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Kek T, Geršak K, Virant-Klun I. Exposure to endocrine disrupting chemicals (bisphenols, parabens, and triclosan) and their associations with preterm birth in humans. Reprod Toxicol 2024; 125:108580. [PMID: 38522559 DOI: 10.1016/j.reprotox.2024.108580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
Preterm birth in humans (PTB), defined as birth prior to 37 weeks of gestation, is one of the most important causes of neonatal morbidity and mortality and is associated with adverse health outcomes later in life. Attributed to many different etiological factors, estimated 15.1 million or 11.1% of births each year are preterm, which is more than 1 per 10 livebirths globally. Environmental pollution is a well-established risk factor that could influence the pathogenesis of PTB. Increasing evidence has shown an association between maternal exposure to endocrine disrupting chemicals (EDCs) and PTB. This scoping review aims to summarize current research on the association between EDC exposure and PTB in humans. Database PubMed was used to identify articles discussing the effect of selected EDCs, namely bisphenol A, bisphenol S, bisphenol F, parabens, and triclosan, found in plastics, cosmetics and other personal care products, on PTB occurrence. Regardless of some inconsistences in the findings across studies, the reviewed studies suggest a potential association between involuntary exposure to reviewed EDCs and the risk of PTB. However, further studies are needed to delineate exact correlations and mechanisms through which EDC exposure causes PTB so that efficient preventative measures could be implemented. Until then, health care providers should inform women about possible EDC exposure thus empowering them to make healthy choices and at the same time decrease the EDC negative effects.
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Affiliation(s)
- Tina Kek
- Clinical Research Centre, University Medical Centre Ljubljana, Zaloška cesta 2, Ljubljana 1000, Slovenia.
| | - Ksenija Geršak
- Medical Faculty, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia; Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, Ljubljana 1000, Slovenia
| | - Irma Virant-Klun
- Clinical Research Centre, University Medical Centre Ljubljana, Zaloška cesta 2, Ljubljana 1000, Slovenia
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Vidal MS, Richardson LS, Kumar Kammala A, Kim S, Lam PY, Cherukuri R, Thomas TJ, Bettayeb M, Han A, Rusyn I, Menon R. Endocrine-disrupting compounds and their impact on human placental function: evidence from placenta organ-on-chip studies. LAB ON A CHIP 2024; 24:1727-1749. [PMID: 38334486 PMCID: PMC10998263 DOI: 10.1039/d3lc00998j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The effects of endocrine-disrupting compounds (EDCs) on the placenta, a critical gestational organ for xenobiotic protection, are well reported; however, models to determine the role of EDCs in placental disruption are limited. An advanced 2nd-trimester human placenta organ-on-chip model (2TPLA-OOC) was developed and validated, with six representative cells of the maternal and the fetal interface interconnected with microchannels. Various EDCs (150 ng mL-1 each of bisphenol A, bisphenol S, and polybrominated diphenyl ethers-47 and -99) were gradually propagated across the chip for 72 hours, and their various effects were determined. Cigarette smoke extract (CSE), an environmental risk factor, was used as a positive control. EDCs produced overall oxidative stress in the placental/decidual cells, induced cell-specific endocrine effects, caused limited (<10%) apoptosis/necrosis in trophoblasts and mesenchymal cells, induced localized inflammation but an overall anti-inflammatory shift, did not change immune cell migration from stroma to decidua, and did not affect placental nutrient transport. Overall, (1) the humanized 2TPLA-OOC recreated the placental organ and generated data distinct from the trophoblast and other cells studied in isolation, and (2) at doses associated with adverse pregnancies, EDCs produced limited and localized insults, and the whole organ compensated for the exposure.
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Affiliation(s)
- Manuel S Vidal
- Division of Basic Science and Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Texas, USA.
