Abstract
Heavy metals are toxic elements that can have significant adverse effects on human health, particularly during vulnerable periods such as pregnancy. The presence of heavy metals in the environment can lead to increased exposure in pregnant women, which may adversely affect both maternal and neonatal health. This study investigates the relationship between heavy metal concentrations, thyroid hormones, and birth outcomes in pregnant women in Isfahan city. Measuring heavy metal concentrations in urine is considered a non-invasive and accurate method for assessing exposure to these harmful substances. The primary aim of this research is to identify the potential impacts of these factors on birth weight and other growth parameters of infants. Results are indicating that 11.4% of the mothers were less than 25 years of age, and 57.1% of the mothers are overweight. Moreover, 19.2% of pregnant women had less than 37 weeks of gestation, and 82.8% of mothers were university-educated. Significant difference in heavy metal levels was observed across residential areas for arsenic (p = 0.007), chromium (p < 0.001), nickel (p = 0.005), lead (p = 0.003), selenium (p = 0.034), and T4 (p = 0.045). Notably, only lead exposure was directly and significantly associated with decreased infant birth weight (β = - 120.99, p = 0.008). All heavy metals showed a positive association with maternal TSH levels (p < 0.05), and except for selenium, they were also positively associated with the maternal T3/T4 ratio (p < 0.05). Both birth weight and head circumference were negatively associated with maternal TSH levels (β = - 209.25, p = 0.001) and the T3/T4 ratio (β = - 203, p = 0.041), especially among female infants. Therefore, careful monitoring of environmental heavy metal exposure and thyroid hormone regulation during pregnancy is essential to optimize birth outcomes and infant health.