{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:40:27Z","timestamp":1792809627084,"version":"4.5.0"},"reference-count":55,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T00:00:00Z","timestamp":1748649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Natural Science Foundation of China","award":["82073573"],"award-info":[{"award-number":["82073573"]}]},{"name":"National Natural Science Foundation of China","award":["U21A20523"],"award-info":[{"award-number":["U21A20523"]}]},{"name":"National Natural Science Foundation of China","award":["BZ0308"],"award-info":[{"award-number":["BZ0308"]}]},{"name":"National Natural Science Foundation of China","award":["2022YFC3703502"],"award-info":[{"award-number":["2022YFC3703502"]}]},{"name":"Beijing Key Laboratory of Maternal\u2013Fetal Medicine in Fetal Heart Disease","award":["82073573"],"award-info":[{"award-number":["82073573"]}]},{"name":"Beijing Key Laboratory of Maternal\u2013Fetal Medicine in Fetal Heart Disease","award":["U21A20523"],"award-info":[{"award-number":["U21A20523"]}]},{"name":"Beijing Key Laboratory of Maternal\u2013Fetal Medicine in Fetal Heart Disease","award":["BZ0308"],"award-info":[{"award-number":["BZ0308"]}]},{"name":"Beijing Key Laboratory of Maternal\u2013Fetal Medicine in Fetal Heart Disease","award":["2022YFC3703502"],"award-info":[{"award-number":["2022YFC3703502"]}]},{"name":"National Key Research and Development Program of China","award":["82073573"],"award-info":[{"award-number":["82073573"]}]},{"name":"National Key Research and Development Program of China","award":["U21A20523"],"award-info":[{"award-number":["U21A20523"]}]},{"name":"National Key Research and Development Program of China","award":["BZ0308"],"award-info":[{"award-number":["BZ0308"]}]},{"name":"National Key Research and Development Program of China","award":["2022YFC3703502"],"award-info":[{"award-number":["2022YFC3703502"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>The relevance of O3 exposure in critical congenital heart disease (CCHD) remains uncertain and requires further investigation. The present study aims at quantitatively assessing the association between ambient O3 exposure during the early pregnancy period with fetal CCHD and identifying possible susceptible exposure windows. A retrospective cohort study involving 24,516 pregnant women was conducted using data from the Maternal\u2013Fetal Medicine Consultation Network, which encompassed 1313 medical centers across China from 2013 to 2021. We extracted daily O3 concentrations from a validated grid dataset with a spatial resolution of 0.1\u00b0 at each participant\u2019s residential county to assess ambient O3 exposure, followed by calculating the average exposure levels in the periconceptional period, embryonic period, first trimester, and preconception period. The diagnosis of CCHD was based on fetal echocardiography. Exposure\u2013response analyses were carried out using logistic regression models. During the study period, a total of 1541 (17.4%) subjects were diagnosed with fetal CCHD. Each 10 \u00b5g\/m3 increase in ambient O3 exposure in the periconceptional period was associated with a 26.0% increase in the odds of CCHD (odds ratio [OR]: 1.260, 95% confidence interval [CI]: 1.189, 1.335; p &lt; 0.001). Importantly, the association was not modified by factors including maternal age and occupation status, paternal age and smoking status, conception mode, and the presence of risk factors. In the sensitivity analysis, significant associations were observed between O3 exposure and CCHD in the embryonic period, first trimester, and preconception period, which was consistent with the results of the main analyses. These findings suggest that lowering ambient O3 exposure in the preconception and early pregnancy periods may be beneficial in reducing the risk of fetal CCHD, especially in regions with elevated O3 levels.<\/jats:p>","DOI":"10.3390\/toxics13060463","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T10:21:49Z","timestamp":1748859709000},"page":"463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Maternal Exposure to Ambient Ozone and Fetal Critical Congenital Heart Disease in China: A Large Multicenter Retrospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Yanping","family":"Ruan","sequence":"first","affiliation":[{"name":"Echocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-5425","authenticated-orcid":false,"given":"Zhiyong","family":"Zou","sequence":"additional","affiliation":[{"name":"Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7682-4311","authenticated-orcid":false,"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihua","family":"He","sequence":"additional","affiliation":[{"name":"Echocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Congenital Heart Disease Collaborators (2020). Global, regional, and national burden of congenital heart disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc. Health, 4, 185\u2013200."