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Multiple-element exposure in early pregnancy and birth defects: a nested case-control study based on the China birth
Weichunbai Zhang1, Jianming Zhang2, Jing Du3
1NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China.
Frontiers in Nutrition
|March 25, 2026
Summary
High levels of certain elements like nickel and zinc in early pregnancy may reduce birth defect risks. This study highlights the protective association of specific element mixtures during the first trimester.
Area of Science:
- Environmental Health
- Toxicology
- Reproductive Health
Background:
- Birth defects are a leading cause of child mortality, imposing significant societal and familial burdens.
- Environmental factors are implicated in fetal development, yet prospective studies on early-trimester multi-element exposure are scarce.
Purpose of the Study:
- To investigate the relationship between first-trimester multi-element exposure and the risk of birth defects.
- To assess the impact of specific elements and their mixtures on fetal development.
Main Methods:
- A case-control study involving 271 cases and 542 matched controls.
- Measurement of 17 elements in first-trimester maternal urine samples.
- Application of conditional logistic regression and Bayesian Kernel Machine Regression (BKMR) models.
Main Results:
- Aluminum (Al), chromium (Cr), manganese (Mn), iron (Fe), nickel (Ni), and zinc (Zn) showed negative associations with total birth defects.
- Nickel (Ni) and zinc (Zn) exhibited dose-response relationships with birth defect risk.
- High levels of the element mixture (above the 50th percentile) were significantly associated with reduced birth defects, with notable interactions between Ni and other elements.
Conclusions:
- A mixture of high Al, Cr, Mn, Fe, Ni, and Zn levels in first-trimester urine is linked to a reduction in total birth defects.
- Nickel (Ni) and zinc (Zn) warrant particular attention regarding their influence on birth defect outcomes.
