Maternal phthalate urine concentrations, fetal growth and adverse birth outcomes. A population-based prospective cohort study

Susana Santos; Chalana M. Sol; Charissa van Zwol – Janssens; Elise M. Philips; Alexandros G. Asimakopoulos; Maria-Pilar Martinez-Moral; Kurunthachalam Kannan; Vincent W.V. Jaddoe; Leonardo Trasande

Environment International (Jun 2021)

Maternal phthalate urine concentrations, fetal growth and adverse birth outcomes. A population-based prospective cohort study

Susana Santos,
Chalana M. Sol,
Charissa van Zwol – Janssens,
Elise M. Philips,
Alexandros G. Asimakopoulos,
Maria-Pilar Martinez-Moral,
Kurunthachalam Kannan,
Vincent W.V. Jaddoe,
Leonardo Trasande

Affiliations

Susana Santos: The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
Chalana M. Sol: The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
Charissa van Zwol – Janssens: The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
Elise M. Philips: The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
Alexandros G. Asimakopoulos: Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12201, United States; Department of Chemistry, the Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
Maria-Pilar Martinez-Moral: Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12201, United States
Kurunthachalam Kannan: Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12201, United States; Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Pediatrics, New York University School of Medicine, New York City, NY 10016, USA; Department of Environmental Medicine, New York University School of Medicine, New York City, NY 10016, USA
Vincent W.V. Jaddoe: The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Corresponding author at: The Generation R Study Group (Na 29-08), Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Leonardo Trasande: Department of Pediatrics, New York University School of Medicine, New York City, NY 10016, USA; Department of Environmental Medicine, New York University School of Medicine, New York City, NY 10016, USA; Department of Population Health, New York University School of Medicine, New York City, NY, USA; New York Wagner School of Public Service, New York City, NY 10016, USA; New York University Global Institute of Public Health, New York City, NY 10016, USA

Journal volume & issue: Vol. 151
p. 106443

Abstract

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Importance: Exposure to phthalates may affect fetal growth, but previous studies are inconsistent and have not explored the trimester-specific effects of phthalates on repeated measures of fetal growth. Objective: To assess the associations of maternal phthalate metabolites urine concentrations with fetal growth measures and birth outcomes and identify potential windows of vulnerability to exposure. Design: Population-based prospective cohort study, the Generation R Study (2002–2006). Data analysis was performed from November 2019 to June 2020. Setting: Rotterdam, the Netherlands. Participants: 1379 pregnant women. Exposures: Maternal phthalate metabolites urine concentrations in first, second and third trimester. Main outcomes and measures: Fetal head circumference, length and weight measured in the second and third trimester by ultrasound and at birth and preterm birth and small size for gestational age at birth. Results: Higher pregnancy-averaged phthalic acid, low molecular weight phthalate (LMWP), high molecular weight phthalate (HMWP) and di-2-ethylhexylphthalate (DEHP) concentrations tended to be associated with lower fetal weight SDS across gestation. The associations of phthalic acid and LMWP with fetal weight became stronger as pregnancy progressed (differences −0.08 (95% CI −0.14 to −0.02) SDS and −0.09 (95% CI −0.16 to −0.02) SDS at 40 weeks per interquartile range increase in phthalic acid and LMWP, respectively). Higher concentrations of specific LMWP, HMWP and DEHP metabolites were also associated with smaller head circumference and lower length SDS at birth and an increased risk of preterm birth and small size for gestational age at birth (p-values < 0.05). We observed differences by timing of exposure in these associations. Conclusions and relevance: Higher maternal phthalate metabolites urine concentrations seem to be related with fetal growth restriction and preterm birth. Phthalates may have trimester specific effects on fetal growth and birth outcomes. Further studies are needed to explore the underlying mechanisms and long-term consequences.

Published in Environment International

ISSN: 0160-4120 (Print)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/environment-international

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