{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:19:58Z","timestamp":1791724798161,"version":"4.3.4"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Intrauterine blood transfusions (IUBTs) are critical for treating fetal anemia but may expose fetuses to toxic metals. This study assessed mercury (Hg), cadmium (Cd), lead (Pb), and arsenic (As) levels in red blood cell (RBC) transfusion bags used during pregnancy, examined metal exposure in maternal and cord blood, and evaluated fetal health risks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Thirty pregnant women who underwent intrauterine blood IUBTs were enrolled in this study. Metal concentrations were measured in one to nine transfusion bags for each participant. These bags contained 8\u2013103\u2009mL volumes and were administered between gestational weeks 18 and 35. We also tested the mothers\u2019 blood for metal levels in the final stages of pregnancy and the umbilical cord blood at birth. The assessment utilized the intravenous reference dose (IVRfD) and the hazard index (HI) to evaluate the non-carcinogenic health risks these metals might pose to the fetus.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Metals were detectable in almost all transfusion bags. The IVRfD was exceeded for Hg in 16 fetuses, Cd in 8 fetuses, Pb in 30 fetuses, and As in 1 fetus. Significant correlations were found between the concentrations of Hg, Cd, and As in transfused RBCs and cord blood. No correlations were observed between these concentrations and maternal blood levels, except for Cd. The influence of multiple IUBTs was positively associated only with Cd levels in the cord (\u00df = 0.529, 95% confidence intervals (CI) between 0.180 and 0.879). The HI exceeded 1, indicating significant health risks, predominantly from Pb, followed by Hg and Cd.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The findings of this study highlight the significant risk of fetal exposure to toxic metals, mainly Pb, through IUBTs. This underscores the critical need for prescreening blood donors for toxic metals to minimize the potential for long-term adverse effects on the fetus. The research stresses the necessity of balancing the immediate benefits of IUBTs against the risks of toxic metal exposure, underscoring the importance of safeguarding fetal health through improved screening practices.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Impact<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>This study highlights the risk of toxic metal exposure through IUBTs, a treatment for fetal anemia.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Hg, Cd, Pb, and As levels were measured in transfusion bags and linked to fetal exposure through maternal and umbilical cord blood analysis.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The HI indicates significant Pb exposure risks, underscoring the need for mandatory blood donor screening.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Recommendations include shifting toward safer practices in managing fetal anemia to protect fetal health.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1038\/s41390-024-03504-w","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T08:04:24Z","timestamp":1725005064000},"page":"647-654","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fetal exposure to toxic metals (mercury, cadmium, lead, and arsenic) via intrauterine blood transfusions"],"prefix":"10.1038","volume":"97","author":[{"given":"Iman","family":"Al-Saleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hissah","family":"Alnuwaysir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Al-Rouqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham","family":"Aldhalaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Tulbah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"3504_CR1","unstructured":"Dean, L. Blood Groups and Red Cell Antigens [Internet]. Ch. 4, Hemolytic disease of the newborn (National Center for Biotechnology Information US, 2005)."},{"key":"3504_CR2","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000362812","volume":"36","author":"IT Lindenburg","year":"2014","unstructured":"Lindenburg, I. T., van Kamp, I. L. & Oepkes, D. Intrauterine blood transfusion: current indications and associated risks. Fetal Diagn. Ther. 36, 263\u2013271 (2014).","journal-title":"Fetal Diagn. Ther."