- Department of Biochemistry and Molecular Biology, University of the Philippines Manila, Manila, Philippines
| | - Lauren S Richardson
- Department of Biochemistry and Molecular Biology, University of the Philippines Manila, Manila, Philippines
| | - Ananth Kumar Kammala
- Department of Biochemistry and Molecular Biology, University of the Philippines Manila, Manila, Philippines
| | - Sungjin Kim
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Po Yi Lam
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Rahul Cherukuri
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Tilu Jain Thomas
- Department of Biochemistry and Molecular Biology, University of the Philippines Manila, Manila, Philippines
| | - Mohammed Bettayeb
- Department of Biochemistry and Molecular Biology, University of the Philippines Manila, Manila, Philippines
| | - Arum Han
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Ivan Rusyn
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Ramkumar Menon
- Division of Basic Science and Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Texas, USA.
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Wu X, Tian Y, Zhu H, Xu P, Zhang J, Hu Y, Ji X, Yan R, Yue H, Sang N. Invisible Hand behind Female Reproductive Disorders: Bisphenols, Recent Evidence and Future Perspectives. TOXICS 2023; 11:1000. [PMID: 38133401 PMCID: PMC10748066 DOI: 10.3390/toxics11121000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Reproductive disorders are considered a global health problem influenced by physiological, genetic, environmental, and lifestyle factors. The increased exposure to bisphenols, a chemical used in large quantities for the production of polycarbonate plastics, has raised concerns regarding health risks in humans, particularly their endocrine-disrupting effects on female reproductive health. To provide a basis for future research on environmental interference and reproductive health, we reviewed relevant studies on the exposure patterns and levels of bisphenols in environmental matrices and humans (including susceptible populations such as pregnant women and children). In addition, we focused on in vivo, in vitro, and epidemiological studies evaluating the effects of bisphenols on the female reproductive system (the uterus, ovaries, fallopian tubes, and vagina). The results indicate that bisphenols cause structural and functional damage to the female reproductive system by interfering with hormones; activating receptors; inducing oxidative stress, DNA damage, and carcinogenesis; and triggering epigenetic changes, with the damaging effects being intergenerational. Epidemiological studies support the association between bisphenols and diseases such as cancer of the female reproductive system, reproductive dysfunction, and miscarriage, which may negatively affect the establishment and maintenance of pregnancy. Altogether, this review provides a reference for assessing the adverse effects of bisphenols on female reproductive health.
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Affiliation(s)
- Xiaoyun Wu
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Yuchai Tian
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Huizhen Zhu
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Pengchong Xu
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Jiyue Zhang
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Yangcheng Hu
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Xiaotong Ji
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China;
| | - Ruifeng Yan
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Huifeng Yue
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
| | - Nan Sang
- Research Center of Environment and Health, College of Environment and Resource, Shanxi University, Taiyuan 030006, China; (X.W.); (Y.T.); (H.Z.); (P.X.); (J.Z.); (Y.H.); (N.S.)
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Algonaiman R, Almutairi AS, Al Zhrani MM, Barakat H. Effects of Prenatal Exposure to Bisphenol A Substitutes, Bisphenol S and Bisphenol F, on Offspring's Health: Evidence from Epidemiological and Experimental Studies. Biomolecules 2023; 13:1616. [PMID: 38002298 PMCID: PMC10669689 DOI: 10.3390/biom13111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Pregnancy and lactation are critical periods for human well-being and are sensitive windows for pollutant exposure. Bisphenol A (BPA) is well demonstrated as a toxicant and has been replaced in the plastic industry with other bisphenol analogs that share similarities in structure and characteristics, most commonly Bisphenol S (BPS) and Bisphenol F (BPF). Maternal exposure to BPS or BPF can result in their accumulation in the fetal compartment, leading to chronic exposure and potentially limiting normal fetal growth and development. This review summarizes considerable findings of epidemiological or experimental studies reporting associations between BPS or BPF and impaired fetal growth and development. Briefly, the available findings indicate that exposure to the two bisphenol analogs during pregnancy and lactation can result in multiple disturbances in the offspring, including fetal growth restrictions, neurological dysfunctions, and metabolic disorders with the potential to persist throughout childhood. The occurrence of premature births may also be attributed to exposure to the two bisphenols. The possible mechanisms of actions by which the two bisphenols can induce such effects can be attributed to a complex of interactions between the physiological mechanisms, including impaired placental functioning and development, dysregulation of gene expression, altered hormonal balance, and disturbances in immune responses as well as induced inflammations and oxidative stress. In conclusion, the available evidence suggests that BPS and BPF have a toxic potential in a compartment level to BPA. Future research is needed to provide more intensive information; long-term studies and epidemiological research, including a wide scale of populations with different settings, are recommended. Public awareness regarding the safety of BPA-free products should also be enhanced, with particular emphasis on educating individuals responsible for the well-being of children.
