{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:22:44Z","timestamp":1787008964773,"version":"build-2736575974"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82304087"],"award-info":[{"award-number":["82304087"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82430104"],"award-info":[{"award-number":["82430104"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82273647"],"award-info":[{"award-number":["82273647"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shanghai Post-doctoral Excellence Program","award":["2022440"],"award-info":[{"award-number":["2022440"]}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","award":["2023M732274"],"award-info":[{"award-number":["2023M732274"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Even low-level prenatal lead exposure may adversely affect fetal development, yet its impact on neonatal birth outcomes and potential sex-specific effects remain unclear in general populations. We aimed to assess the associations between low-level prenatal lead exposure and neonatal anthropometric outcomes, and to investigate sex-specific susceptibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilized data from a prospective birth cohort established in Wujiang District, Jiangsu Province, China, including 2020 mother\u2013infant pairs. Cord blood lead levels were measured at delivery by using graphite furnace atomic absorption spectrometry. Neonatal birthweight, length, and head circumference were recorded. Multiple linear regression models were used to assess associations between log-transformed lead concentrations and birth outcomes, with stratification by infant sex. Dose\u2013response relationships were examined by using restricted cubic splines (RCSs) and threshold effects were tested via piecewise linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median cord blood lead concentration was 32.10\u2009\u03bcg\/L [95% confidence interval (CI): 31.40, 32.82\u2009\u03bcg\/L]. Higher cord blood lead concentrations were significantly associated with reduced head circumference (adjusted \u03b2 = \u22120.314\u2009cm per 1-unit increase in log10 Pb; 95% CI: \u22120.502, \u22120.126; P\u2009=\u2009.001) but not with birthweight or length. Sex-stratified analysis revealed that this association was significant in males (adjusted \u03b2 = \u20130.461\u2009cm per 1-unit increase in log10 Pb; 95% CI: \u20130.735, \u20130.188; P\u2009=\u2009.001) but not in females. RCS models demonstrated a nonlinear relationship, with a threshold at \u223c40\u2009\u03bcg\/L, above which the head circumference declined more steeply. This threshold effect persisted in males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prenatal exposure to lead is associated with reduced neonatal head circumference, with evidence of sex-specific vulnerability and threshold effects. These findings underscore the need for stringent environmental monitoring and suggest that head circumference may serve as a sensitive biomarker of early lead toxicity, even at low exposure levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyag040","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:52:00Z","timestamp":1776430320000},"source":"Crossref","is-referenced-by-count":1,"title":["Threshold and sex-specific associations of prenatal low-level lead exposure with neonatal birth outcomes: a Chinese prospective birth cohort study"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7360-6511","authenticated-orcid":false,"given":"Susu","family":"Wang","sequence":"first","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Liang","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailong","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, XinHua Hospital, Affiliated to Shanghai JiaoTong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxia","family":"Liu","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Li","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong-Huai","family":"Yan","sequence":"additional","affiliation":[{"name":"Ministry of Education-Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianting","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"2026042100052047400_dyag040-B1","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1016\/S2542-5196(20)30278-3","article-title":"Blood lead levels in low-income and middle-income countries: a systematic 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