{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T14:32:27Z","timestamp":1793543547403,"version":"4.5.0"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Natural Science Foundation of China","award":["82204060"],"award-info":[{"award-number":["82204060"]}]},{"name":"National Natural Science Foundation of China","award":["82273651"],"award-info":[{"award-number":["82273651"]}]},{"name":"National Natural Science Foundation of China","award":["81874266"],"award-info":[{"award-number":["81874266"]}]},{"name":"Key Research and Development Project of Hainan Province","award":["82204060"],"award-info":[{"award-number":["82204060"]}]},{"name":"Key Research and Development Project of Hainan Province","award":["82273651"],"award-info":[{"award-number":["82273651"]}]},{"name":"Key Research and Development Project of Hainan Province","award":["81874266"],"award-info":[{"award-number":["81874266"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>The relationship between ozone (O3) exposure and gestational diabetes mellitus (GDM) in twin pregnancies remains unexplored. This study aimed to investigate the association between O3 exposure and GDM risk in twin pregnancies, and to explore the synergistic effects of O3 exposure with other maternal factors. A total of 428 pregnancies recruited from a prospective twin cohort were included. Cox proportional hazard models with distributed lag non-linear models (DLNMs) were applied to examine the associations between O3 exposure and the risk of GDM and to identify the critical windows. The multiplicative and additive interaction were further analyzed to test the synergistic effects. A 10 \u03bcg\/m3 increase in average O3 exposure during the 12 weeks before pregnancy was associated with a 26% higher risk of GDM. The critical windows were identified in the period from the 3rd week before gestation to the 2nd gestational week as well as from the 17th to 19th gestational week. There were synergistic effects between high O3 exposure during preconception and advanced maternal age, and a history of preterm birth\/abortion\/stillbirth. Periconceptional O3 exposure could increase the risk of GDM in twin pregnancy women, and the synergism of O3 exposure with certain GDM risk factors was observed.<\/jats:p>","DOI":"10.3390\/toxics13020117","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T04:36:51Z","timestamp":1738557411000},"page":"117","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ozone Exposure and Gestational Diabetes in Twin Pregnancies: Exploring Critical Windows and Synergistic Risks"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3284-2531","authenticated-orcid":false,"given":"Anda","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"},{"name":"Huadong Hospital, Fudan University, Shanghai 200040, China"},{"name":"Hainan Branch, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya 572000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanqing","family":"Xia","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoyu","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Kang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-737X","authenticated-orcid":false,"given":"Renyi","family":"Hua","sequence":"additional","affiliation":[{"name":"International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China"},{"name":"Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China"},{"name":"Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuping","family":"Lyu","sequence":"additional","affiliation":[{"name":"International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China"},{"name":"Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China"},{"name":"Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"The People\u2019s Hospital of Nujiang Lisu Autonomous Prefecture, Lushui 673199, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyu","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Public Health, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0995-2393","authenticated-orcid":false,"given":"Yanlin","family":"Wang","sequence":"additional","affiliation":[{"name":"International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China"},{"name":"Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China"},{"name":"Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenghui","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"},{"name":"Hainan Branch, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya 572000, China"},{"name":"MOE-Shanghai Key Laboratory of Children\u2019s Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1210\/endrev\/bnac003","article-title":"A Clinical Update on Gestational Diabetes Mellitus","volume":"43","author":"Sweeting","year":"2022","journal-title":"Endocr. 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