Association of blood metal exposure with testosterone and hemoglobin: A cross-sectional study in Hangzhou Birth Cohort Study

Background: Few epidemiological studies have investigated associations of exposure to multiple metals with testosterone homeostasis and erythropoiesis, especially for the pregnant women. Methods: Among all the 1644 participants enrolled in Hangzhou Birth Cohort Study (HBCS) at baseline, a total of 918 pregnant women with complete data of interest were analyzed. The whole blood metals levels were examined by inductively coupled plasma mass spectrometry (ICP-MS), and serum testosterone level was evaluated by chemiluminescent microparticle immunoassay (CMIA), and erythropoietic parameters values were extracted from medical record. Multivariable linear regression models were applied to estimate the relationships between metals levels and testosterone level, and between metals levels and erythropoietic parameters, and potential confounders were adjusted. Results: Single metal model analysis revealed a significant association of blood As, Mn and Pb level with serum testosterone level. After controlling for multiple testing, the dose-response trend with statistical significance (FDR-adjusted p trend < 0.05) was observed across tertiles of Pb with testosterone. This association, when by stratified by gender, remained in pregnant women with a male fetus but did not reach significant in those with a female fetus. Furthermore, blood Pb level was positively associated with red blood cell counts, hemoglobin level and hematocrit. Serum testosterone level was positively associated with red blood cell counts, hemoglobin level and hematocrit. Mediation analyses indicated that testosterone might act as a mediator in the association between Pb exposure and erythropoietic parameters. Conclusions: Serum testosterone level and hemoglobin level was positively related to blood Pb level among Chinese pregnant women, and testosterone might mediate the effect of Pb exposure on hemoglobin. Additional prospective studies are warranted to confirm the causality.