{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T20:44:23Z","timestamp":1767991463071,"version":"3.49.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Twin growth discordance is one of the leading causes of perinatal mortality in twin pregnancies. Whether prenatal exposure to heavy metals and trace elements is associated with twin growth discordance has not been studied yet.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the prenatal level of heavy metals and trace elements in twin pregnancy and its relationship with twin growth discordance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study involving 60 twin pairs and their mothers was conducted in Zhejiang Province, China, in 2020\u20132021. The concentration of heavy metals and trace elements in maternal blood, umbilical cord, and placenta were collected at delivery and measured by inductively coupled plasma tandem mass spectrometer. The association of prenatal level with twin growth discordance was evaluated using conditional logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>High levels of heavy metal elements (thallium in maternal blood and umbilical cord blood of larger twins, vanadium in the placenta of larger twins) and trace elements (iodine in the placenta of larger twins) during pregnancy, as well as low levels of heavy metal elements (strontium in the umbilical cord blood of larger twins, strontium and chromium in the umbilical cord blood of smaller twins, strontium in the placenta of larger twins, molybdenum and lead in the placenta of smaller twins and difference of molybdenum in the placenta of twins), are associated with intertwin birthweight discordance. Univariate regression analyses showed a significant effect of gestational age at delivery and eleven trace element data on intertwin birthweight discordance. Multivariable logistic regression analysis with transformed variables as dichotomous risk factors combined with baseline demographic characteristics showed Tl in maternal blood as an independent risk factor. The model constructed by combining Tl in maternal blood (OR\u2009=\u200954.833, 95% CI, 3.839\u201383.156) with the gestational week (OR\u2009=\u20090.618, 95% CI, 0.463\u20130.824) had good predictive power for intertwin birthweight discordance (AUC\u2009=\u20090.871). The sensitivity analysis results indicate that the effect of maternal blood thallium on intertwin birthweight discordance is stable and reliable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To our knowledge, ours is the first case\u2013control study to investigate the association between elevated maternal thallium levels before delivery and twin growth discordance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1203381","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T04:56:59Z","timestamp":1708405019000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Exposure to heavy metals and trace elements among pregnant women with twins: levels and association with twin growth discordance"],"prefix":"10.3389","volume":"12","author":[{"given":"Lu","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiongxin","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weixiao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanhua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Wen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.ajog.2011.06.075","article-title":"Discordant twins: diagnosis, evaluation and management","volume":"206","author":"Miller","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s00431-015-2648-8","article-title":"Neuro-developmental outcome of a large cohort of growth discordant twins","volume":"175","author":"Halling","year":"2016","journal-title":"Eur J Pediatr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"393.e1","DOI":"10.1016\/j.ajog.2013.01.044","article-title":"Significance of growth discordance in appropriately grown twins","volume":"208","author":"Harper","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1038\/jp.2012.121","article-title":"Discordance in neonatal risk factors and early childhood outcomes of very low birth weight (<1.5 kg) twins","volume":"33","author":"Steingass","year":"2013","journal-title":"J Perinatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1097\/AOG.0b013e31821fd208","article-title":"Definition of intertwin birth weight discordance","volume":"118","author":"Breathnach","year":"2011","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"871","DOI":"10.2147\/IJWH.S115515","article-title":"Adverse maternal outcomes and birth weight discordance in twin gestation: British Columbia, Canadian data","volume":"9","author":"Jahanfar","year":"2017","journal-title":"Int J Women's Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1111\/ahg.12146","article-title":"Differentially methylated genomic regions in birth-weight discordant twin pairs","volume":"80","author":"Chen","year":"2016","journal-title":"Ann Hum Genet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1055\/s-0030-1270116","article-title":"Intrauterine growth restriction in twin pregnancies: incidence and associated risk factors","volume":"28","author":"Fox","year":"2011","journal-title":"Am J Perinatol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1017\/thg.2013.22","article-title":"Perinatal outcomes in preterm growth-restricted twins: effects of gestational age and fetal condition","volume":"16","author":"Manzanares","year":"2013","journal-title":"Twin