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This nested case\u2013control study included 326 SA couples and 326 matched controls from a multicenter preconception cohort in Anhui Province (2019\u20132021). Eight REEs and eight oxidative stress biomarkers (OSBs) were measured in preconception urine. Conditional logistic regression found that urinary concentrations of lanthanum, cerium, praseodymium, neodymium, and samarium in females and males were associated with SA risk. Weighted quantile sum regression indicated that mixed REEs exposure in males was associated with SA in female partners (Odds ratio (OR) = 1.82, 95%CI: 1.40\u20132.36); mixed REEs exposure in females was associated with their SA risk (OR = 1.33, 95%CI: 1.04\u20131.69). Dual high exposure to lanthanum, cerium, praseodymium, neodymium, samarium, and dysprosium conferred a higher risk than dual low exposure (P &amp;lt; 0.05), and high REE exposure (Q4) in either partner was associated with increased SA risk in female partners (OR = 2.17\u20136.57). The OSB, 4-hydroxy-2-nonenal mercapturic acid (HNE-MA), mediated 19.4% of the praseodymium-SA association in females (P &amp;lt; 0.05). This study provides the first epidemiological evidence that preconception REE coexposure in couples was associated with increased SA risk, likely through oxidative stress; yet, with no established safety thresholds, further validation, including animal studies, is warranted.<\/jats:p>","DOI":"10.1021\/acs.est.6c03112","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:02:20Z","timestamp":1789578140000},"page":"26974-26986","source":"Crossref","is-referenced-by-count":0,"title":["Preconceptional\nExposure to Rare Earth Elements in\nCouples and Spontaneous Abortion Risk: The Potential Role of Oxidative\nStress"],"prefix":"10.1021","volume":"60","author":[{"given":"Junjun","family":"Liu","sequence":"first","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangshuang","family":"Bao","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Wang","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqiao","family":"Hu","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengjiao","family":"Du","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengdie","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical College of Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Shen","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Gao","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luobin","family":"Xia","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Key Laboratory of Population Health Across Life Cycle (Anhui Medical University) , , ,","place":["Hefei, Anhui, China, 230032"]},{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiqi","family":"Fang","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siqi","family":"Dai","sequence":"additional","affiliation":[{"name":"Anhui Medical University , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Wang","sequence":"additional","affiliation":[{"name":"the 901th Hospital of the Joint Logistics Support Force of People\u2019s Liberation Army , , ,","place":["Hefei, Anhui, China, 230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiyun","family":"Wu","sequence":"additional","affiliation":[{"name":"the 901th Hospital of the Joint Logistics Support Force of People\u2019s Liberation Army , , 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230032"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"10285","key":"2026092909072130000_cit1","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1016\/S0140-6736(21)00682-6","article-title":"Miscarriage matters: the epidemiological, physical,\npsychological, and economic costs of early pregnancy loss","volume":"397","author":"Quenby","year":"2021","journal-title":"Lancet"},{"issue":"2","key":"2026092909072130000_cit2","first-page":"60","article-title":"Spontaneous\nabortion in the first trimester of pregnancy","volume":"59","author":"Daumova\u0301","year":"2023","journal-title":"Cesk. 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Immunol."},{"issue":"8","key":"2026092909072130000_cit7","doi-asserted-by":"publisher","first-page":"876","DOI":"10.3967\/bes2024.123","article-title":"Association between\nExposure of Rare\nEarth Elements and Outcomes of In Vitro Fertilization-Embryo Transfer\nin Beijing","volume":"37","author":"Wang","year":"2024","journal-title":"Biomed. Environ. Sci."},{"key":"2026092909072130000_cit8","doi-asserted-by":"publisher","first-page":"106966","DOI":"10.1016\/j.envint.2021.106966","article-title":"Associations of maternal exposure to 41 metals\/metalloids\nduring\nearly pregnancy with the risk of spontaneous preterm birth: Does oxidative\nstress or DNA methylation play a crucial role?","volume":"158","author":"Xu","year":"2022","journal-title":"Environ. Int."},{"key":"2026092909072130000_cit9","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.gsf.2018.12.005","article-title":"Rare earth\nelements: a review of applications, occurrence, exploration, analysis,\nrecycling, and environmental impact","volume":"10","author":"Balaram","year":"2019","journal-title":"Geosci.\nFront."