the average weekly weight gain in early pregnancy increased by 0.016(95％CI:0.003,0.029)and 0.018(95％CI:0.001,0.036)at the 60th and 65th percentiles,respectively;conversely,at the 25th percentile,it decreased by 0.026(95％CI:0.002,0.050).Overall,the joint effect of the metal mixture on early-pregnancy weight gain showed an upward trend.In the BKMR model for mid-to-late pregnancy gestational weight gain,all PIPs were<0.5,and no significant single-metal effects,interactions,or joint effects were identified.Qgcomp results confirmed a positive association between the metal mixture and early-pregnancy weight gain(b=0.031,95％CI:0.010,0.051;P<0.01),with V contributing the highest positive weight(0.71).No significant association was found for weight gain in mid-to-late preg-nancy(b=0.007,P=0.339). [Conclusion]Higher levels of co-exposure to the Li,V,Bi,and U metal mixture during early pregnancy may be associated with increased average weekly weight gain in early pregnancy.Among these metals,V exhibits a predominant role and appears to interact with Li.No association is observed between early-pregnancy metal mixture exposure and average weekly gestational weight gain in mid-to-late pregnancy.These findings suggest that monitoring and managing metal exposure during early pregnancy may be crucial for the rational regulation of gestational weight gain.关键词
金属混合暴露/贝叶斯核机器回归/基于分位数的g计算法/孕期/体重Key words
metal mixture/Bayesian kernel machine regression/quantile-based g-computation/pregnancy/weight分类
医药卫生引用本文复制引用
李娇,李琪,程爽,宋佳艺,郭晓慧,王翔,程迪,樊克锋,王菊..妊娠早期金属锂、钒、铀、铋混合暴露与孕妇体重增长的关联[J].环境与职业医学,2026,43(4):475-484,10.基金项目
山东省自然科学基金项目(ZR2024QH118),国家自然科学基金项目(82003416) （ZR2024QH118）