},{"key":"ref_2","unstructured":"Ossa Galvis, M.M., Bhakta, R.T., Tarmahomed, A., and Mendez, M.D. (2025). Cyanotic Heart Disease. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_3","first-page":"620","article-title":"Infant mortality from congenital malformations in the United States, 1970\u20131997","volume":"98","author":"Lee","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1502-8","DOI":"10.1542\/peds.2012-3435","article-title":"Temporal trends in survival among infants with critical congenital heart defects","volume":"131","author":"Oster","year":"2013","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101249","DOI":"10.1016\/j.eclinm.2021.101249","article-title":"Global, regional, and national time trends in mortality for congenital heart disease, 1990\u20132019: An age-period-cohort analysis for the Global Burden of Disease 2019 study","volume":"43","author":"Su","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jpeds.2018.08.040","article-title":"Prevalence of congenital heart disease at live birth in China","volume":"204","author":"Zhao","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e185","DOI":"10.1542\/peds.2012-3926","article-title":"Implementing recommended screening for critical congenital heart disease","volume":"132","author":"Martin","year":"2013","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"American Institute of Ultrasound in Medicine (2013). AIUM practice guideline for the performance of fetal echocardiography. J. Ultrasound Med., 32, 1067\u20131082.","DOI":"10.7863\/jum.2013.32.6.1067"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/uog.12403","article-title":"ISUOG Practice Guidelines (updated): Sonographic screening examination of the fetal heart","volume":"41","author":"Carvalho","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1016\/S0735-1097(99)00049-2","article-title":"Accuracy of prenatal echocardiographic diagnosis and prognosis of fetuses with conotruncal anomalies","volume":"33","author":"Tometzki","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1161\/01.cir.0000437597.44550.5d","article-title":"Diagnosis and treatment of fetal cardiac disease: A scientific statement from the American Heart Association","volume":"129","author":"Donofrio","year":"2014","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e373","DOI":"10.1542\/peds.2013-3949","article-title":"Delayed diagnosis of critical congenital heart defects: Trends and associated factors","volume":"134","author":"Liberman","year":"2014","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1055\/s-0029-1237424","article-title":"Developmental origins of health and disease: Brief history of the approach and current focus on epigenetic mechanisms","volume":"27","author":"Wadhwa","year":"2009","journal-title":"Semin. Reprod. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164431","DOI":"10.1016\/j.scitotenv.2023.164431","article-title":"The association between maternal air pollution exposure and the incidence of congenital heart diseases in children: A systematic review and meta-analysis","volume":"892","author":"Wan","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_15","first-page":"100517","article-title":"Antagonism between ambient ozone increase and urbanization-oriented population migration on Chinese cardiopulmonary mortality","volume":"4","author":"Sun","year":"2023","journal-title":"Innovation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"H1499","DOI":"10.1152\/ajpheart.00849.2014","article-title":"Exposure to medium and high ambient levels of ozone causes adverse systemic inflammatory and cardiac autonomic effects","volume":"308","author":"Arjomandi","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1001\/jamainternmed.2017.2842","article-title":"Association of ozone exposure with cardiorespiratory pathophysiologic mechanisms in healthy adults","volume":"177","author":"Day","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12940-017-0335-0","article-title":"Ozone exposure is associated with acute changes in inflammation, fibrinolysis, and endothelial cell function in coronary artery disease patients","volume":"16","author":"Mirowsky","year":"2017","journal-title":"Environ. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.envres.2013.03.005","article-title":"Air pollution and congenital heart defects","volume":"124","author":"Friger","year":"2013","journal-title":"Environ. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.reprotox.2021.07.007","article-title":"Independent and interactive effects of air pollutants and ambient heat exposure on congenital heart defects","volume":"104","author":"Jiang","year":"2021","journal-title":"Reprod. Toxicol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"136470","DOI":"10.1016\/j.scitotenv.2019.136470","article-title":"Maternal air pollution exposure associated with risk of congenital heart defect in pre-pregnancy overweighted women","volume":"712","author":"Yang","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhang, B., Zhao, J.Z., Yang, R., Qian, Z.M., Liang, S.W., Bassig, B.A., Zhang, Y.M., Hu, K., Xu, S.Q., and Dong, G.H. (2016). Ozone and other air pollutants and the risk of congenital heart defects. Sci. Rep., 6.","DOI":"10.1038\/srep34852"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.envres.2011.01.022","article-title":"Ambient air pollution and congenital heart disease: A register-based study","volume":"111","author":"Dadvand","year":"2011","journal-title":"Environ. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.envres.2014.08.024","article-title":"The possible association between exposure to air pollution and the risk for congenital malformations","volume":"135","author":"Farhi","year":"2014","journal-title":"Environ. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104953","DOI":"10.1016\/j.envint.2019.104953","article-title":"Spatial variations in ambient ultrafine particle concentrations and risk of congenital heart defects","volume":"130","author":"Lavigne","year":"2019","journal-title":"Environ. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envpol.2015.03.001","article-title":"An exploratory analysis of the relationship between ambient ozone and particulate matter concentrations during early pregnancy and selected birth defects in Texas","volume":"202","author":"Stewart","year":"2015","journal-title":"Environ. Pollut."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1289\/ehp.1002946","article-title":"Ambient air pollution and risk of congenital anomalies: A systematic review and meta-analysis","volume":"119","author":"Vrijheid","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/CIRCULATIONAHA.122.061245","article-title":"Maternal Exposure to PM2.5 and the risk of congenital heart defects in 1.4 Million Births: A nationwide surveillance-based study","volume":"147","author":"Yuan","year":"2023","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1016\/j.fertnstert.2007.12.043","article-title":"Periconception window: Advising the pregnancy-planning couple","volume":"89","author":"Louis","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12989-021-00445-8","article-title":"Exposure to environmentally relevant concentrations of ambient fine particulate matter (PM2.5) depletes the ovarian follicle reserve and causes sex-dependent cardiovascular changes in apolipoprotein E null mice","volume":"19","author":"Luderer","year":"2022","journal-title":"Part. Fibre Toxicol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"106544","DOI":"10.1016\/j.envint.2021.106544","article-title":"Association between exposure to ambient air pollutants and the outcomes of in vitro fertilization treatment: A multicenter retrospective study","volume":"153","author":"Wu","year":"2021","journal-title":"Environ. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"537526","DOI":"10.1155\/2013\/537526","article-title":"Pregnancy and lifestyle: Short- and long-term effects on mother\u2019s and her children\u2019s health","volume":"2013","author":"Luoto","year":"2013","journal-title":"J. Pregnancy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3844","DOI":"10.1080\/14767058.2019.1700498","article-title":"Comparison of fetal echocardiogram with fetal cardiac autopsy findings in fetuses with congenital heart disease","volume":"34","author":"Gao","year":"2021","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/S0735-1097(02)01886-7","article-title":"The incidence of congenital heart disease","volume":"39","author":"Hoffman","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1002\/bdra.23098","article-title":"Selected birth defects data from population-based birth defects surveillance programs in the United States, 2005\u20132009: Featuring critical congenital heart defects targeted for pulse oximetry screening","volume":"94","author":"Mai","year":"2012","journal-title":"Birth Defects Res. A Clin. Mol. Teratol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e20154573","DOI":"10.1542\/peds.2015-4573","article-title":"Lessons learned from newborn screening for critical congenital heart defects","volume":"137","author":"Oster","year":"2016","journal-title":"Pediatrics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6922","DOI":"10.1021\/acs.est.1c04548","article-title":"Tracking PM2.5 and O3 pollution and the related health burden in China 2013\u20132020","volume":"56","author":"Xiao","year":"2022","journal-title":"Environ. Sci. Technol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"126668","DOI":"10.1016\/j.chemosphere.2020.126668","article-title":"Maternal air pollution exposure and congenital heart defects in offspring: A systematic review and meta-analysis","volume":"253","author":"Hu","year":"2020","journal-title":"Chemosphere"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3273","DOI":"10.5194\/acp-20-3273-2020","article-title":"Improved 1km resolution PM2.5 estimates across China using enhanced space\u2013time extremely randomized trees","volume":"20","author":"Wei","year":"2020","journal-title":"Atmos. Chem. Phys."