},{"issue":"5","key":"2026092909072130000_cit10","doi-asserted-by":"publisher","first-page":"317","DOI":"10.3390\/toxics12050317","article-title":"Toxic Effects of Rare\nEarth Elements on Human Health: A Review","volume":"12","author":"Wang","year":"2024","journal-title":"Toxics"},{"issue":"6","key":"2026092909072130000_cit11","doi-asserted-by":"publisher","first-page":"2795","DOI":"10.1007\/s10653-018-0146-4","article-title":"Inhalation exposure\nand potential health risk estimation of lanthanides elements in PM2.5\nassociated with rare earth mining areas: a case of Baotou city, northern\nChina","volume":"40","author":"Li","year":"2018","journal-title":"Environ. Geochem. Health"},{"issue":"9","key":"2026092909072130000_cit12","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1007\/s00216-014-8368-5","article-title":"Analysis of gadolinium-based\ncontrast agents in tap water with a\nnew hydrophilic interaction chromatography (ZIC-cHILIC) hyphenated\nwith inductively coupled plasma mass spectrometry","volume":"407","author":"Lindner","year":"2015","journal-title":"Anal. Bioanal. Chem."},{"key":"2026092909072130000_cit13","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/j.chemosphere.2016.11.023","article-title":"Concentrations\nand\nhealth risk assessment of rare earth elements in vegetables from mining\narea in Shandong, China","volume":"168","author":"Zhuang","year":"2017","journal-title":"Chemosphere"},{"issue":"1","key":"2026092909072130000_cit14","doi-asserted-by":"publisher","first-page":"9772","DOI":"10.1038\/s41598-017-10256-7","article-title":"Health risk\nassessment of rare earth elements in cereals from mining area in Shandong,\nChina","volume":"7","author":"Zhuang","year":"2017","journal-title":"Sci. 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Mass Spectrom."},{"key":"2026092909072130000_cit16","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.chemosphere.2015.01.057","article-title":"Levels of rare earth elements, heavy metals and uranium in a population\nliving in Baiyun Obo, Inner Mongolia, China: a pilot study","volume":"128","author":"Hao","year":"2015","journal-title":"Chemosphere"},{"key":"2026092909072130000_cit17","doi-asserted-by":"publisher","first-page":"154119","DOI":"10.1016\/j.scitotenv.2022.154119","article-title":"Residual levels and\nhealth risk assessment of rare earth elements in Chinese resident\ndiet: A market-based investigation","volume":"828","author":"Dai","year":"2022","journal-title":"Sci. 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Int."},{"issue":"3","key":"2026092909072130000_cit19","doi-asserted-by":"publisher","DOI":"10.1111\/and.12920","article-title":"Cerium\noxide nanoparticle elicits\noxidative stress, endocrine imbalance and lowers sperm characteristics\nin testes of balb\/c mice","volume":"50","author":"Adebayo","year":"2018","journal-title":"Andrologia"},{"key":"2026092909072130000_cit20","doi-asserted-by":"publisher","first-page":"121830","DOI":"10.1016\/j.jhazmat.2019.121830","article-title":"Maternal exposure to CeO2NPs during early pregnancy\nimpairs pregnancy\nby inducing placental abnormalities","volume":"389","author":"Zhong","year":"2020","journal-title":"J. Hazard.\nMater."},{"key":"2026092909072130000_cit21","doi-asserted-by":"publisher","first-page":"143106","DOI":"10.1016\/j.scitotenv.2020.143106","article-title":"Association between\nexposure of light rare earth elements\nand outcomes of in vitro fertilization-embryo transfer in North China","volume":"762","author":"Li","year":"2021","journal-title":"Sci. Total Environ."},{"issue":"1","key":"2026092909072130000_cit22","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12940-023-01027-1","article-title":"Association\nbetween light rare earth elements in maternal plasma and the risk\nof spontaneous preterm birth: a nested case-control study from the\nBeijing birth cohort study","volume":"22","author":"Chen","year":"2023","journal-title":"Environ. 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Biomed."},{"issue":"3","key":"2026092909072130000_cit34","doi-asserted-by":"publisher","first-page":"hoae032","DOI":"10.1093\/hropen\/hoae032","article-title":"Preconception depression\nreduces fertility: a couple-based prospective preconception cohort","volume":"2024","author":"Liao","year":"2024","journal-title":"Hum. Reprod. Open"},{"issue":"32","key":"2026092909072130000_cit35","doi-asserted-by":"publisher","first-page":"14110","DOI":"10.1021\/acs.est.4c01945","article-title":"Prenatal parental exposure to metals and birth defects:\na prospective birth cohort study","volume":"58","author":"Lv","year":"2024","journal-title":"Environ. Sci.\nTechnol."},{"issue":"4","key":"2026092909072130000_cit36","doi-asserted-by":"publisher","first-page":"047004","DOI":"10.1289\/EHP5838","article-title":"A quantile-based g-computation approach to addressing\nthe effects of exposure mixtures","volume":"128","author":"Keil","year":"2020","journal-title":"Environ. Health\nPerspect."},{"issue":"1","key":"2026092909072130000_cit37","doi-asserted-by":"publisher","first-page":"5624","DOI":"10.1038\/s41467-020-19335-2","article-title":"Application of an analytical framework\nfor multivariate mediation analysis of environmental data","volume":"11","author":"Aung","year":"2020","journal-title":"Nat. Commun."},{"issue":"10","key":"2026092909072130000_cit38","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1034\/j.1600-0412.2003.00244.x","article-title":"A prospective study of maternal smoking\nand spontaneous\nabortion","volume":"82","author":"Wisborg","year":"2003","journal-title":"Acta Obstet. Gynecol. Scand."},{"issue":"1","key":"2026092909072130000_cit39","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1093\/ije\/20.1.157","article-title":"Risk factors for spontaneous abortion","volume":"20","author":"Parazzini","year":"1991","journal-title":"Int.\nJ. 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