The association between prenatal exposure to mixed air pollutants and birth defects risk: a population-based study in Tangshan, China

Background: Birth defects (BDs) are a major health concern worldwide, with air pollution being a key environmental risk factor. Current evidence, especially from industrial regions and regarding multi-pollutant exposure, is limited. This study examined the association between prenatal exposure to mixed air pollutants from preconception to early pregnancy and the risk of BDs in Tangshan, China. Methods: ) from 12 weeks before pregnancy to gestational week 13 was assessed using inverse distance weighting interpolation. Multi-pollutant statistical models, including quantile g-computation (QGC) and Bayesian kernel machine regression (BKMR), were employed to analyze the association with offspring BDs while adjusting for covariates. Results: in female offspring. Furthermore, BKMR showed a significant positive association in all subgroups when the mixture exposure level exceeded the median. Conclusion: . Thus, these results provide a foundation for developing targeted air pollution protection strategies for pregnant women, advancing primary prevention of BDs, and guiding the optimization of healthcare resource allocation.