Fig. 1.

Participants’ flowchart. Blood heavy metal concentrations were measured in 96,693 expectant women with 103,060 pregnancies who were registered in the Japan Environment and Children’s Study. This study excluded children whose small-for-gestational-age (SGA) status could not be determined because of the lack of data on parity, sex, birth weight, or gestational age. Children who were not SGA and had missing height standard deviation score (SDS) data at 2, 3, at 4 years were also excluded. Finally, 4683 individuals were analyzed. Those with available information on metal concentrations in cord blood were also analyzed as a subcohort