},{"key":"3504_CR3","unstructured":"World Health Organization (WHO). Screening Donated Blood for Transfusion-transmissible Infections (WHO, 2010)."},{"key":"3504_CR4","doi-asserted-by":"crossref","unstructured":"Aly, S. M. et al. Lead, mercury, and cadmium concentrations in blood products transfused to neonates: elimination not just mitigation. Toxics 11, 712 (2023).","DOI":"10.3390\/toxics11080712"},{"key":"3504_CR5","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/s41390-018-0175-9","volume":"85","author":"SM Aly","year":"2019","unstructured":"Aly, S. M., Omran, A., Abdalla, M. O., Gaulier, J. M. & El-Metwally, D. Lead: a hidden \u201cuntested\u201d risk in neonatal blood transfusion. Pediatr. Res. 85, 50\u201354 (2019).","journal-title":"Pediatr. Res."},{"key":"3504_CR6","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/tme.12662","volume":"30","author":"M Averina","year":"2020","unstructured":"Averina, M. et al. Environmental pollutants in blood donors: the multicentre Norwegian donor study. Transfus. Med. 30, 201\u2013209 (2020).","journal-title":"Transfus. Med."},{"key":"3504_CR7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1053\/j.seminhematol.2019.11.004","volume":"56","author":"EA Godbey","year":"2019","unstructured":"Godbey, E. A. & Thibodeaux, S. R. Ensuring safety of the blood supply in the United States: donor screening, testing, emerging pathogens, and pathogen inactivation. Semin. Hematol. 56, 229\u2013235 (2019).","journal-title":"Semin. Hematol."},{"key":"3504_CR8","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/s41390-018-0177-7","volume":"85","author":"KMR White","year":"2019","unstructured":"White, K. M. R. et al. Donor blood remains a source of heavy metal exposure. Pediatr. Res. 85, 4\u20135 (2019).","journal-title":"Pediatr. Res."},{"key":"3504_CR9","doi-asserted-by":"crossref","first-page":"127173","DOI":"10.1016\/j.jtemb.2023.127173","volume":"78","author":"I Al-Saleh","year":"2023","unstructured":"Al-Saleh, I. et al. Exposure of preterm neonates to toxic metals during their stay in the neonatal intensive care unit and its impact on neurodevelopment at 2 months of age. J. Trace Elem. Med. Biol. 78, 127173 (2023).","journal-title":"J. Trace Elem. Med. Biol."},{"key":"3504_CR10","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.jpeds.2013.03.003","volume":"163","author":"E Gehrie","year":"2013","unstructured":"Gehrie, E. et al. Primary prevention of pediatric lead exposure requires new approaches to transfusion screening. J. Pediatr. 163, 855\u2013859 (2013).","journal-title":"J. Pediatr."},{"key":"3504_CR11","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.ijheh.2007.01.035","volume":"210","author":"C Schulz","year":"2007","unstructured":"Schulz, C., Angerer, J., Ewers, U. & Kolossa-Gehring, M. The German Human Biomonitoring Commission. Int. J. Hyg. Environ. Health 210, 373\u2013382 (2007).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR12","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ijheh.2012.01.003","volume":"215","author":"C Schulz","year":"2012","unstructured":"Schulz, C., Wilhelm, M., Heudorf, U. & Kolossa-Gehring, M. Reprint of \u201cUpdate of the reference and HBM values derived by the German Human Biomonitoring Commission. Int. J. Hyg. Environ. Health 215, 150\u2013158 (2012).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.ijheh.2010.04.002","volume":"213","author":"M Wilhelm","year":"2010","unstructured":"Wilhelm, M., Heinzow, B., Angerer, J. & Schulz, C. Reassessment of critical lead effects by the German Human Biomonitoring Commission results in suspension of the human biomonitoring values (HBM I and HBm II) for lead in blood of children and adults. Int. J. Hyg. Environ. Health 213, 265\u2013269 (2010).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.neuro.2019.02.021","volume":"73","author":"A Rocha","year":"2019","unstructured":"Rocha, A. & Trujillo, K. A. Neurotoxicity of low-level lead exposure: history, mechanisms of action, and behavioral effects in humans and preclinical models. Neurotoxicology 73, 58\u201380 (2019).","journal-title":"Neurotoxicology"},{"key":"3504_CR15","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1038\/s41390-019-0463-z","volume":"86","author":"AJ Falck","year":"2019","unstructured":"Falck, A. J., Sundararajan, S., Al-Mudares, F., Contag, S. A. & Bearer, C. F. Fetal exposure to mercury and lead from intrauterine blood transfusions. Pediatr. Res. 86, 510\u2013514 (2019).","journal-title":"Pediatr. Res."