A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes

Haitong Zhe Sun; Haiyang Tang; Jing Fang; Haizhen Dai; Huan Zhao; Siyuan Xu; Qingyi Xiang; Yijia Tian; Yurong Jiao; Ting Luo; Meishuang Huang; Jia Shu; Lu Zang; Hengyi Liu; Yuming Guo; Wei Xu; Xiaoxia Bai; on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group

doi:10.1016/j.jhazmat.2023.132915

A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes

Haitong Zhe Sun, Haiyang Tang, Jing Fang, Haizhen Dai, Huan Zhao, Siyuan Xu, Qingyi Xiang, Yijia Tian, Yurong Jiao, Ting Luo, Meishuang Huang, Jia Shu, Lu Zang, Hengyi Liu, Yuming Guo, Wei Xu, Xiaoxia Bai, on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group

Research output: Contribution to journal › Article › Research › peer-review

13 Citations (Scopus)

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease that occurs during mid-to-late pregnancy and is associated with various adverse pregnancy outcomes, including intrauterine fetal demise. However, since the underlying cause of ICP remains unclear, there is an ongoing debate on the phenotyping criteria used in the diagnostic process. Here, we identified single- and multi-symptomatic ICP (ICP-S and ICP-M) in 104,221 Chinese females from the ZEBRA maternity cohort, with the objective of exploring the risk implications of the two phenotypes on pregnancy outcomes and from environmental exposures. We employed multivariate binary logistic regression to estimate confounder-adjusted odds ratios and found that ICP-M was more strongly associated with preterm birth and low birth weight compared to ICP-S. Throughout pregnancy, incremental exposure to PM_2.5, O₃, and greenness could alter ICP risks by 17.3%, 12.5%, and –2.3%, respectively, with more substantial associations observed with ICP-M than with ICP-S. The major scientific advancements lie in the elucidation of synergistic risk interactions between pollutants and the protective antagonistic effects of greenness, as well as highlighting the risk impact of preconceptional environmental exposures. Our study, conducted in the context of the “three-child policy” in China, provides epidemiological evidence for policy-making to safeguard maternal and neonatal health.

Original language	English
Article number	132915
Number of pages	11
Journal	Journal of Hazardous Materials
Volume	463
DOIs	https://doi.org/10.1016/j.jhazmat.2023.132915
Publication status	Published - 5 Feb 2024

Keywords

Adverse pregnancy outcome
Air pollution
Greenness
Intrahepatic cholestasis of pregnancy
Maternal and reproductive health

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10.1016/j.jhazmat.2023.132915Licence: CC BY-NC-ND

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Sun, H. Z., Tang, H., Fang, J., Dai, H., Zhao, H., Xu, S., Xiang, Q., Tian, Y., Jiao, Y., Luo, T., Huang, M., Shu, J., Zang, L., Liu, H., Guo, Y., Xu, W., Bai, X., & on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group (2024). A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes. Journal of Hazardous Materials, 463, Article 132915. https://doi.org/10.1016/j.jhazmat.2023.132915

@article{6e5827b42db4450fa10ca13e82b8f7b6,

title = "A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes",

abstract = "Intrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease that occurs during mid-to-late pregnancy and is associated with various adverse pregnancy outcomes, including intrauterine fetal demise. However, since the underlying cause of ICP remains unclear, there is an ongoing debate on the phenotyping criteria used in the diagnostic process. Here, we identified single- and multi-symptomatic ICP (ICP-S and ICP-M) in 104,221 Chinese females from the ZEBRA maternity cohort, with the objective of exploring the risk implications of the two phenotypes on pregnancy outcomes and from environmental exposures. We employed multivariate binary logistic regression to estimate confounder-adjusted odds ratios and found that ICP-M was more strongly associated with preterm birth and low birth weight compared to ICP-S. Throughout pregnancy, incremental exposure to PM2.5, O3, and greenness could alter ICP risks by 17.3\%, 12.5\%, and –2.3\%, respectively, with more substantial associations observed with ICP-M than with ICP-S. The major scientific advancements lie in the elucidation of synergistic risk interactions between pollutants and the protective antagonistic effects of greenness, as well as highlighting the risk impact of preconceptional environmental exposures. Our study, conducted in the context of the “three-child policy” in China, provides epidemiological evidence for policy-making to safeguard maternal and neonatal health.",

keywords = "Adverse pregnancy outcome, Air pollution, Greenness, Intrahepatic cholestasis of pregnancy, Maternal and reproductive health",

