{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:02:20Z","timestamp":1782842540077,"version":"3.54.5"},"reference-count":56,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Prior research has linked exposure to particulate matter with an aerodynamic diameter of \u22642.5 \u03bcm (PM\n 2.5<\/jats:sub>\n ) with preterm birth (PTB). However, the modulating effect of preconception thyroid stimulating hormone (TSH) levels on the relationship between PM\n 2.5<\/jats:sub>\n exposure and PTB has not been investigated.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aimed to assess whether preconception TSH levels modulate the impact of PM\n 2.5<\/jats:sub>\n exposure on PTB.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This cohort study was conducted in Guangdong, China, as a part of the National Free Pre-Pregnancy Checkups Project. PM\n 2.5<\/jats:sub>\n exposure was estimated by using the inverse distance weighting method. To investigate the moderating effects of TSH levels on trimester-specific PM\n 2.5<\/jats:sub>\n exposure and PTB, we used the Cox proportional hazards model. Additionally, to identify the susceptible exposure windows for weekly specific PM\n 2.5<\/jats:sub>\n exposure and PTB, we built distributed lag models incorporating Cox proportional hazards models.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 633,516 women who delivered between January 1, 2014, to December 31, 2019, were included. In total, 34,081 (5.4%) of them had abnormal preconception TSH levels. During the entire pregnancy, each 10-\u03bcg\/m\n 3<\/jats:sup>\n increase in PM\n 2.5<\/jats:sub>\n was linked to elevated risks of PTB (hazard ratio [HR] 1.559, 95% CI 1.390\u20101.748), early PTB (HR 1.559, 95% CI 1.227\u20101.980), and late PTB (HR 1.571, 95% CI 1.379\u20101.791) among women with abnormal TSH levels. For women with normal preconception TSH levels, PM\n 2.5<\/jats:sub>\n exposure during the entire pregnancy was positively associated with the risk of PTB (HR 1.345, 95% CI 1.307\u20101.385), early PTB (HR 1.203, 95% CI 1.126\u20101.285), and late PTB (HR 1.386, 95% CI 1.342\u20101432). The critical susceptible exposure windows were the 3rd-13th and 28th-35th gestational weeks for women with abnormal preconception TSH levels, compared to the 1st-13th and 21st-35th gestational weeks for those with normal preconception TSH levels.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n PM\n 2.5<\/jats:sub>\n exposure was linked with a higher PTB risk, particularly in women with abnormal preconception TSH levels. PM\n 2.5<\/jats:sub>\n exposure appears to have a greater effect on pregnant women who are in the early or late stages of pregnancy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/53879","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T05:28:55Z","timestamp":1723094935000},"page":"e53879-e53879","source":"Crossref","is-referenced-by-count":1,"title":["Association Between P\n \n articulate Matter Exposure and Preterm Birth in Women With Abnormal Preconception Thyrotropin Levels: Large Cohort Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7411-7669","authenticated-orcid":false,"given":"Ting","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-814X","authenticated-orcid":false,"given":"Haobo","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1368-9218","authenticated-orcid":false,"given":"Xiaoyan","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0312-7546","authenticated-orcid":false,"given":"Tingting","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9233-5876","authenticated-orcid":false,"given":"Lingxi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-4325","authenticated-orcid":false,"given":"Lina","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4966-898X","authenticated-orcid":false,"given":"Qinghui","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9248-9568","authenticated-orcid":false,"given":"Xiaolin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-5519","authenticated-orcid":false,"given":"Lu","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0990-6461","authenticated-orcid":false,"given":"Pi","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1289\/ehp.10952","article-title":"A cohort study of traffic-related air pollution impacts on birth outcomes","volume":"116","author":"Brauer","journal-title":"Environ Health Perspect"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.105410","article-title":"Ambient air pollution and markers of fetal growth: a retrospective population-based cohort study of 2.57 million term singleton births in China","volume":"135","author":"Guo","journal-title":"Environ Int"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2018.08.002","article-title":"Does the air pollution model influence the evidence of socio-economic disparities in exposure and