Ruiz Patricia, Cheng Po-Yung, Desai Siddhi, Shin Mikyong, Jarrett Jeffery M, Ward Cynthia D, Shim Youn K
Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA.
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA.
J Xenobiot. 2025 Mar 1;15(2):38. doi: 10.3390/jox15020038.
Although exposure to metals remains a public health concern, few studies have examined exposure to combinations of metals. This study characterized prevalent combinations of cadmium (Cd), mercury (Hg), and lead (Pb) in women (n = 10,152; aged 20-44 years) who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2018. To explore relative metal exposures within this population, Cd, Hg, and Pb blood levels were dichotomized as "high" and "low" categories using median values to represent the center of the metal concentrations in the study population, not thresholds for adverse health effects. The prevalence of the three metal combinations at "high" levels (singular, binary, tertiary combinations) was calculated. Multinomial logistic regression was used to calculate odds ratios for each combination relative to none of these combinations after adjusting for potential confounders. Among the pregnant women (n = 1297), singular Hg was most prevalent (19.2% [95% CI 15.0-23.3]), followed by singular Cd (14.7% [95% CI 11.2-18.2]), tertiary combination Cd/Hg/Pb (11.0% [95% CI 8.7-13.2]), binary combinations Cd/Pb (9.8% [95% CI 7.4-12.2]), Hg/Pb (9.2% [95% CI 6.5-11.8]), Cd/Hg (7.8% [95% CI 6.0-9.6]), and singular Pb (5.5% [95% CI 4.1-6.9]). We found significantly lower odds of having Cd/Hg/Pb (adjusted odds ratio (adjOR) = 0.49: < 0.001) and Cd/Pb (adjOR = 0.68: < 0.0364) combinations among pregnant women compared to non-pregnant women. The odds of having higher levels of singular Pb were significantly lower (adjOR = 0.31: < 0.0001) in women pregnant in their first and second trimesters (n = 563) than in non-pregnant women (n = 6412), whereas, though nonsignificant, the odds were higher for women pregnant in their third trimester (n = 366) (adjOR = 1.25: = 0.4715). These results indicate the possibility that the fetus might be exposed to higher levels of the metal mixtures due to placental transfer, particularly to Pb, during the early stages of pregnancy. Further research is warranted to understand the relationship between metal combination exposures during pregnancy and maternal and infant health.
尽管接触金属仍然是一个公共卫生问题，但很少有研究考察金属组合的接触情况。本研究对参与1999 - 2018年美国国家健康与营养检查调查（NHANES）的10152名20 - 44岁女性中镉（Cd）、汞（Hg）和铅（Pb）的常见组合进行了特征分析。为了探究该人群中相对的金属暴露情况，将Cd、Hg和Pb的血铅水平分为“高”和“低”两类，使用中位数来代表研究人群中金属浓度的中心值，而非不良健康影响的阈值。计算了三种金属组合处于“高”水平（单一、二元、三元组合）的患病率。在调整潜在混杂因素后，使用多项逻辑回归计算每种组合相对于无这些组合的比值比。在1297名孕妇中，单一Hg最为常见（19.2% [95% CI 15.0 - 23.3]），其次是单一Cd（14.7% [95% CI 11.2 - 18.2]）、三元组合Cd/Hg/Pb（11.0% [95% CI 8.7 - 13.2]）、二元组合Cd/Pb（9.8% [95% CI 7.4 - 12.2]）、Hg/Pb（9.2% [95% CI 6.5 - 11.8]）、Cd/Hg（7.8% [95% CI 6.0 - 9.6]）以及单一Pb（5.5% [95% CI 4.1 - 6.9]）。我们发现，与非孕妇相比，孕妇中Cd/Hg/Pb（调整后的比值比（adjOR） = 0.49: ＜0.001）和Cd/Pb（adjOR = 0.68: ＜0.0364）组合的几率显著更低。孕早期和孕中期（n = 563）的孕妇中单一Pb水平较高的几率显著低于非孕妇（n = 6412）（adjOR = 0.31: ＜0.0001），而孕晚期（n = 366）孕妇的几率虽无显著差异，但更高（adjOR = 1.25: = 0.4715）。这些结果表明，由于胎盘转运，胎儿在怀孕早期可能接触到更高水平的金属混合物，尤其是铅。有必要进一步研究以了解孕期金属组合暴露与母婴健康之间的关系。