Res Hum Genet"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3109\/14767058.2016.1174209","article-title":"Hypertension in dichorionic twin gestations: how is birthweight affected?","volume":"30","author":"Sparks","year":"2017","journal-title":"Prenat Neonatal Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.reprotox.2020.02.004","article-title":"Review of the environmental prenatal exposome and its relationship to maternal and fetal health","volume":"98","author":"Rager","year":"2020","journal-title":"Reprod Toxicol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.envres.2016.03.006","article-title":"Small for gestational age and exposure to particulate air pollution in the early-life environment of twins","volume":"148","author":"Bijnens","year":"2016","journal-title":"Environ Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"105148","DOI":"10.1016\/j.envint.2019.105148","article-title":"Twin growth discordance in association with maternal exposure to fine particulate matter and its chemical constituents during late pregnancy","volume":"133","author":"Qiao","year":"2019","journal-title":"Environ Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1126\/science.344.6185.691-a","article-title":"China's soil pollution: farms on the frontline","volume":"344","author":"Chen","year":"2014","journal-title":"Science"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"909","DOI":"10.3390\/ijerph16060909","article-title":"Analysis of heavy metals in foodstuffs and an assessment of the health risks to the general public via consumption in Beijing, China","volume":"16","author":"Liang","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/s41370-021-00289-6","article-title":"Cadmium exposure and risk of adverse pregnancy and birth outcomes: a systematic review and dose-response meta-analysis of cohort and cohort-based case-control studies","volume":"31","author":"Amegah","year":"2021","journal-title":"J Expo Sci Environ Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s12011-019-01819-y","article-title":"Maternal exposure to cadmium and fetal growth: a systematic review and meta-analysis","volume":"195","author":"Khoshhali","year":"2020","journal-title":"Biol Trace Elem Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1007\/s12011-018-1312-3","article-title":"Maternal cadmium levels during pregnancy and the relationship with preeclampsia and fetal biometric parameters","volume":"186","author":"Wang","year":"2018","journal-title":"Biol Trace Elem Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"109879","DOI":"10.1016\/j.ecoenv.2019.109879","article-title":"Maternal cadmium exposure during late pregnancy causes fetal growth restriction via inhibiting placental progesterone synthesis","volume":"187","author":"Xiong","year":"2020","journal-title":"Ecotoxicol Environ Saf"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1080\/15287394.2015.1090939","article-title":"Systematic review of chromium and nickel exposure during pregnancy and impact on child outcomes","volume":"78","author":"McDermott","year":"2015","journal-title":"J Toxicol Environ Health A"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.envres.2014.12.010","article-title":"The critical fetal stage for maternal manganese exposure","volume":"137","author":"Tsai","year":"2015","journal-title":"Environ Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.envres.2019.02.007","article-title":"Association between blood manganese level during pregnancy and birth size: the Japan environment and children's study (jecs)","volume":"172","author":"Yamamoto","year":"2019","journal-title":"Environ Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.envint.2018.03.048","article-title":"Occurrence of 44 elements in human cord blood and their association with growth indicators in newborns","volume":"116","author":"Cabrera-Rodr\u00edguez","year":"2018","journal-title":"Environ Int"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.envint.2018.08.010","article-title":"Intrauterine multi-metal exposure is associated with reduced fetal growth through modulation of the placental gene network","volume":"120","author":"Deyssenroth","year":"2018","journal-title":"Environ Int"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1097\/01.ede.0000072104.65240.69","article-title":"Arsenic exposure from drinking water and birth weight","volume":"14","author":"Hopenhayn","year":"2003","journal-title":"Epidemiology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12199-017-0635-6","article-title":"Effects of intrauterine exposures to polychlorinated biphenyls, methylmercury, and lead on birth weight in japanese male and female newborns","volume":"22","author":"Tatsuta","year":"2017","journal-title":"Environ Health Prev Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/1471-0528.12756","article-title":"Adverse effects of maternal lead levels on birth outcomes in the alspac study: a prospective birth cohort study","volume":"122","author":"Taylor","year":"2015","journal-title":"BJOG"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1002\/ajim.23187","article-title":"Association between blood lead level during pregnancy and birth weight: a meta-analysis","volume":"63","author":"Wang","year":"2020","journal-title":"Am J Ind Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.reprotox.2008.11.057","article-title":"Fetal growth restriction is related to placental levels of cadmium, lead and arsenic but not with