Association of exposure to PM2.5-bound metals with premature rupture of membranes: a prospective cohort study

Mengdan Liang; Liping Qiu; Biyun Lin; Zhehui Chen; Xiannuan Jiang; Mengying Xie; Xiaowei Xie; Hanbing Chen; Xiongkun He; Xiaoxiao Huang; Liang Lu; Lanlan Zhang; Hongjie Qiu; Yihong Chen; Junqi Wu; Xiaoxu Xie

doi:10.3389/fpubh.2025.1603156

Association of exposure to PM_2.5-bound metals with premature rupture of membranes: a prospective cohort study

Front Public Health. 2025 Jun 16:13:1603156. doi: 10.3389/fpubh.2025.1603156. eCollection 2025.

Authors

Mengdan Liang^#¹, Liping Qiu^#², Biyun Lin^#³, Zhehui Chen¹, Xiannuan Jiang¹, Mengying Xie⁴, Xiaowei Xie⁵, Hanbing Chen¹, Xiongkun He¹, Xiaoxiao Huang¹, Liang Lu², Lanlan Zhang⁶, Hongjie Qiu⁷, Yihong Chen⁸, Junqi Wu⁹, Xiaoxu Xie^{1

10}

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
² The Collaboration Unit for State Key Laboratory of Infectious Disease Prevention and Control, Jiangxi Provincial Health Commission Key Laboratory of Pathogenic Diagnosis and Genomics of Emerging Infectious Diseases, Nanchang Center for Disease Control and Prevention, Nanchang, China.
³ Department of Neonatal Intensive Care Unit, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁴ The Second Clinical Medical School, Nanchang University, Nanchang, China.
⁵ Department of Urology, Harbin Medical University Cancer Hospital, Harbin, China.
⁶ Hospital-Acquired Infection Control Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
⁷ Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
⁸ Department of Obstetrics and Gynecology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁹ Department of Laboratory Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
¹⁰ Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.

^# Contributed equally.

Abstract

Background: Exposure to PM_2.5 has been linked to premature rupture of membranes (PROM). However, research on the effects of PM_2.5-bound metals on the PROM is limited.

Methods: Here, we investigated this relationship using data from 6090 pregnant women, estimating exposure to 11 PM_2.5-bound metals throughout pregnancy. Cox models assessed associations between individual metals and PROM, while grouped weighted quantile sum regression (GWQS), quantile g-computation (Q-gcomp), and Bayesian kernel machine regression (BKMR) were used for metal mixtures.

Results: Exposure to Al, Cd, Pb, Cr, Ni, Se, and Tl increased PROM risk, with hazard ratios ranging from 1.40 to 1.87. As and Mn were also correlated with PROM during specific trimesters. The GWQS model showed a 3% increased risk of PROM with metal mixture exposure (95% CI: 2%, 4%), mainly driven by Pb in the positive direction. The Q-gcomp model revealed a 5% increased risk (95% CI: 2%, 8%), also primarily due to Pb. In the BKMR model, Ni had the highest influence.

Conclusion: Both individual metals and metal mixtures were associated with PROM, with Pb, Se, and Tl positively correlated with preterm PROM.

Keywords: air pollution; metal; mixture; particulate matter; premature rupture of membranes.

MeSH terms

Adult
Air Pollutants* / adverse effects
Environmental Exposure* / adverse effects
Female
Fetal Membranes, Premature Rupture* / chemically induced
Fetal Membranes, Premature Rupture* / epidemiology
Humans
Maternal Exposure* / adverse effects
Maternal Exposure* / statistics & numerical data
Metals* / adverse effects
Particulate Matter* / adverse effects
Particulate Matter* / analysis
Pregnancy
Prospective Studies

Substances

Particulate Matter
Metals
Air Pollutants

Supplementary concepts

Preterm Premature Rupture of the Membranes