Cumulative health risks for bisphenols using the maximum cumulative ratio among Chinese pregnant women

Bisphenol A and its alternatives are frequently detected in environmental and human samples, but studies associated with the pattern of combined health hazards from the exposure to the bisphenol mixtures are lacking, particularly for pregnant women. Here, we recruited 941 pregnant women with a full set of urine samples in the three trimesters collected under a cohort study project in Wuhan, China, between 2014 and 2015. We measured the concentrations of 8 bisphenols in 2823 urine samples, and calculated the average concentrations of bisphenols, which were detected in over 50% of samples, once during each trimester of pregnancy. We calculated the maximum cumulative ratio (MCR) on basis of estimated daily intake (EDI), hazard quotient (HQ), hazard index (HI) of three major bisphenols, including bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS), to find which one or mixtures drive risks. Participants were categorized into four groups according to their maximum HQ, HI and MCR values. We found negative relationships between log(MCR-1) and log(HI) with the slope (-0.6431). Percentage of HQ of BPA in HI ranged from 37.1% (<25th percentiles of HI) to 75.5% (>95th percentiles of HI) indicating the upward trend of dominance by BPA at increasing HI ranges. The cumulative health risks of bisphenol exposures largely originated from the health hazards of BPA and BPS, particularly BPA. The intervention for regulation on the production and application of BPA and its alternatives are urgent, and China should consider national regulation on these chemicals based on its risk to human health.