author = "Sun, \{Haitong Zhe\} and Haiyang Tang and Jing Fang and Haizhen Dai and Huan Zhao and Siyuan Xu and Qingyi Xiang and Yijia Tian and Yurong Jiao and Ting Luo and Meishuang Huang and Jia Shu and Lu Zang and Hengyi Liu and Yuming Guo and Wei Xu and Xiaoxia Bai and \{on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group\}",

note = "Funding Information: This study is funded by the Zhejiang Province Health Innovative Talent Project (A0466), International Cooperation Seed Program of Women's Hospital, Zhejiang University (GH2022B008-01), Key Projects of the Science and Technology Co-construction by National Administration of Traditional Chinese Medicine and Zhejiang Provincial Administration of Traditional Chinese Medicine (GZY-ZJ-KJ-23082), Australian Research Council (DP210102076), and Australian National Health and Medical Research Council (APP2000581). Haitong Zhe Sun also thanks generous support from the U.S. Fulbright Program. Yuming Guo is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). Special appreciations to Professor Weiguo Lu, director of the Key Laboratory of Women's Reproductive Health, and Dr. Jing He, Chief Physician of the Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, for their comprehensive supports in establishing and coordinating the maternity cohort. We would also like to thank Editage (www.editage.cn) for English language editing. Funding Information: This study is funded by the Zhejiang Province Health Innovative Talent Project ( A0466 ), International Cooperation Seed Program of Women{\textquoteright}s Hospital, Zhejiang University ( GH2022B008-01 ), Key Projects of the Science and Technology Co-construction by National Administration of Traditional Chinese Medicine and Zhejiang Provincial Administration of Traditional Chinese Medicine ( GZY-ZJ-KJ-23082 ), Australian Research Council ( DP210102076 ), and Australian National Health and Medical Research Council ( APP2000581 ). Haitong Zhe Sun also thanks generous support from the U.S. Fulbright Program. Yuming Guo is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council ( APP1163693 ). Special appreciations to Professor Weiguo Lu, director of the Key Laboratory of Women{\textquoteright}s Reproductive Health, and Dr. Jing He, Chief Physician of the Department of Obstetrics, Women{\textquoteright}s Hospital, School of Medicine, Zhejiang University, for their comprehensive supports in establishing and coordinating the maternity cohort. We would also like to thank Editage ( www.editage.cn ) for English language editing. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = feb,

day = "5",

doi = "10.1016/j.jhazmat.2023.132915",

language = "English",

volume = "463",

journal = "Journal of Hazardous Materials",

issn = "0304-3894",

publisher = "Elsevier BV",

}

Sun, HZ, Tang, H, Fang, J, Dai, H, Zhao, H, Xu, S, Xiang, Q, Tian, Y, Jiao, Y, Luo, T, Huang, M, Shu, J, Zang, L, Liu, H, Guo, Y, Xu, W, Bai, X & on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group 2024, 'A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes', Journal of Hazardous Materials, vol. 463, 132915. https://doi.org/10.1016/j.jhazmat.2023.132915

A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes. / Sun, Haitong Zhe; Tang, Haiyang; Fang, Jing et al.
In: Journal of Hazardous Materials, Vol. 463, 132915, 05.02.2024.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes

T2 - Risk associations from environmental exposure to adverse pregnancy outcomes

AU - Sun, Haitong Zhe

AU - Tang, Haiyang

AU - Fang, Jing

AU - Dai, Haizhen

AU - Zhao, Huan

AU - Xu, Siyuan

AU - Xiang, Qingyi

AU - Tian, Yijia

AU - Jiao, Yurong

AU - Luo, Ting

AU - Huang, Meishuang

AU - Shu, Jia

AU - Zang, Lu

AU - Liu, Hengyi

AU - Guo, Yuming

AU - Xu, Wei

AU - Bai, Xiaoxia

AU - on behalf of the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) collaborative group