},{"key":"3504_CR16","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/0273-2300(88)90047-5","volume":"8","author":"DG Barnes","year":"1998","unstructured":"Barnes, D. G. & Dourson, M. Reference dose (RfD): description and use in health risk assessments. Regul. Toxicol. Pharmacol. 8, 471\u2013486 (1998).","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"3504_CR17","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s12011-018-1436-5","volume":"188","author":"S Takci","year":"2019","unstructured":"Takci, S. et al. Lead and mercury levels in preterm infants before and after blood transfusions. Biol. Trace Elem. Res. 188, 344\u2013352 (2019).","journal-title":"Biol. Trace Elem. Res."},{"key":"3504_CR18","unstructured":"United States Environmental Protection Agency (US EPA). EPA\u2019s National-scale Air Toxics Assessment, an Overview of Methods for EPA\u2019s National-scale Air Toxics Assessment (US EPA, 2011)."},{"key":"3504_CR19","doi-asserted-by":"crossref","first-page":"e1002220","DOI":"10.1371\/journal.pmed.1002220","volume":"14","author":"T Kiserud","year":"2017","unstructured":"Kiserud, T. et al. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 14, e1002220 (2017).","journal-title":"PLoS Med."},{"key":"3504_CR20","unstructured":"United States Environmental Protection Agency (US EPA). Mercury: Human Exposure (US EPA, 2007)."},{"key":"3504_CR21","first-page":"127","volume":"116","author":"KR Mahaffey","year":"2005","unstructured":"Mahaffey, K. R. Mercury exposure: medical and public health issues. Trans. Am. Clin. Climatol. Assoc. 116, 127\u2013153 (2005).","journal-title":"Trans. Am. Clin. Climatol. Assoc."},{"key":"3504_CR22","unstructured":"Occupational Safety and Health Administration (OSHA). Cadmium. OSHA 3136-06R (U.S. Department of Labor, 2004)."},{"key":"3504_CR23","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/vox.12854","volume":"114","author":"R Boehm","year":"2019","unstructured":"Boehm, R. et al. Toxic elements in packed red blood cells from smoker donors: a risk for paediatric transfusion? Vox Sang. 114, 808\u2013815 (2019).","journal-title":"Vox Sang."},{"key":"3504_CR24","unstructured":"Centers for Disease Control (CDC). Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. Advisory Committee on Childhood Lead Poisoning Prevention (CDC, 2012)."},{"key":"3504_CR25","doi-asserted-by":"crossref","DOI":"10.1186\/s12940-019-0457-7","volume":"18","author":"JA Paulson","year":"2019","unstructured":"Paulson, J. A. & Brown, M. J. The CDC blood lead reference value for children: time for a change. Environ. Health 18, 16 (2019).","journal-title":"Environ. Health"},{"key":"3504_CR26","doi-asserted-by":"crossref","first-page":"104516","DOI":"10.1016\/j.yrtph.2019.104516","volume":"110","author":"BM Flannery","year":"2020","unstructured":"Flannery, B. M. et al. U.S. Food and Drug Administration\u2019s interim reference levels for dietary lead exposure in children and women of childbearing age. Regul. Toxicol. Pharmacol. 110, 104516 (2020).","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"3504_CR27","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ijheh.2016.10.006","volume":"220","author":"G Saravanabhavan","year":"2017","unstructured":"Saravanabhavan, G. et al. Human biomonitoring reference values for metals and trace elements in blood and urine derived from the Canadian Health Measures Survey 2007\u20132013. Int. J. Hyg. Environ. Health 220, 189\u2013200 (2017).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR28","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1038\/s41390-019-0635-x","volume":"87","author":"AJ Falck","year":"2020","unstructured":"Falck, A. J., Medina, A. E., Cummins-Oman, J., El-Metwally, D. & Bearer, C. F. Mercury, lead, and cadmium exposure via red blood cell transfusions in preterm infants. Pediatr. Res. 87, 677\u2013682 (2020).","journal-title":"Pediatr. Res."},{"key":"3504_CR29","unstructured":"Rossman, T. G. Arsenic in Environmental and Occupational Medicine (eds Rom, W. N. & Markowitz, S. B.) 1006\u20131021 (Lippincott, Williams & Wilkins, 2007)."},{"key":"3504_CR30","unstructured":"Integrated Risk Information System (IRIS). Chemical Assessment Summary: Arsenic, Inorganic; CASRN 7440-38-2 (US EPA, 1991)."