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Trimester-specific prenatal heavy metal exposures and sex-specific postpartum size and growth



There has been limited research considering the effects of prenatal exposure to multiple heavy metals on early childhood size and growth.


We evaluated prenatal exposures to 15 heavy metals in association with measures of weight, length, and head circumference (HC) measured at birth, and 1, 3 and 6 months of age in a study of 358 mother-child pairs.


Urinary concentrations were measured in the first and third trimesters of pregnancy and examined, using sex-stratified general linear models, in association with average standardized size and changes in size (growth) over the first 6 months of life. Confounding effects among metals were explored.


Increased first trimester Hg and V were associated with decreased average HC among males and weight among females, respectively. Increased first trimester V was associated with a decline in weight among females over time. Increased third trimester Cs, Rb and Tl were associated with increased average weight and HC among males. Increased third trimester Se was associated with increased HC among females over time. Evidence for confounding was observed between Cs, Rb and Tl in association with weight and HC.


We observed multiple biologically plausible associations between prenatal heavy metal exposures and postnatal size and growth.


We have taken a comprehensive and novel approach to evaluating the impacts of prenatal heavy metal exposures on size and growth during early childhood. Our detailed analyses consider exposures to 15 different heavy metals at two time points during pregnancy, as well as multiple metrics of size and growth collected at birth and 1, 3 and 6 months of age.

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Access to data and code will require approval by the Guangdong Province Hospital for Occupational Disease Prevention and Treatment and the Chinese Center for Disease Control and Prevention. Contact the corresponding author for further details.


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National Institute of Environmental Health Sciences, National Institutes of Health (R01ES025796); National Natural Science Foundation of China (No. 81972990, LLiu); Guangdong Provincial Science and Technology Plan (2017B030314152, JC).

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Authors and Affiliations



LY, LLiu, JC, XS, SS and PB were responsible for the overall design of the study. LLiu, MD, JY and ZZ were responsible for generating heavy metal measurements. LLv, ZW, JW and XS oversaw participant recruitment and data and biospecimen collection. LLiu conducted all data analyses with oversight by LY and SS. LY, LLiu, SS and PB contributed to writing the report. All authors provided feedback on the report.

Corresponding author

Correspondence to Parveen Bhatti.

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The authors declare no competing interests.

Ethical approval

The study was approved by the ethical committee of the Chinese Center for Disease Control and Prevention.

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Yao, L., Liu, L., Dong, M. et al. Trimester-specific prenatal heavy metal exposures and sex-specific postpartum size and growth. J Expo Sci Environ Epidemiol (2022).

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  • Child exposure/health
  • Metals
  • Children’s health
  • Early life exposure
  • Vulnerable populations


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