Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
Environ Int. 2022 Apr;162:107161. doi: 10.1016/j.envint.2022.107161. Epub 2022 Feb 24.
Exposure to some conventional trace elements has been found to be associated with miscarriage; however, evidence for combined exposure is inconclusive. Therefore, it is important to explore the joint associations between toxic and essential trace elements and miscarriage.
This cross-sectional study measured a wide range of element levels in the whole blood of pregnant women by using inductively coupled plasma mass spectrometry. The associations between individual elements and miscarriage were appraised using logistic regression model. Multi-exposure models, including Bayesian kernel machine regression (BKMR) and weighted quantile sum regression (WQS), were used to explore the mixed exposure to elements. Furthermore, grouped weighted quantile sum (GWQS) considered multiple elements with different magnitudes and directions of associations.
In logistic regression, the odds ratios (ORs) with a 95% confidence interval (CI) in the highest quartiles were 5.45 (2.00, 15.91) for barium, 0.28 (0.09, 0.76) for copper, and 0.32 (0.12, 0.83) for rubidium. These exposure-outcome associations were confirmed and supplemented by BKMR, which indicated a positive association for barium and negative associations for copper and rubidium. In WQS, a positive association was found between mixed elements and miscarriage (OR: 1.71; 95% CI: 1.07, 2.78), in which barium (75.7%) was the highest weighted element. The results of GWQS showed that the toxic trace element group dominated by barium was significantly associated with increased ORs (OR: 2.71; 95% CI: 1.74, 4.38). Additionally, a negative association was observed between the essential trace element group and miscarriage (OR: 0.32; 95% CI: 0.18, 0.54), with rubidium contributing the most to the result.
As a toxic trace element, barium was positively associated with miscarriage both by individual and multiple evaluations, while essential trace elements, particularly rubidium and copper, exhibited negative associations. Our findings provide significant evidence for exploring the effects of trace elements on miscarriage.
一些常规微量元素的暴露已被发现与流产有关，但关于联合暴露的证据尚无定论。因此，探索有毒微量元素和必需微量元素与流产之间的联合关系非常重要。
本横断面研究采用电感耦合等离子体质谱法检测孕妇全血中多种元素的水平。使用逻辑回归模型评估单个元素与流产之间的关系。采用贝叶斯核机器回归（BKMR）和加权分位数总和回归（WQS）多暴露模型探讨元素的混合暴露。此外，分组加权分位数总和（GWQS）考虑了具有不同大小和方向关联的多个元素。
在逻辑回归中，最高四分位组的比值比（OR）及其 95%置信区间（CI）分别为钡的 5.45（2.00，15.91）、铜的 0.28（0.09，0.76）和铷的 0.32（0.12，0.83）。BKMR 证实并补充了这些暴露-结局关联，表明钡呈正相关，铜和铷呈负相关。在 WQS 中，混合元素与流产之间存在正相关（OR：1.71；95%CI：1.07，2.78），其中钡（75.7%）是权重最高的元素。GWQS 的结果表明，以钡为主的有毒微量元素组与增加的 OR 显著相关（OR：2.71；95%CI：1.74，4.38）。此外，必需微量元素组与流产呈负相关（OR：0.32；95%CI：0.18，0.54），其中铷对结果的贡献最大。
作为一种有毒微量元素，钡无论是个体评估还是多因素评估，均与流产呈正相关，而必需微量元素，特别是铷和铜，与流产呈负相关。我们的研究结果为探索微量元素对流产的影响提供了重要证据。
