ArticleEnvironmental research2021
Performance of urine, blood, and integrated metal biomarkers in relation to birth outcomes in a mixture setting.
Article in Environmental research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Prenatal metal(loid) exposure and preterm birth: a systematic review of the epidemiologic evidence.Journal of exposure science & environmental epidemiology · 2025Pooled it
- Evaluation of integrated, multimedia biomarkers of prenatal metals exposure in association with child neurodevelopment in Puerto Rico.Journal of exposure science & environmental epidemiology · 2026Article
- Trace Element Content in Fingernails of Vietnamese Men with Laryngeal Cancer: Cumulative Exposure Assessment.Biological trace element research · 2026Article
- Prenatal Metal Exposome Reprograms Neonatal Metabolism: Trimester-Dependent Effects on Amino Acid and Carnitine Networks.Environment & health (Washington, D.C.) · 2026Article
- Maternal and Newborn Factors Associated with Meconium Metal Concentrations: A Cross-Sectional Study.Toxics · 2026Article
- Prenatal and childhood exposures to heavy metals and their associations with child cognition, motor skills, behaviour and mental health.Essays in biochemistry · 2025Review
- Essential and non-essential metals in children's intellectual functioning: A multi-media biomarker approach from a Mexico City birth cohort.Environmental research · 2025Article
- Association of maternal metal exposure and psychological status with adverse pregnancy outcomes: a nested case-control study.Frontiers in public health · 2025Article
- Association between blood essential metal elements in early pregnancy and gestational diabetes mellitus.Frontiers in nutrition · 2025Article
- Accelerated Longitudinal Glycemic Changes in Relation to Urinary Toxic/Essential Metals and Metal Mixtures Among Mexican Americans Living in Starr County, Texas.Diabetes care · 2024Article
- Interpregnancy interval, air pollution, and the risk of low birth weight: a retrospective study in China.BMC public health · 2024Article
- Gestational exposure to organochlorine compounds and metals and infant birth weight: effect modification by maternal hardships.Environmental health : a global access science source · 2024Article
- Prenatal Metal Exposures and Child Social Responsiveness Scale Scores in 2 Prospective Studies.Environmental health insights · 2024Article
- Individual, Independent, and Joint Associations of Toxic Metals and Manganese on Hypertensive Disorders of Pregnancy: Results from the MIREC Canadian Pregnancy Cohort.Environmental health perspectives · 2023Article
- Prenatal exposure to heavy metal mixtures and anthropometric birth outcomes: a cross-sectional study.Environmental health : a global access science source · 2022Article
- Biomarkers of Exposure to Phthalate Mixtures and Adverse Birth Outcomes in a Puerto Rico Birth Cohort.Environmental health perspectives · 2022Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundStudies on the health effects of metal mixtures typically utilize biomarkers measured in a single biological medium, such as blood or urine. However, the ability to evaluate mixture effects are limited by the uncertainty whether a unified medium can fully capture exposure for each metal. Therefore, it is important to compare and assess metal mixtures measured in different media in epidemiology studies.
objectivesThe aim of this study was to examine the mixture predictive performance of urine and blood metal biomarkers and integrated multi-media biomarkers in association with birth outcomes.
methodsIn our analysis of 847 women from the Puerto Rico PROTECT Cohort, we measured 10 essential and non-essential metals in repeated and paired samples of urine and blood during pregnancy. For each metal, we integrated exposure estimates from paired urine and blood biomarkers into multi-media biomarkers (MMBs), using intraclass-correlation coefficient (ICC) and weighted quantile sum (WQS) approaches. Using Ridge regressions, four separate Environmental risk scores (ERSs) for metals in urine, blood, MMB
resultsPb was the most important contributor of blood ERS as well as the two integrated multi-media biomarker ERSs. Individuals with high ERS (3rd tertile) showed increased odds of preterm birth compared to individuals with low ERS (1st tertile), with 2.8-fold (95% CI, 1.49 to 5.40) for urine (specific gravity corrected); 3.2- fold (95% CI, 1.68 to 6.25) for blood; 3.9-fold (95% CI, 1.72 to 8.66) for multi-media biomarkers composed using ICC; and 5.2-fold (95% CI, 2.34 to 11.42) for multi-media biomarkers composed using WQS. The four ERSs had comparable predictive performances (AUC ranging from 0.64 to 0.68) when urine is examined with specific gravity corrected concentrations.
conclusionsWithin a practical metal panel, measuring metals in either urine or blood may be an equally good approach to evaluate the metals as a mixture. Applications in practical study design require validation of these methods with other cohorts, larger panels of metals and within the context of other adverse health effects of interest.
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