Endocrine disrupting chemicals: translating mechanisms into perinatal risk assessment

To evaluate the evidence linking prenatal exposure to environmental endocrine-disrupting chemicals (EDCs) - including bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) - with adverse pregnancy and fetal developmental outcomes, and to assess the potential translation of this evidence into clinical perinatal risk assessment.

A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2000 and May 2025. Eligible studies included epidemiological and experimental research addressing prenatal EDC exposure and fetal-placental outcomes. After duplicate removal and screening, 52 studies met inclusion criteria and were categorized by study type (epidemiological, mechanistic, translational). Data extraction included exposure metrics, critical developmental windows, and reported effect sizes (odds ratios, risk ratios, hazard ratios).

Evidence suggests that EDC exposure during early pregnancy is associated with placental dysfunction, altered fetal growth trajectories, endocrine and epigenetic modifications, and increased risk of selected neonatal outcomes. Effect sizes were variable, often modest (many<2.0), but consistently indicated biological plausibility supported by mechanistic data. Biomonitoring studies demonstrate widespread EDC exposure across populations, including higher body burdens in lower-income and racially diverse groups. Despite robust basic science evidence, clinical screening for EDC exposure remains limited, and routine risk assessment frameworks rarely incorporate environmental chemical exposures.

Prenatal EDC exposure is biologically linked to disrupted fetal-placental development, yet translation into clinical practice remains incomplete. Integrating environmental exposure assessment and preventive counseling into perinatal care may improve maternal-fetal health and reduce disparities.