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Affiliation(s)
- Raya Algonaiman
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah 51452, Saudi Arabia;
| | - Abdulkarim S. Almutairi
- Al-Rass General Hospital, Qassim Health Cluster, Ministry of Health, Ibn Sina Street, King Khalid District, Al-Rass 58883, Saudi Arabia;
| | - Muath M. Al Zhrani
- Department of Applied Medical Science, Applied College, Bishah University, Bishah 67616, Saudi Arabia;
| | - Hassan Barakat
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Food Technology, Faculty of Agriculture, Benha University, Moshtohor 13736, Egypt
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Tantengco OAG, Vidal MS, Bento GFC, Menon R. Impact of bisphenol A on cell viability and inflammatory cytokine production in human cervical epithelial cells. Am J Reprod Immunol 2023; 90:e13784. [PMID: 37881122 PMCID: PMC10607601 DOI: 10.1111/aji.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
PROBLEM An intact cervix is a barrier that prevents pathogenic bacteria from invading the uterine and amniotic cavity during pregnancy. Its disruption is associated with ascending infection and adverse pregnancy outcomes. This study analyzed the effects of bisphenol A (BPA), a chemical used in plastics manufacturing, on cell death and inflammation in cervical epithelial cells. METHODS Ectocervical epithelial (ecto) and endocervical epithelial (endo) cells were treated with 100 ng/mL and 300 ng/mL of BPA for 48 h. The cells were subjected to flow cytometry using annexin V and propidium iodide to determine apoptosis and necrosis, cell cycle analysis, and ELISA to determine the levels of inflammatory cytokines (IL-6, IL-8, and IL-10). RESULTS Low-dose and high-dose BPA significantly increased the live ecto cell population dose-dependently. BPA did not have any noticeable effect on cell cycle progression in either cell type. BPA treatment also decreased the apoptotic ecto and endo cell population dose-dependently. Lastly, high dose BPA significantly increased IL-6 in ecto and endo cells. However, IL-8 and IL-10 were not affected by BPA treatments. CONCLUSION Chemical exposure damage to the cervix can lead to adverse pregnancy outcomes. Our study showed that the BPA concentrations reported in pregnant subjects do not induce cervical cell toxicity . The decrease in apoptosis and increase in live cells may be a compensatory mechanism to preserve the integrity of the cervical epithelial layer.
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Affiliation(s)
- Ourlad Alzeus G Tantengco
- Division of Basic Science & Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Biology, College of Science, De La Salle University, Manila, Philippines
| | - Manuel S Vidal
- Division of Basic Science & Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Giovana Fernanda Cosi Bento
- Division of Basic Science & Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, UNESP, Botucatu, São Paulo, Brazil
| | - Ramkumar Menon
- Division of Basic Science & Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Loukas N, Vrachnis D, Antonakopoulos N, Pergialiotis V, Mina A, Papoutsis I, Iavazzo C, Fotiou A, Stavros S, Valsamakis G, Vlachadis N, Maroudias G, Mastorakos G, Iliodromiti Z, Drakakis P, Vrachnis N. Prenatal Exposure to Bisphenol A: Is There an Association between Bisphenol A in Second Trimester Amniotic Fluid and Fetal Growth? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050882. [PMID: 37241114 DOI: 10.3390/medicina59050882] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/25/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Fetal growth abnormalities increase the risk of negative perinatal and long-term outcomes. Bisphenol A (BPA) is a ubiquitous endocrine-disrupting chemical to which humans may be exposed in a number of ways, such as from the environment, via various consumer products, and through the individual's diet. Since the compound possesses estrogen-mimicking properties and exerts epigenetic and genotoxic effects, it has been associated with harmful effects impacting the entire spectrum of human life, including, vitally, the intrauterine period. We investigated the role of maternal exposure to BPA in abnormal fetal growth velocity, both impaired and excessive. Materials and Methods: Amniotic fluid samples were collected from 35 women who underwent amniocentesis early in the second trimester due to medical reasons. Pregnancies were followed until delivery, and birth weights were recorded. The amniotic fluid samples were subsequently divided into three groups based on fetal birth weight, as follows: AGA (appropriate for gestational age), SGA (small for gestational age), and LGA (large for gestational age). Amniotic fluid BPA levels were determined by gas chromatography coupled with mass spectrometry. Results: BPA was detected in 80% (28/35) of our amniotic fluid samples. Median concentration was 281.495 pg/mL and ranged from 108.82 pg/mL to 1605.36 pg/mL. No significant association was observed between the study groups regarding BPA concentration. A significant positive correlation between amniotic fluid BPA concentration and birth weight centile (r = 0.351, p-value = 0.039) was identified. BPA levels were also inversely associated with gestational age in pregnancies at term (between 37 and 41 weeks) (r = -0.365, p-value = 0.031). Conclusions: Our findings suggest that maternal exposure to BPA during the early second trimester of pregnancy can potentially contribute to increased birthweight percentiles and to decreased gestational age in pregnancies at term.