},{"key":"3504_CR31","doi-asserted-by":"crossref","first-page":"110896","DOI":"10.1016\/j.envres.2021.110896","volume":"196","author":"M Sakamoto","year":"2021","unstructured":"Sakamoto, M. et al. Plasma and red blood cells distribution of total mercury, inorganic mercury, and selenium in maternal and cord blood from a group of Japanese women. Environ. Res. 196, 110896 (2021).","journal-title":"Environ. Res."},{"key":"3504_CR32","unstructured":"WHO & and International Programme on Chemical Safety (IPCS). Methylmercury (WHO, 1990)."},{"key":"3504_CR33","doi-asserted-by":"crossref","first-page":"353","DOI":"10.3961\/jpmph.2012.45.6.353","volume":"4","author":"YS Hong","year":"2012","unstructured":"Hong, Y. S., Kim, Y. M. & Lee, K. E. Methylmercury exposure and health effects. J. Prev. Med. Public Health 4, 353\u2013363 (2012).","journal-title":"J. Prev. Med. Public Health"},{"key":"3504_CR34","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ijheh.2010.10.001","volume":"214","author":"I Al-Saleh","year":"2011","unstructured":"Al-Saleh, I., Shinwari, N., Mashhour, A., Mohamed Gel, D. & Rabah, A. Heavy metals (lead, cadmium and mercury) in maternal, cord blood and placenta of healthy women. Int. J. Hyg. Environ. Health 214, 79\u2013101 (2011).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR35","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.envint.2007.06.001","volume":"33","author":"W Jedrychowski","year":"2007","unstructured":"Jedrychowski, W. et al. Fish consumption in pregnancy, cord blood mercury level and cognitive and psychomotor development of infants followed over the first three years of life: Krakow epidemiologic study. Environ. Int. 33, 1057\u20131062 (2007).","journal-title":"Environ. Int."},{"key":"3504_CR36","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1289\/ehp.10831","volume":"116","author":"SA Lederman","year":"2008","unstructured":"Lederman, S. A. et al. Relation between cord blood mercury levels and early child development in a World Trade Center cohort. Environ. Health Perspect. 116, 1085\u20131091 (2008).","journal-title":"Environ. Health Perspect."},{"key":"3504_CR37","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/j.ajog.2006.03.005","volume":"194","author":"RL Sato","year":"2006","unstructured":"Sato, R. L., Li, G. G. & Shaha, S. Antepartum seafood consumption and mercury levels in newborn cord blood. Am. J. Obstet. Gynecol. 194, 1683\u20131688 (2006).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"3504_CR38","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1289\/ehp.6187","volume":"111","author":"AH Stern","year":"2003","unstructured":"Stern, A. H. & Smith, A. E. An assessment of the cord blood:maternal blood methylmercury ratio: implications for risk assessment. Environ. Health Perspect. 111, 1465\u20131470 (2003).","journal-title":"Environ. Health Perspect."},{"key":"3504_CR39","doi-asserted-by":"crossref","first-page":"344","DOI":"10.3961\/jpmph.2012.45.6.344","volume":"45","author":"JD Park","year":"2012","unstructured":"Park, J. D. & Zheng, W. Human exposure and health effects of inorganic and elemental mercury. J. Prev. Med. Public Health 45, 344\u2013352 (2012).","journal-title":"J. Prev. Med. Public Health"},{"key":"3504_CR40","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-841","volume":"13","author":"E Garc\u00eda-Esquinas","year":"2013","unstructured":"Garc\u00eda-Esquinas, E. et al. Lead, mercury and cadmium in umbilical cord blood and its association with parental epidemiological variables and birth factors. BMC Public Health 13, 841 (2013).","journal-title":"BMC Public Health"},{"key":"3504_CR41","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00128-020-03088-1","volume":"106","author":"M Wang","year":"2021","unstructured":"Wang, M. et al. A review on cadmium exposure in the population and intervention strategies against cadmium toxicity. Bull. Environ. Contam. Toxicol. 106, 65\u201374 (2021).","journal-title":"Bull. Environ. Contam. Toxicol."},{"key":"3504_CR42","first-page":"17","volume":"17","author":"I Al-Saleh","year":"1998","unstructured":"Al-Saleh, I. Sources of lead in Saudi Arabia: a review. J. Environ. Pathol. Toxicol. Oncol. 17, 17\u201335 (1998).","journal-title":"J. Environ. Pathol. Toxicol. Oncol."