N1 - Funding Information: This study is funded by the Zhejiang Province Health Innovative Talent Project (A0466), International Cooperation Seed Program of Women's Hospital, Zhejiang University (GH2022B008-01), Key Projects of the Science and Technology Co-construction by National Administration of Traditional Chinese Medicine and Zhejiang Provincial Administration of Traditional Chinese Medicine (GZY-ZJ-KJ-23082), Australian Research Council (DP210102076), and Australian National Health and Medical Research Council (APP2000581). Haitong Zhe Sun also thanks generous support from the U.S. Fulbright Program. Yuming Guo is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). Special appreciations to Professor Weiguo Lu, director of the Key Laboratory of Women's Reproductive Health, and Dr. Jing He, Chief Physician of the Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, for their comprehensive supports in establishing and coordinating the maternity cohort. We would also like to thank Editage (www.editage.cn) for English language editing. Funding Information: This study is funded by the Zhejiang Province Health Innovative Talent Project ( A0466 ), International Cooperation Seed Program of Women’s Hospital, Zhejiang University ( GH2022B008-01 ), Key Projects of the Science and Technology Co-construction by National Administration of Traditional Chinese Medicine and Zhejiang Provincial Administration of Traditional Chinese Medicine ( GZY-ZJ-KJ-23082 ), Australian Research Council ( DP210102076 ), and Australian National Health and Medical Research Council ( APP2000581 ). Haitong Zhe Sun also thanks generous support from the U.S. Fulbright Program. Yuming Guo is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council ( APP1163693 ). Special appreciations to Professor Weiguo Lu, director of the Key Laboratory of Women’s Reproductive Health, and Dr. Jing He, Chief Physician of the Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, for their comprehensive supports in establishing and coordinating the maternity cohort. We would also like to thank Editage ( www.editage.cn ) for English language editing. Publisher Copyright: © 2023 The Authors

PY - 2024/2/5

Y1 - 2024/2/5

N2 - Intrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease that occurs during mid-to-late pregnancy and is associated with various adverse pregnancy outcomes, including intrauterine fetal demise. However, since the underlying cause of ICP remains unclear, there is an ongoing debate on the phenotyping criteria used in the diagnostic process. Here, we identified single- and multi-symptomatic ICP (ICP-S and ICP-M) in 104,221 Chinese females from the ZEBRA maternity cohort, with the objective of exploring the risk implications of the two phenotypes on pregnancy outcomes and from environmental exposures. We employed multivariate binary logistic regression to estimate confounder-adjusted odds ratios and found that ICP-M was more strongly associated with preterm birth and low birth weight compared to ICP-S. Throughout pregnancy, incremental exposure to PM2.5, O3, and greenness could alter ICP risks by 17.3%, 12.5%, and –2.3%, respectively, with more substantial associations observed with ICP-M than with ICP-S. The major scientific advancements lie in the elucidation of synergistic risk interactions between pollutants and the protective antagonistic effects of greenness, as well as highlighting the risk impact of preconceptional environmental exposures. Our study, conducted in the context of the “three-child policy” in China, provides epidemiological evidence for policy-making to safeguard maternal and neonatal health.

AB - Intrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease that occurs during mid-to-late pregnancy and is associated with various adverse pregnancy outcomes, including intrauterine fetal demise. However, since the underlying cause of ICP remains unclear, there is an ongoing debate on the phenotyping criteria used in the diagnostic process. Here, we identified single- and multi-symptomatic ICP (ICP-S and ICP-M) in 104,221 Chinese females from the ZEBRA maternity cohort, with the objective of exploring the risk implications of the two phenotypes on pregnancy outcomes and from environmental exposures. We employed multivariate binary logistic regression to estimate confounder-adjusted odds ratios and found that ICP-M was more strongly associated with preterm birth and low birth weight compared to ICP-S. Throughout pregnancy, incremental exposure to PM2.5, O3, and greenness could alter ICP risks by 17.3%, 12.5%, and –2.3%, respectively, with more substantial associations observed with ICP-M than with ICP-S. The major scientific advancements lie in the elucidation of synergistic risk interactions between pollutants and the protective antagonistic effects of greenness, as well as highlighting the risk impact of preconceptional environmental exposures. Our study, conducted in the context of the “three-child policy” in China, provides epidemiological evidence for policy-making to safeguard maternal and neonatal health.

KW - Adverse pregnancy outcome

KW - Air pollution

KW - Greenness

KW - Intrahepatic cholestasis of pregnancy

KW - Maternal and reproductive health

UR - https://www.scopus.com/pages/publications/85176258218

U2 - 10.1016/j.jhazmat.2023.132915

DO - 10.1016/j.jhazmat.2023.132915

M3 - Article

C2 - 37951168

AN - SCOPUS:85176258218

SN - 0304-3894

VL - 463

JO - Journal of Hazardous Materials

JF - Journal of Hazardous Materials

M1 - 132915

ER -

A Chinese longitudinal maternity cohort study (2013–2021) on intrahepatic cholestasis phenotypes: Risk associations from environmental exposure to adverse pregnancy outcomes

Abstract

Keywords

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