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Affiliation(s)
- Nikolaos Loukas
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 185 36 Piraeus, Greece
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Areti Mina
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Memorial Cancer Hospital, 185 37 Piraeus, Greece
| | - Alexandros Fotiou
- Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Georgios Valsamakis
- Second Department of Obstetrics and Gynecology, Endocrine Unit, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Nikolaos Vlachadis
- Department of Obstetrics and Gynecology, Kalamata General Hospital, 241 00 Kalamata, Greece
| | - Georgios Maroudias
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 185 36 Piraeus, Greece
| | - George Mastorakos
- Second Department of Obstetrics and Gynecology, Endocrine Unit, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Zoi Iliodromiti
- Department of Neonatology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
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Chen Y, Xiao H, Namat A, Liu J, Ruan F, Xu S, Li R, Xia W. Association between trimester-specific exposure to thirteen endocrine disrupting chemicals and preterm birth: Comparison of three statistical models. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158236. [PMID: 36041600 DOI: 10.1016/j.scitotenv.2022.158236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Growing evidence indicated that maternal exposure to some endocrine disrupting chemicals (EDCs) may increase the risk of preterm birth (PTB). However, few studies have evaluated the joint effect of EDCs on PTB. OBJECTIVES This study aimed to evaluate the associations of maternal EDCs mixture in the 1st, 2nd, and 3rd trimesters during pregnancy with PTB, and identify the vital components that mainly contribute to PTB. METHODS This study included 847 pregnant women that provided urine samples for all three trimesters. Urinary concentrations of thirteen EDC metabolites (four phthalates, two parabens, three phenols, and four benzotriazoles and benzothiazoles) were examined. Logistic regression model, quantile g-computation and Bayesian kernel machine regression (BKMR) models were applied to study the association. RESULTS Logistic regression model suggested that only bisphenol A (BPA) in the 1st trimester significantly increased the OR of PTB after adjusting for BPA exposure in the 2nd and 3rd trimesters. Quantile g-computation model identified that urinary EDCs mixture in the 1st trimester were positively associated with PTB [OR (95 % CI): 1.98 (1.10, 3.58)], and the most heavily weighted component for PTB was BPA (26 %), followed by mono-2ethylhexyl phthalate (MEHP) (22 %). BKMR model determined a significant association between EDCs mixture in the 1st trimester and PTB when all EDC concentrations were at or above their 55th percentile compared with the median. The BKMR model found that BPA and MEHP were associated with an increase in the estimated probability of PTB, when the other EDCs were held to their 50th and 75th percentiles, respectively, in the 1st trimester. CONCLUSIONS The results of mixture analysis models indicated that exposure to higher EDCs mixture in the 1st trimester may increase the risk of PTB. BPA was considered as the most contributing factor for PTB among the detected EDCs.
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Affiliation(s)
- Yingyu Chen
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Han Xiao
- Institute of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Asmagvl Namat
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Juan Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Fengyu Ruan
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Ruizhen Li
- Department of Child Health Care, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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