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Joint impact of prenatal polycyclic aromatic hydrocarbons, anxiety and depression exposure on birth outcomes across pre-pregnancy BMI categories

Journal of Exposure Science & Environmental Epidemiology (2025)Cite this article

Abstract

Background

While polycyclic aromatic hydrocarbons (PAHs) and maternal psychological distress (anxiety/depression) are risk factors for adverse birth outcomes, their joint effects remain poorly understood, particularly across different pre-pregnancy BMI categories.

Objective

To examine the individual and combined effects of prenatal PAHs exposure and maternal psychological distress on birth outcomes, with emphasis on effect modification by pre-pregnancy BMI.

Methods

In this prospective cohort study, we enrolled 699 pregnant women from two primary hospitals in Hefei, China, from April 2020 through October 2022. Urinary PAHs were assessed using gas chromatography tandem triple quadrupole mass spectrometry (GC-MS/MS). Anxiety and depression symptoms were assessed via Generalized Anxiety Disorder Scale (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS), respectively. Logistic regression and BKMR models were used to explore the individual and combined effects of prenatal PAHs exposure and psychological distress on birth outcomes.

Results

Logistic regression revealed significant associations between PAHs and anxiety symptoms with adverse birth outcomes. In the overall population, 1-OHPHe is significantly associated with low birth weight (LBW) (OR: 2.21, 95% CI: 1.25, 4.03), 2-OHDBF and 2-OHPHe were significantly associated with preterm birth (PTB), respectively (1.43, 95% CI: 1.04, 1.98; 1.38, 95% CI: 1.02, 1.90). GAD-7 score in the third tertile was positively linked to macrosomia (OR: 3.27, 95% CI: 1.28, 10.06). BKMR demonstrated that among pre-pregnancy overweight/obese women (BMI ≧ 24.0), combined exposure to PAHs, depression, and anxiety was positively associated with LBW. Meanwhile, among the women with normal pre-pregnancy BMI (18.5–23.9), combined exposure was positively associated with macrosomia and PTB.

SIGNIFICANCE

Study results indicate that combined exposure to PAHs, anxiety, and depression increases the risk of adverse birth outcomes in pregnant women.

Impact

  • This study provides novel evidence that prenatal coexposure to PAHs and psychological distress differentially impacts birth outcomes based on maternal BMI. Our findings underscore the importance of considering both chemical and non-chemical stressors in prenatal care, particularly for at-risk subpopulations. These results inform targeted interventions to improve birth outcomes.

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Fig. 1: Relationship between PAHs, depression and anxiety symptoms and birth outcomes in pregnant women (n = 699).
Fig. 2: The overall effects of combined exposure to PAHs, depression and anxiety on LBW, macrosomia, and PTB in different pre-pregnancy BMI categories (n = 683).
Fig. 3: Using the BKMR, the effect of changes in individual exposure percentiles on outcomes, while holding the remaining exposure variables in the mixture constant at their respective percentiles.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the staff involved in this study for their support and assistance.

Funding

This work was supported by the Natural Science Foundation of China (No. 82003419), Scientific Research Training Project for Anhui Medical University clinical eight-year student (2022-ZQKY-176).

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Author notes

  1. These authors contributed equally: Yunfei Jia, Hualong Zhen.

Authors and Affiliations

  1. School of Public Health, Anhui Medical University, Hefei, Anhui, China

    Yunfei Jia, Hualong Zhen, Shuilan Liu, Beibei Zhu, Fengying Hu, Hengshun Cheng, Wei Jv, Mengjuan Lu, Haiyan Li, Yue Gu, Fangbiao Tao & Minmin Jiang

  2. Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, Anhui, China

    Beibei Zhu, Fangbiao Tao & Minmin Jiang

  3. Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui, China

    Beibei Zhu, Fangbiao Tao & Minmin Jiang

  4. Second Clinical Medical College of Anhui Medical University, Hefei, Anhui, China

    Yiran Li

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  1. Yunfei Jia
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Contributions

Yunfei Jia: Methodology, Formal analysis, Software, Data curation, Writing—original draft. Hualong Zhen: Methodology, Formal analysis, Software, Data curation, Validation. Shuilan Liu: Methodology, Investigation. Beibei Zhu: Data curation, Formal analysis. Fengying Hu: Data curation, Software, Investigation. Hengshun Cheng: Investigation, Data curation, Software. Wei Jv: Methodology, Investigation, Software. Yihan Li: Methodology, Investigation, Software. Mengjuan Lu: Investigation, Data curation. Haiyan Li: Data curation, Software. Yue Gu: Data curation, Software. Fangbiao Tao: Resources, Supervision, Writing—review and editing. Minmin Jiang: Resources, Supervision, Writing—review and editing, Funding acquisition, Final approval of the version to be published.

Corresponding authors

Correspondence to Fangbiao Tao or Minmin Jiang.

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The authors declare no competing interests.

Ethical statement

The research ethics was granted by the Ethics Committee of Anhui Medical University (No: 83220006). Each participant gave their written consent after being thoroughly informed. All methods were performed in accordance with the relevant guidelines and regulations.

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Jia, Y., Zhen, H., Liu, S. et al. Joint impact of prenatal polycyclic aromatic hydrocarbons, anxiety and depression exposure on birth outcomes across pre-pregnancy BMI categories. J Expo Sci Environ Epidemiol (2025). https://doi.org/10.1038/s41370-025-00829-4

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