Journal article
Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth A Pooled Study of 16 US Cohorts
JAMA pediatrics, Vol.176(9), pp.895-905
09/01/2022
DOI: 10.1001/jamapediatrics.2022.2252
PMCID: PMC9274448
PMID: 35816333
Abstract
IMPORTANCE Phthalate exposure is widespread among pregnant women and may be a risk factor for preterm birth.
OBJECTIVE To investigate the prospective association between urinary biomarkers of phthalates in pregnancy and preterm birth among individuals living in the US.
DESIGN, SETTING, AND PARTICIPANTS Individual-level data were pooled from 16 preconception and pregnancy studies conducted in the US. Pregnant individuals who delivered between 1983 and 2018 and provided 1 or more urine samples during pregnancy were included.
EXPOSURES Urinary phthalate metabolites were quantified as biomarkers of phthalate exposure. Concentrations of 11 phthalate metabolites were standardized for urine dilution and mean repeated measurements across pregnancy were calculated.
MAIN OUTCOMES AND MEASURES Logistic regression models were used to examine the association between each phthalate metabolite with the odds of preterm birth, defined as less than 37 weeks of gestation at delivery (n = 539). Models pooled data using fixed effects and adjusted for maternal age, race and ethnicity, education, and prepregnancy body mass index. The association between the overall mixture of phthalate metabolites and preterm birth was also examined with logistic regression. G-computation, which requires certain assumptions to be considered causal, was used to estimate the association with hypothetical interventions to reduce the mixture concentrations on preterm birth.
RESULTS The final analytic sample included 6045 participants (mean [SD] age, 29.1[6.1] years). Overall, 802 individuals (13.3%) were Black, 2323 (384%) were Hispanic/Latina, 2576 (42.6%) were White, and 328 (5.4%) had other race and ethnicity (including American Indian/Alaskan Native, Native Hawaiian, >1 racial identity, or reported as other). Most phthalate metabolites were detected in more than 96% of participants. Higher odds of preterm birth, ranging from 12% to 16%, were observed in association with an interquartile range increase in urinary concentrations of mono-N-butyl phthalate (odds ratio [OR], 1.12 [95% CI, 0.98-1.27]), mono-isobutyl phthalate (OR, 1.16 [95% CI, 1.00-1.34]), mono(2-ethyl-5-carboxypentyl) phthalate (OR, 1.16 [95% CI, 1.00-1.34]), and mono(3-carboxypropyl) phthalate (OR, 1.14 [95% CI, 1.01-1.29]). Among approximately 90 preterm births per 1000 live births in this study population, hypothetical interventions to reduce the mixture of phthalate metabolite levels by 10%, 30%, and 50% were estimated to prevent 1.8 (95% CI, 0.5-3.1), 5.9 (95% CI, 1.7-9.9), and 11.1(95% CI, 3.6-18.3) preterm births, respectively.
CONCLUSIONS AND RELEVANCE Results from this large US study population suggest that phthalate exposure during pregnancy may be a preventable risk factor for preterm delivery.
Details
- Title: Subtitle
- Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth A Pooled Study of 16 US Cohorts
- Creators
- Barrett M. Welch - National Institute of Environmental Health SciencesAlexander P. Keil - University of North Carolina at Chapel HillJessie P. Buckley - BloombergAntonia M. Calafat - Centers for Disease Control and PreventionKate E. Christenbury - Scientific SystemsStephanie M. Engel - University of North Carolina at Chapel HillKatie M. O'Brien - National Institute of Environmental Health SciencesEmma M. Rosen - University of North Carolina at Chapel HillTamarra James-Todd - Harvard UniversityAmi R. Zota - Milken InstituteKelly K. Ferguson - National Institute of Environmental Health SciencesPooled Phthalate Exposure and Preterm Birth Study Group
- Contributors
- Amy E Sparks (Contributor) - University of Iowa, Obstetrics and Gynecology
- Resource Type
- Journal article
- Publication Details
- JAMA pediatrics, Vol.176(9), pp.895-905
- Publisher
- Amer Medical Assoc
- DOI
- 10.1001/jamapediatrics.2022.2252
- PMID
- 35816333
- PMCID
- PMC9274448
- ISSN
- 2168-6203
- eISSN
- 2168-6211
- Number of pages
- 11
- Grant note
- P01ES022844; R01ES017500; T32ES007018; R01ES0125169-01; R21ES025551; R24ES028533; R01ES016863-04; R01ES016863-02S4; P01ES011261 / the NIEH Intramural Research Program of the National Institutes of Health (NIH)/National Institute of Environmental Health Sciences (NIEHS); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Environmental Health Sciences (NIEHS) P42ES017198; P30ES005022; R21ES031231; P01ES009605; R01ES021369; R01ES024381; R01ES030078; R01ES016863; R01ES022934; P30ES010126; P01ES09584; R01ES013543; R01ES014393; R01ES08977; R01ES009718; ES013543; P30ES023513; Z01ES103333; R01ES031591; R01ES031657 / NIEH R01DK076648 / National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R21CA128382 / National Cancer Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) P30ES005022; UH3OD023251; UH3OD023365; UH3OD023342 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA UL1TR001881 / National Center for Advancing Translational Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) R21HD058019 / Eunice Kennedy Shriver National Institute of Child Health and Human Development; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) R82670901; R827039 / US Environmental Protection Agency; United States Environmental Protection Agency
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984318222602771
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