Background: Thyroid hormones play a key role in fetal and child development. Recent studies have linked prenatal exposure to atmospheric contaminants with changes in thyroid hormone levels in newborns, but the data from the few studies that have explored this issue are inconclusive. The present study aims to assess the association of total thyroxine (TT4) levels in newborns with prenatal exposure to PM2.5 and NO2. Methods: This prospective cohort study included mother-child pairs from the INMA-Gipuzkoa project. Specifically, 463 mother-child pairs with data on PM2.5 and NO2 exposure during pregnancy and TT4 levels at birth were included. PM2.5 and NO2 levels were measured by high-volume aerosol samplers and passive samplers respectively during the women’s pregnancies. TT4 levels were measured in heel-prick blood samples from infants. Data on maternal and infant covariates were gathered through questionnaires administered in the first and third trimesters of pregnancy and review of clinical records. Potential associations of PM2.5 and NO2 with TT4 levels over the entire pregnancy period and by trimesters were assessed by linear regression models. Findings: According to the results, the exposure of pregnant women to PM2.5 in the three trimesters of pregnancy was positively associated with infant TT4 level at birth (β= 0.15, 95% CI: 0.206 [0.083, 0.329], 0.119 [0.011, 0.228], 0.173 [0.058, 0.287] and 0.198 [0.091, 0.305] for the entire pregnancy, first, second and third trimesters of pregnancy, respectively). In addition, the later the exposure, the stronger the association. In contrast, no association was observed between NO2 exposure and TT4 levels. Interpretation: The results indicate that prenatal exposure to PM2.5 could lead to a thyroid function impairment in newborns. Further, they suggest that the effect of PM2.5 could be partially mediated by maternal thyroid function. Funding: This study was funded by the Carlos III Health Institute (PI06/0867), Department of Health of the Government of the Basque Country (2005111093), Gipuzkoa Regional Government (DFG06/002) and the local councils of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia, Azpeitia and Beasain). Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: The study was approved by the Ethics Committee of Donostia University Hospital (Gipuzkoa) and all mothers gave written informed consent before inclusion.
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