},{"key":"3504_CR43","doi-asserted-by":"crossref","first-page":"113473","DOI":"10.1016\/j.ijheh.2020.113473","volume":"225","author":"I Al-Saleh","year":"2020","unstructured":"Al-Saleh, I. Reference values for heavy metals in the urine and blood of Saudi women derived from two human biomonitoring studies. Int. J. Hyg. Environ. Health 225, 113473 (2020).","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"3504_CR44","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.yrtph.2009.02.005","volume":"54","author":"I Al-Saleh","year":"2009","unstructured":"Al-Saleh, I., Al-Enazi, S. & Shinwari, N. Assessment of lead in cosmetic products. Regul. Toxicol. Pharmacol. 54, 105\u2013113 (2009).","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"3504_CR45","doi-asserted-by":"crossref","first-page":"415160","DOI":"10.1155\/2014\/415160","volume":"2014","author":"AP Shaik","year":"2014","unstructured":"Shaik, A. P., Sultana, S. A. & Alsaeed, A. H. Lead exposure: a summary of global studies and the need for new studies from Saudi Arabia. Dis. Markers 2014, 415160 (2014).","journal-title":"Dis. Markers"},{"key":"3504_CR46","doi-asserted-by":"crossref","first-page":"108641","DOI":"10.1016\/j.envres.2019.108641","volume":"177","author":"JG D\u00f3rea","year":"2019","unstructured":"D\u00f3rea, J. G. Environmental exposure to low-level lead (Pb) co-occurring with other neurotoxicants in early life and neurodevelopment of children. Environ. Res. 177, 108641 (2019).","journal-title":"Environ. Res."},{"key":"3504_CR47","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1038\/s41370-022-00457-2","volume":"33","author":"J Ashley-Martin","year":"2023","unstructured":"Ashley-Martin, J., Fisher, M., Belanger, P., Cirtiu, C. M. & Arbuckle, T. E. Biomonitoring of inorganic arsenic species in pregnancy. J. Expo. Sci. Environ. Epidemiol. 33, 921\u2013932 (2023).","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"3504_CR48","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1038\/s41366-022-01127-x","volume":"46","author":"W Huang","year":"2022","unstructured":"Huang, W. et al. In-utero co-exposure to toxic metals and micronutrients on childhood risk of overweight or obesity: new insight on micronutrients counteracting toxic metals. Int. J. Obes. 46, 1435\u20131445 (2022).","journal-title":"Int. J. Obes."},{"key":"3504_CR49","doi-asserted-by":"crossref","first-page":"e0265648","DOI":"10.1371\/journal.pone.0265648","volume":"17","author":"M Takeuchi","year":"2022","unstructured":"Takeuchi, M., Yoshida, S., Kawakami, C., Kawakami, K. & Ito, S. Association of maternal heavy metal exposure during pregnancy with isolated cleft lip and palate in offspring: Japan Environment and Children\u2019s Study (JECS) cohort study. PLoS ONE 17, e0265648 (2022).","journal-title":"PLoS ONE"},{"key":"3504_CR50","doi-asserted-by":"crossref","first-page":"106976","DOI":"10.1016\/j.envint.2021.106976","volume":"158","author":"M Zhang","year":"2022","unstructured":"Zhang, M. et al. A metabolome-wide association study of in utero metal and trace element exposures with cord blood metabolome profile: findings from the Boston Birth Cohort. Environ. Int. 158, 106976 (2022).","journal-title":"Environ. Int."},{"key":"3504_CR51","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.etap.2003.03.001","volume":"18","author":"SB Wilbur","year":"2004","unstructured":"Wilbur, S. B., Hansen, H., Pohl, H., Colman, J. & McClure, P. Using the ATSDR guidance manual for the assessment of joint toxic action of chemical mixtures. Environ. Toxicol. Pharmacol. 18, 223\u2013230 (2004).","journal-title":"Environ. Toxicol. Pharmacol."}],"container-title":["Pediatric Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03504-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03504-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03504-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T11:01:27Z","timestamp":1745319687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03504-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,30]]},"references-count":51,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["3504"],"URL":"https:\/\/doi.org\/10.1038\/s41390-024-03504-w","relation":{},"ISSN":["0031-3998","1530-0447"],"issn-type":[{"value":"0031-3998","type":"print"},{"value":"1530-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,30]]},"assertion":[{"value":"19 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by the Research Ethics Committee of the KFSH&RC (approval number RAC #2200007). Informed consent was obtained from the mothers at enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}