Maternal exposure to some individual rare earth elements and trace elements is associated with preterm birth, but few elements have been studied and little is known about the potential effect of simultaneous exposure to multiple elements. We examined individual and mixture effects of elements on preterm birth among 745 pregnant women in a prospective birth cohort in Bangladesh (2008–2011). We measured 56 elements in umbilical cord blood collected during delivery using inductively coupled plasma-mass spectrometry. Using elastic net (ENET) regularization and multivariate logistic regression, we examined independent associations between element concentrations and preterm birth. Bayesian kernel machine regression identified mixture effects of elements most critical to preterm birth, accounting for correlated exposure and interaction. ENET identified titanium (Ti), arsenic (As), and barium (Ba) as the most important predictors of shortened gestational age and preterm birth. In adjusted models, cord blood Ti (OR = 2.52; 95% CI: 1.08–5.93; P = 0.033), As (odds ratio (OR) = 1.34; 95% CI: 1.04–1.73; P = 0.023), and Ba (OR = 1.18; 95% CI: 1.02–1.38; P = 0.029) were significantly associated with preterm birth. Bayesian kernel machine regression suggested an interaction effect between As and Ba. Further, we constructed an element risk score (ERS) using estimated weights from a multivariate regression model for Ti, As, and Ba and regressed preterm birth by this score (OR = 2.72, 95% CI: 1.57–4.69; P = 3.35 × 10^-4). Additionally, we observed a significant modification effect of child marriage on ERS, which means marriage before the age of 18 (P_interaction = 0.0438). This study identified element exposures profiles in cord blood and constructed metal risk score that are jointly associated with the risk of preterm birth. Ti, As, and Ba exposure may adversely affect birth outcomes as well as child marriage may be a modifiable factor potentially affecting environmental element exposure and preterm birth.

孕妇接触某些单独的稀土元素和微量元素与早产有关，但很少有人研究过这些元素，而且对同时接触多种元素的潜在影响知之甚少。我们检查了孟加拉国（2008-2011 年）前瞻性出生队列中 745 名孕妇的个体和混合因素对早产的影响。我们使用电感耦合等离子体质谱法测量了分娩过程中收集的脐带血中的 56 种元素。使用弹性网 (ENET) 正则化和多元逻辑回归，我们检查了元素浓度​​和早产之间的独立关联。贝叶斯核机器回归确定了对早产最关键的元素的混合效应，说明了相关的暴露和相互作用。ENET 确定钛 (Ti)、砷 (As) 和钡 (Ba) 是缩短胎龄和早产的最重要预测因子。在调整后的模型中，脐带血 Ti（OR = 2.52；95% CI：1.08–5.93；P = 0.033），As（优势比 (OR) = 1.34；95% CI：1.04–1.73；P  = 0.023）和 Ba（OR = 1.18；95% CI：1.02-1.38；P  = 0.029）与早产显着相关。贝叶斯核机器回归表明 As 和 Ba 之间存在交互作用。此外，我们使用来自 Ti、As 和 Ba 的多元回归模型的估计权重构建了元素风险评分 (ERS)，并通过该评分对早产进行了回归 (OR = 2.72, 95% CI: 1.57–4.69; P  = 3.35 × 10 ^-4 )。此外，我们观察到童婚对 ERS ​​有显着的修正作用，这意味着 18 岁之前结婚（P_交互作用 = 0.0438)。本研究确定了脐带血中的元素暴露概况，并构建了与早产风险共同相关的金属风险评分。Ti、As 和 Ba 暴露可能会对出生结果产生不利影响，而童婚可能是一个可改变的因素，可能会影响环境元素暴露和早产。