antioxidant activities","volume":"27","author":"Llanos","year":"2009","journal-title":"Reprod Toxicol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1016\/j.envint.2018.10.038","article-title":"Associations of blood metal exposure with thyroid hormones in chinese pregnant women: a cross-sectional study","volume":"121","author":"Guo","year":"2018","journal-title":"Environ Int"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"125721","DOI":"10.1016\/j.chemosphere.2019.125721","article-title":"Repeated measures of prenatal thallium exposure and placental inflammatory cytokine mrna expression: the ma'anshan birth cohort (mabc) study","volume":"246","author":"Zhu","year":"2020","journal-title":"Chemosphere"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"125499","DOI":"10.1016\/j.chemosphere.2019.125499","article-title":"Prenatal serum thallium exposure and 36-month-old children's attention-deficit\/hyperactivity disorder symptoms: Ma'anshan birth cohort study","volume":"244","author":"Tong","year":"2020","journal-title":"Chemosphere"},{"key":"ref33","first-page":"21","article-title":"Distributions of heavy metals in maternal and cord blood and the association with infant birth weight in China","volume":"60","author":"Hu","year":"2015","journal-title":"J Reprod Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1002\/tox.21900","article-title":"Toxicity of thallium on isolated rat liver mitochondria: the role of oxidative stress and mpt pore opening","volume":"30","author":"Eskandari","year":"2015","journal-title":"Environ Toxicol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1289\/ehp.1409202","article-title":"A case-control study of prenatal thallium exposure and low birth weight in China","volume":"124","author":"Xia","year":"2016","journal-title":"Environ Health Perspect"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"495","DOI":"10.3390\/ijerph13050495","article-title":"Combined effects of prenatal exposures to environmental chemicals on birth weight","volume":"13","author":"Govarts","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.envint.2018.12.005","article-title":"Prenatal thallium exposure and poor growth in early childhood: a prospective birth cohort study","volume":"123","author":"Qi","year":"2019","journal-title":"Environ Int"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1196\/annals.1299.049","article-title":"Thallium induces apoptosis in jurkat cells","volume":"1010","author":"Bragadin","year":"2003","journal-title":"Ann N Y Acad Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1023\/A:1026182511897","article-title":"Thallium induces opening of the mitochondrial permeability transition pore in the inner membrane of rat liver mitochondria","volume":"392","author":"Korotkov","year":"2003","journal-title":"Dokl Biochem Biophys"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1016\/j.taap.2006.07.003","article-title":"Thallium induces hydrogen peroxide generation by impairing mitochondrial function","volume":"216","author":"Hanzel","year":"2006","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1016\/j.ijheh.2012.08.005","article-title":"Metals in blood and urine, and thyroid function among adults in the United States 2007-2008","volume":"216","author":"Yorita Christensen","year":"2013","journal-title":"Int J Hyg Environ Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"4732","DOI":"10.3390\/ijerph16234732","article-title":"Toxicity of thallium at low doses: a review","volume":"16","author":"Campanella","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.envint.2017.05.022","article-title":"Neonatal exposure to environmental pollutants and placental mitochondrial DNA content: a multi-pollutant approach","volume":"106","author":"Vriens","year":"2017","journal-title":"Environ Int"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.chemosphere.2018.11.115","article-title":"Trace element profiles in pregnant women's sera and umbilical cord sera and influencing factors: repeated measurements","volume":"218","author":"Liang","year":"2019","journal-title":"Chemosphere"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1080\/15287394.2013.738171","article-title":"Effect of pregnancy on the levels of urinary metals for females aged 17-39 years old: data from national health and nutrition examination survey 2003-2010","volume":"76","author":"Jain","year":"2013","journal-title":"J Toxicol Environ Health A"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.envint.2013.06.017","article-title":"Associations between socioeconomic status and environmental toxicant concentrations in adults in the USA: Nhanes 2001-2010","volume":"59","author":"Tyrrell","year":"2013","journal-title":"Environ Int"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"13464","DOI":"10.1007\/s11356-019-04731-z","article-title":"Urinary concentrations of environmental metals and associating factors in pregnant women","volume":"26","author":"Wang","year":"2019","journal-title":"Environ Sci Pollut Res Int"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1203381\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T04:57:03Z","timestamp":1708405023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1203381\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":47,"alternative-id":["10.3389\/fpubh.2024.1203381"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1203381","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"article-number":"1203381"}}