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Integrating measurements across multiple media as a multimedia biomarker (MMB) may better characterize an exposure, allowing for improved assessment of exposure-outcome relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study utilized concentrations of 10 metals in urine, blood, and as MMBs, integrated using intraclass correlation coefficients (MMB\n                      <jats:sub>ICC<\/jats:sub>\n                      ) and weighted quantile sum regression (MBB\n                      <jats:sub>WQS<\/jats:sub>\n                      ), to investigate associations with child neurodevelopment, using the Child Behavior Checklist (CBCL).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined log-transformed geometric mean prenatal metal concentrations (in urine, blood, or as MMBs) in association with repeatedly measured CBCL scores for ages 1.5\u20135 years, in 284 mother-child pairs in the PROTECT birth cohort in Puerto Rico. Summary scores were modeled as log(CBCL\u2009+\u20091). Associations were assessed as single-pollutants and as a mixture, using linear mixed-effects models, adaptive elastic net, and Bayesian kernel machine regression, adjusted for sex, maternal education level, maternal age, and child age at assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In single-pollutant models, prenatal urinary As and Co; blood Cd and Mn; MMB\n                      <jats:sub>ICC<\/jats:sub>\n                      Cd and Co; and MMB\n                      <jats:sub>WQS<\/jats:sub>\n                      Cd, Co, and Mn were associated with higher emotional and behavioral problems in children. For example, Cd was associated with 0.24 (0.08, 0.41) higher CBCL total problem scores per interquartile range (IQR) increase in blood, 0.19 (0.07, 0.31) in MMB\n                      <jats:sub>ICC<\/jats:sub>\n                      , and 0.19 (0.06, 0.31) in MMB\n                      <jats:sub>WQS<\/jats:sub>\n                      (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05;\n                      <jats:italic>q<\/jats:italic>\n                      \u2009&lt;\u20090.1 for blood and MMB\n                      <jats:sub>WQS<\/jats:sub>\n                      ). The effects of the cumulative mixture of MMB metals were not consistently\u00a0more strongly associated with CBCL scores\u00a0compared to blood media.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>The results of this study can inform future research on optimizing biomarker assessment and reducing measurement error to assess the effect of metal mixtures on child neurodevelopment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact statement<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Combining multiple biomarker media may better capture health effects compared to single-media biomarker analyses, especially for the effects of exposure to metals with varied toxicokinetic properties. Our findings provide insight to potential approaches for combining blood and urine biomarkers and to the selection of preferred media for toxic and essential metals, with the goal of reducing measurement error and accounting for toxicokinetics. Future research should explore the integration of other commonly utilized biomarkers to compare their performance and efficacy as integrated MMBs in larger sample sizes.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41370-026-00935-x","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:41:22Z","timestamp":1780926082000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of integrated, multimedia biomarkers of prenatal metals exposure in association with child neurodevelopment in Puerto Rico"],"prefix":"10.1038","author":[{"given":"Savannah M.","family":"Sturla Irizarry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber L.","family":"Cathey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Zimmerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ting","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhramar","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaira Y.","family":"Rosario Pab\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gredia","family":"Huerta Monta\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen M.","family":"V\u00e9lez Vega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram N.","family":"Alshawabkeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 F.","family":"Cordero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Meeker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6692-2206","authenticated-orcid":false,"given":"Deborah J.","family":"Watkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"935_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.112450","volume":"205","author":"C Liu","year":"2022","unstructured":"Liu C, Huang L, Huang S, Wei L, Cao D, Zan G, et al. 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