susceptibility?","volume":"167","author":"Loizeau","journal-title":"Environ Res"},{"issue":"10409","key":"R4","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis","volume":"402","author":"Ohuma","journal-title":"Lancet"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.siny.2015.12.011","article-title":"The epidemiology, etiology, and costs of preterm birth","volume":"21","author":"Frey","journal-title":"Semin Fetal Neonatal Med"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2018.12.013","article-title":"Preterm birth and economic benefits of reduced maternal exposure to fine particulate matter","volume":"170","author":"Kim","journal-title":"Environ Res"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.8243","article-title":"Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review","volume":"3","author":"Bekkar","journal-title":"JAMA Netw Open"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-020-00144-5","article-title":"Maternal PM exposure triggers preterm birth: a cross-sectional study in Wuhan, China","volume":"5","author":"Zhang","journal-title":"Glob Health Res Policy"},{"issue":"Suppl 2","key":"R9","doi-asserted-by":"publisher","first-page":"S64","DOI":"10.1513\/AnnalsATS.201707-574MG","article-title":"Ambient air pollution and clinical implications for susceptible populations","volume":"15","author":"Hooper","journal-title":"Ann Am Thorac Soc"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2016.04.026","article-title":"Ambient air pollution and adverse birth outcomes: differences by maternal comorbidities","volume":"148","author":"Lavigne","journal-title":"Environ Res"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1089\/thy.2018.0475","article-title":"Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and meta-analysis","volume":"29","author":"Dong","journal-title":"Thyroid"},{"issue":"Pt 1","key":"R12","doi-asserted-by":"publisher","first-page":"115128","DOI":"10.1016\/j.envpol.2020.115128","article-title":"The mediation effect of maternal glucose on the association between ambient air pollution and birth weight in Foshan, China","volume":"266","author":"Yang","journal-title":"Environ Pollut"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100723","article-title":"Estimated change in prevalence of abnormal thyroid-stimulating hormone levels in China according to the application of the kit-recommended or NACB standard reference interval","volume":"32","author":"Li","journal-title":"EClinicalMedicine"},{"issue":"18","key":"R14","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1080\/14767058.2016.1242123","article-title":"First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome","volume":"30","author":"Arbib","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"6","key":"R15","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1111\/cen.13329","article-title":"Preconception TSH and pregnancy outcomes: a population-based cohort study in 184 611 women","volume":"86","author":"Chen","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.5723","article-title":"Preconception thyrotropin levels and risk of adverse pregnancy outcomes in Chinese women aged 20 to 49 years","volume":"4","author":"Yang","journal-title":"JAMA Netw Open"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2017.12.050","article-title":"Exposure to low concentrations of air pollutants and adverse birth outcomes in Brisbane, Australia, 2003-2013","volume":"622-623","author":"Chen","journal-title":"Sci Total Environ"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2021.117629","article-title":"Ambient fine particulate matter air pollution and the risk of preterm birth: a multicenter birth cohort study in China","volume":"287","author":"Chu","journal-title":"Environ Pollut"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1111\/ppe.12836","article-title":"Air pollution and preterm birth: a time-stratified case-crossover study in the San Joaquin Valley of California","volume":"36","author":"Ha","journal-title":"Paediatr Perinat Epidemiol"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2021.127645","article-title":"Composition of fine particulate matter and risk of preterm birth: a nationwide birth cohort study in 336 Chinese cities","volume":"425","author":"He","journal-title":"J Hazard Mater"},{"issue":"10","key":"R21","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/abb8a3","article-title":"Examining the joint effects of heatwaves, air pollution, and green space on the risk of preterm birth in California","volume":"15","author":"Sun","journal-title":"Environ Res Lett"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000179","article-title":"Association between maximum temperature and PM with pregnancy outcomes in Lima, Peru","volume":"5","author":"Tapia","journal-title":"Environ Epidemiol"},{"issue":"7","key":"R23","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/j.ijheh.2019.07.004","article-title":"Migrant