title: Cumulative risk assessment of phthalates associated with birth outcomes in pregnant Chinese women: A prospective cohort study.
abstract: A prospective cohort study of a Chinese population of mother-neonate pairs (n = 3103) was conducted to investigate the relationship between the cumulative hazard index (HI) of combined diethyl phthalate (DEP), dibutyl phthalate (DBP), dibenzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) exposure and birth outcomes. The estimated HI for phthalates was based on phthalate metabolite concentrations in urine collected between 5th and 14th gestational weeks. The median HI values according to the European Food Safety Authority tolerable daily intake (HITDI) and U.S. Environmental Protection Agency reference dose (HIRfD) were 0.358 and 0.187, respectively. A total of 16.3% and 1.9% of the women exhibited HITDIand HIRfDexceeding the value of one, respectively. In unadjusted models, the categories (low < P25, median P25-P50, high > P75) of HITDIwere associated with decreased birth weight (β = -26.34 g, p = 0.021) and head circumference (β = -0.09 cm, p = 0.029), whereas those for HIRfDwere negatively associated with birth weight (β = -31.74 g, p = 0.005), birth length (β = -0.11 cm, p = 0.032), head circumference (β = -0.13 cm, p = 0.003) and chest circumference (β = -0.10 cm, p = 0.021) in all neonates. Adjustment for potential confounders revealed that HIRfDwas inversely associated with head circumference (β = -0.10 cm, p = 0.020). Stratification by gender indicated that HIRfDwas associated with decreased birth length (β = -0.17 cm, p = 0.041) in infant boys and HITDIwas associated with decreased birth weight (β = -33.12 g, p = 0.036) and head circumference (β = -0.13 cm, p = 0.027) in girls. This is the first study on the cumulative risk assessment of phthalate exposures in pregnant Chinese women. We found that the HI values of multiple phthalate co-exposure were sex-specifically related to birth outcomes.
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Gao
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Xu
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Huang
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Ge
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Yun-Wei
authors.initials: YW
authors.lastname: Zhang
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Hui-Yuan
authors.initials: HY
authors.lastname: Yao
authors.affiliation: Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, China.
authors.forename: Ye-Qing
authors.initials: YQ
authors.lastname: Xu
authors.affiliation: Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, China.
authors.forename: Shuang-Qin
authors.initials: SQ
authors.lastname: Yan
authors.affiliation: Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
authors.forename: Zhong-Xiu
authors.initials: ZX
authors.lastname: Jin
authors.affiliation: Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Sheng
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhu
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
authors.forename: Jia-Hu
authors.initials: JH
authors.lastname: Hao
authors.affiliation: Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China. Electronic address: fbtao@126.com.
authors.forename: Fang-Biao
authors.initials: FB
authors.lastname: Tao
mesh_terms: D000328:Adult; D044466:Asian People; D001724:Birth Weight; D049628:Body Size; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000378:metabolism / Q000633:toxicity*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019055:No-Observed-Adverse-Effect Level; D010795:Phthalic Acids / Q000378:metabolism / Q000633:toxicity*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D004785:Environmental Pollutants; D010795:Phthalic Acids
keywords: Birth outcome; Cumulative risk assessment; Hazard index; Phthalate; Pregnancy