{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:42:48Z","timestamp":1768873368274,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82260647"],"award-info":[{"award-number":["82260647"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Ningxia Key Research and Development Program","award":["2023BEG02005"],"award-info":[{"award-number":["2023BEG02005"]}]},{"name":"the Open competition mechanism to select the best candidates for key research projects of Ningxia Medical University","award":["XJKF240317"],"award-info":[{"award-number":["XJKF240317"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>Prenatal ozone (O3) exposure may trigger systemic inflammation and oxidative stress. These effects could contribute to adverse pregnancy outcomes. We conducted a prospective cohort study involving 235 pregnant women in Ningxia, China. Maternal O3 exposure during pregnancy and prior to conception was assessed using high-resolution spatiotemporal models. Multivariable logistic and linear regression analyses were employed to evaluate the associations between O3 exposure and adverse pregnancy outcomes. Mediation and interaction models were further applied to examine the potential modifying roles of gestational diabetes mellitus (GDM) and inflammatory biomarkers. In multivariable analyses adjusted for maternal and environmental covariates, higher prenatal O3 exposure was significantly associated with an increased risk of preterm birth (PTB) (OR = 1.24, 95% CI: 1.05~1.45, p = 0.010) and low birth weight (LBW) (OR = 1.29, 95% CI: 1.09~1.54, p = 0.004). Similarly, elevated maternal SAA and CRP levels were positively associated with these adverse pregnancy outcomes (p &lt; 0.05). Notably, higher TNF-\u03b1 levels were inversely associated with the risks of PTB (OR = 0.15, 95% CI: 0.03~0.85, p = 0.032) and LBW (OR = 0.05, 95% CI: 0.01~0.39, p = 0.005). IL-17A levels were inversely associated with neonatal length-for-age Z scores (\u03b2 = \u22120.28, 95% CI: \u22120.55~\u22120.01, p = 0.043). Our findings suggest that prenatal O3 exposure is associated with increased risks of PTB and LBW. Alterations in systemic inflammatory markers and metabolic dysfunction during pregnancy were related to adverse pregnancy outcomes and fetal growth deficits, but they did not mediate these associations, with O3 remaining an independent predictor after adjustment.<\/jats:p>","DOI":"10.3390\/toxics13110983","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T15:03:15Z","timestamp":1763564595000},"page":"983","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Prenatal Ozone Exposure with Fetal Growth and Birth Outcomes: Roles of Maternal Inflammation and Metabolic Dysregulation"],"prefix":"10.3390","volume":"13","author":[{"given":"Zexin","family":"Yu","sequence":"first","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueyi","family":"Lv","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengjun","family":"Chang","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunyun","family":"Du","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianjia","family":"Li","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Ji","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzhen","family":"Guan","sequence":"additional","affiliation":[{"name":"Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan 750004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e236347","DOI":"10.1001\/jamanetworkopen.2023.6347","article-title":"Ozone Exposure During Pregnancy and Risk of Gestational Hypertension or Preeclampsia in China","volume":"6","author":"Cheng","year":"2023","journal-title":"JAMA Netw. 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