population is more vulnerable to the effect of air pollution on preterm birth: results from a birth cohort study in seven Chinese cities","volume":"222","author":"Liang","journal-title":"Int J Hyg Environ Health"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-6307-7","article-title":"The association between air pollution and preterm birth and low birth weight in Guangdong, China","volume":"19","author":"Liu","journal-title":"BMC Public Health"},{"issue":"Pt 2","key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.chemosphere.2021.131833","article-title":"Prenatal exposure to air pollution and the risk of preterm birth in rural population of Henan Province","volume":"286","author":"Zhou","journal-title":"Chemosphere"},{"issue":"11","key":"R26","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1093\/aje\/kwx184","article-title":"Potential for bias when estimating critical windows for air pollution in children's health","volume":"186","author":"Wilson","journal-title":"Am J Epidemiol"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2021.151775","article-title":"Prenatal exposure to air pollution and the risk of macrosomia: identifying windows of susceptibility","volume":"818","author":"Shang","journal-title":"Sci Total Environ"},{"issue":"Pt 1","key":"R28","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.envint.2018.09.021","article-title":"Identifying windows of susceptibility for maternal exposure to ambient air pollution and preterm birth","volume":"121","author":"Wang","journal-title":"Environ Int"},{"issue":"12","key":"R29","doi-asserted-by":"publisher","first-page":"127010","DOI":"10.1289\/EHP6386","article-title":"Folic acid supplementation and the association between maternal airborne particulate matter exposure and preterm delivery: a national birth cohort study in China","volume":"128","author":"Li","journal-title":"Environ Health Perspect"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.fertnstert.2015.03.024","article-title":"Preconception blood pressure and risk of preterm birth: a large historical cohort study in a Chinese rural population","volume":"104","author":"Yang","journal-title":"Fertil Steril"},{"issue":"3","key":"R31","first-page":"162","volume":"95","author":"Zhang","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-11-49","article-title":"Methodological challenges when estimating the effects of season and seasonal exposures on birth outcomes","volume":"11","author":"Strand","journal-title":"BMC Med Res Methodol"},{"issue":"3","key":"R33","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/01.aoa.0000432360.25014.c3","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications","volume":"33","author":"Blencowe","journal-title":"Obstetric Anesthesia Digest"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1053\/j.semperi.2006.01.009","article-title":"Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002","volume":"30","author":"Davidoff","journal-title":"Semin Perinatol"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecoenv.2018.04.002","article-title":"Maternal air pollution exposure and preterm birth in Wuxi, China: effect modification by maternal age","volume":"157","author":"Han","journal-title":"Ecotoxicol Environ Saf"},{"issue":"12","key":"R36","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1136\/jech-2017-208963","article-title":"Maternal ambient air pollution, preterm birth and markers of fetal growth in Rhode Island: results of a hospital-based linkage study","volume":"71","author":"Kingsley","journal-title":"J Epidemiol Community Health"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2019.108549","article-title":"Synergistic effects of prenatal exposure to fine particulate matter (PM) and ozone (O) on the risk of preterm birth: a population-based cohort study","volume":"176","author":"Siddika","journal-title":"Environ Res"},{"issue":"Pt D","key":"R38","doi-asserted-by":"publisher","first-page":"112403","DOI":"10.1016\/j.envres.2021.112403","article-title":"PM exposure increases the risk of preterm birth in pre-pregnancy impaired fasting glucose women: a cohort study in a southern province of China","volume":"204","author":"Liang","journal-title":"Environ Res"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.02.017","article-title":"Ambient PM and birth outcomes: estimating the association and attributable risk using a birth cohort study in nine Chinese cities","volume":"126","author":"Liang","journal-title":"Environ Int"},{"issue":"9","key":"R40","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1093\/aje\/kwz120","article-title":"Ambient fine particulate matter and preterm birth in California: identification of critical exposure windows","volume":"188","author":"Sheridan","journal-title":"Am J