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"112136","DOI":"10.1016\/j.rse.2020.112136","article-title":"Reconstructing 1-km-resolution high-quality PM2.5 data records from 2000 to 2018 in China: Spatiotemporal variations and policy implications","volume":"252","author":"Wei","year":"2021","journal-title":"Remote Sens. Environ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.5194\/acp-23-1511-2023","article-title":"Ground-level gaseous pollutants (NO2, SO2, and CO) in China: Daily seamless mapping and spatiotemporal variations","volume":"23","author":"Wei","year":"2023","journal-title":"Atmos. Chem. Phys."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Xin, Y., Yang, Y., Chen, X., Yue, X., Liu, Y., and Yin, C. (2022). Evaluation of IMERG and ERA5 precipitation products over the Mongolian Plateau. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-26047-8"},{"key":"ref_43","unstructured":"R Core Team (2024, May 31). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/j.scitotenv.2018.11.284","article-title":"Prenatal exposure to PM2.5 and Congenital Heart Diseases in Taiwan","volume":"655","author":"Huang","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envres.2015.12.010","article-title":"Maternal exposure to traffic-related air pollution and birth defects in Massachusetts","volume":"146","author":"Girguis","year":"2016","journal-title":"Environ. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1289\/ehp.1306802","article-title":"Traffic-related air pollution and congenital anomalies in Barcelona","volume":"122","author":"Schembari","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"7863","DOI":"10.5194\/acp-21-7863-2021","article-title":"Himawari-8-derived diurnal variations in ground-level PM2.5 pollution across China using the fast space-time Light Gradient Boosting Machine (LightGBM)","volume":"21","author":"Wei","year":"2021","journal-title":"Atmos. Chem. Phys."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/j.fertnstert.2013.01.103","article-title":"Intrauterine exposure to diesel exhaust diminishes adult ovarian reserve","volume":"99","author":"Ogliari","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S206","DOI":"10.1016\/j.fertnstert.2008.07.488","article-title":"Effects of short-term exposure of female mice to diesel exhaust particles on in vitro fertilization and embryo development","volume":"90","author":"Perin","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.envres.2018.07.008","article-title":"Ambient air pollution and pregnancy outcomes: A comprehensive review and identification of environmental public health challenges","volume":"167","author":"Klepac","year":"2018","journal-title":"Environ. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1089\/jamp.2011.0932","article-title":"Air pollution during pregnancy and neonatal outcome: A review","volume":"26","author":"Proietti","year":"2013","journal-title":"J. Aerosol Med. Pulm. Drug Deliv."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1093\/toxsci\/kfq165","article-title":"Biological effects and dose-response assessment of diesel exhaust particles on in vitro early embryo development in mice","volume":"117","author":"Perin","year":"2010","journal-title":"Toxicol. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ecoenv.2018.10.109","article-title":"Impact of ambient PM2.5 on adverse birth outcome and potential molecular mechanism","volume":"169","author":"Li","year":"2019","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1073\/pnas.0705896105","article-title":"Germ-line mutations, DNA damage, and global hypermethylation in mice exposed to particulate air pollution in an urban\/industrial location","volume":"105","author":"Yauk","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"120850","DOI":"10.1016\/j.envpol.2022.120850","article-title":"A systematic review of evidence for maternal preconception exposure to outdoor air pollution on Children\u2019s health","volume":"318","author":"Blanc","year":"2023","journal-title":"Environ. Pollut."}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/6\/463\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:37Z","timestamp":1760031877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/6\/463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,31]]},"references-count":55,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["toxics13060463"],"URL":"https:\/\/doi.org\/10.3390\/toxics13060463","relation":{},"ISSN":["2305-6304"],"issn-type":[{"value":"2305-6304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,31]]}}}