Associations Of Maternal Phthalic Acid Esters And Polycyclic Aromatic Hydrocarbons Exposure Levels With Birth Outcomes

Phthalic acid esters(PAEs)and polycyclic aromatic hydrocarbons(PAHs)are common foodborne chemical contaminants that pose a risk to human health,especially to pregnant women and fetuses.To prevent adverse pregnancy outcomes and improve population quality,it is necessary to explore predictors of PAEs and PAHs exposure in the pregnant population,and to identify the associations of maternal PAEs and PAHs exposure with adverse birth outcomes.Part Ⅰ Profiles and predictors of phthalic acid esters and polycyclic aromatic hydrocarbons exposure levels during pregnancyObjective:To characterize the exposure profiles and predictors of PAEs and PAHs in the pregnant population in Wuhan.Methods:Based on the Tongji birth cohort,1190 mother-infant pairs recruited from 2018 to 2021 were included in this study.The levels of 9 PAEs and 10 PAHs metabolites in 1370 urine samples were measured by gas chromatography-triple quadrupole tandem mass spectrometry.Information on demographic characteristics,lifestyles,and diets was obtained by questionnaires.Dietary patterns were constructed by principal component analysis.Multiple linear regressions were used to analyze the predictors of PAEs and PAHs exposure during pregnancy.Results:The detection rate of 6 PAEs and 6 PAHs metabolites were more than 70%(71.18%～100.00%).The urinary metabolite concentrations were influenced by age,education levels,pre-pregnancy BMI,use of disposable tableware and secondhand smoke exposure.Four dietary patterns were identified by principal component analysis.We found egg-dairy products pattern,whole grain-tuber crop pattern,and meat-aquatic products pattern were positively associated with specific pollutants exposure.In contrast,fruit-nut-vegetable pattern was negatively correlated with PAEs or PAHs exposure.Every SD increase in this pattern score was associated with 14.36%reduced MEOHP(95%confidence interval(CI):-24.50,-2.96;P trend=0.01),10.86%reduced 2-OHNap(95%CI:-20.07,-0.60;P trend=0.04),19.35%reduced 9-OHPhe(95%CI:-34.49,-0.70;P trend=0.01),and 8.33%reduced scores of PAHs group(95%CI:-15.97,-0.10;P trend=0.02).Conclusion:In this study,demographic characteristics,use of disposable tableware,secondhand smoke exposure,and dietary intake were found to be important predictors of PAEs and PAHs exposure during pregnancy.Adhering to egg-dairy products pattern,whole grain-tuber crop pattern,and meat-aquatic products pattern may be related to increased PAEs or PAHs exposure,while following fruit-nut-vegetable pattern seems to correlate with a lower burden of PAEs and PAHs exposure.Part Ⅱ Associations of phthalic acid esters and polycyclic aromatic hydrocarbons exposure during pregnancy with birth outcomesObjective:To explore the associations of PAEs and PAHs exposure during pregnancy with birth outcomes.Methods:Based on the same mother-infant pairs in part Ⅰ.Multiple linear regression models,logistic regression models and quantile g calculations were used to explore the associations of maternal PAEs and PAHs exposure with birth outcomes.In addition,we identified the potential effect modification by fetal sex.Results:Urinary PAEs metabolites were inversely associated with gestational age at birth(βMMP=-0.09,95%CI:-0.17,-0.01;βMBP=-0.10,95%CI:-0.17,-0.02;βMIBP=-0.13,95%CI:-0.22,-0.04),birth weight(βMEHHP=-25.87,95%CI:-48.03,-3.70)and birth weight Z score(βMEHHP=-0.07,95%CI:-0.12,-0.01)in female infants.While exposure to PAEs during pregnancy was associated with a reduced risk of preterm birth in male infants(ORMEOHP=0.57,95%CI:0.35,0.93).Individual and joint effects of maternal PAHs exposure were associated with lower gestational age at birth(β2-OHPhe=-0.07,95%CI:-0.13,-0.01;β9-OHPhe=-0.06,95%CI:-0.09,-0.03;pTotal PAHs=-0.21,95%CI:-0.31,-0.10),birth weight(β2-OHFlu=-19.80,95%CI:-37.19,-2.40;β9-OHPhe=-12.28,95%CI:-21.43,-3.12;βTotal PAHs=-38.02,95%CI:-68.40,-7.64),and birth weight Z score(β2-OHFlu=-0.05,95%CI:-0.09,-0.01;p9-OHPhe=-0.03,95%Ci:-0.05,-0.01;βTotal PAHs=-0.08,95%CI:-0.16,-0.01),and associated with an increased risk of preterm delivery(OR9-OHPhe=1.15,95%CI:1.01,1.31;ORTotal PAHs=1.73,95%CI:1.07,2.80).There were gender differences between PAEs or PAHs exposure and the risk of small for gestational age(SGA).As PAEs and PAHs concentrations increased,we observed a decreased risk of SGA in male infants(P<0.05),while an increased risk of SGA in female infants(P<0.05).PAEs and PAHs mixture exposure was associated with lower gestational age at birth(β=-0.20,95%CI:-0.32,-0.08),lower birth weight(β=-40.79,95%CI:-74.13,-7.44),and lower birth weight Z scores(β=-0.09,95%CI:-0.17,-0.02).The compound with the greatest effect on gestational age at birth was 9-OHPhe.For birth weight,MEHHP was the most influential compound,followed by 9-OHPhe.Conclusion:PAEs and PAHs exposure during pregnancy was associated with lower gestational age at birth,birth weight,and birth weight Z score.MEHHP and 9-OHPhe were identified as the main risk compounds.Individual and joint effects of PAHs were positively associated with elevated risks of preterm birth.In addition,we observed associations between maternal PAEs or PAHs exposure and risk of SGA,and there were gender differences in these associations.