Epidemiol"},{"issue":"3","key":"R41","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1089\/thy.2016.0457","article-title":"2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum","volume":"27","author":"Alexander","journal-title":"Thyroid"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1210\/jc.2013-1674","article-title":"Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women?","volume":"99","author":"Li","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"R43","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12940-021-00748-5","article-title":"Preterm birth and PM in Puerto Rico: evidence from the PROTECT birth cohort","volume":"20","author":"Kirwa","journal-title":"Environ Health"},{"issue":"9","key":"R44","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1289\/ehp.1510133","article-title":"A statewide nested case-control study of preterm birth and air pollution by source and composition: California, 2001-2008","volume":"124","author":"Laurent","journal-title":"Environ Health Perspect"},{"issue":"4","key":"R45","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1289\/ehp.1306837","article-title":"Outdoor air pollution, preterm birth, and low birth weight: analysis of the World Health Organization Global Survey on Maternal and Perinatal Health","volume":"122","author":"Fleischer","journal-title":"Environ Health Perspect"},{"issue":"8","key":"R46","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1289\/ehp.1510266","article-title":"Ambient fine particulate matter, nitrogen dioxide, and preterm birth in New York City","volume":"124","author":"Johnson","journal-title":"Environ Health Perspect"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/aje\/kwt216","article-title":"Fine particulate matter and risk of preterm birth in Connecticut in 2000-2006: a longitudinal study","volume":"179","author":"Pereira","journal-title":"Am J Epidemiol"},{"issue":"7","key":"R48","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1001\/jama.2019.10931","article-title":"Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis","volume":"322","author":"Consortium on Thyroid and Pregnancy\u2014Study Group on Preterm Birth","journal-title":"JAMA"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecoenv.2016.01.030","article-title":"The health effects of ambient PM and potential mechanisms","volume":"128","author":"Feng","journal-title":"Ecotoxicol Environ Saf"},{"issue":"21","key":"R50","doi-asserted-by":"publisher","first-page":"6670","DOI":"10.26355\/eurrev_202111_27111","article-title":"PM-induced inflammation and myocardial cell injury in rats","volume":"25","author":"Ma","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"12","key":"R51","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22126521","article-title":"Environmental factors affecting thyroid-stimulating hormone and thyroid hormone levels","volume":"22","author":"Babi\u0107 Leko","journal-title":"Int J Mol Sci"},{"issue":"8","key":"R52","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1089\/thy.2010.0429","article-title":"Thyroid hormones as modulators of immune activities at the cellular level","volume":"21","author":"De Vito","journal-title":"Thyroid"},{"issue":"3","key":"R53","doi-asserted-by":"publisher","first-page":"254","DOI":"10.4158\/EP.15.3.254","article-title":"Excess thyroid hormone and carbohydrate metabolism","volume":"15","author":"Potenza","journal-title":"Endocr Pract"},{"issue":"6","key":"R54","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1067\/mob.2000.107621","article-title":"Preterm delivery in women with pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network","volume":"183","author":"Sibai","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"R55","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.mehy.2013.11.042","article-title":"Air pollution, inflammation and preterm birth: a potential mechanistic link","volume":"82","author":"Vadillo-Ortega","journal-title":"Med Hypotheses"},{"issue":"3","key":"R56","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s10995-012-1028-5","article-title":"First trimester exposure to ambient air pollution, pregnancy complications and adverse birth outcomes in Allegheny County, PA","volume":"17","author":"Lee","journal-title":"Matern Child Health J"}],"container-title":["JMIR Public Health and Surveillance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publichealth.jmir.org\/2024\/1\/e53879","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:39:59Z","timestamp":1782841199000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealth.jmir.org\/2024\/1\/e53879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,2]]},"references-count":56,"URL":"https:\/\/doi.org\/10.2196\/53879","relation":{},"ISSN":["2369-2960"],"issn-type":[{"value":"2369-2960","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,2]]},"article-number":"v10i5e53879"}}