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Associations Between Prenatal Phthalate Exposure and Atopic Symptoms in Childhood: Effect Modification by Child Sex

Khushbu Dharmendra Bhatt1, Shachi Mistry1, Héctor Lamadrid-Figueroa2

  • 1Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

Toxics
|September 27, 2025
PubMed

Insights

Prenatal phthalate exposure is linked to childhood atopic dermatitis, with effects differing by child sex. Higher exposure in early pregnancy showed stronger associations in males than females.

Area of Science:

  • Environmental Health
  • Pediatric Allergy and Immunology
  • Toxicology

Background:

  • Global incidence of atopic diseases, including atopic dermatitis and allergic rhinitis, is rising.
  • Prenatal exposure to endocrine-disrupting chemicals, such as phthalates, is a potential contributing factor.
  • Evidence suggests that phthalate exposure may have sex-specific effects on health outcomes.

Purpose of the Study:

  • To investigate the association between prenatal phthalate exposure and childhood atopic dermatitis.
  • To examine potential sex-specific effects of phthalate exposure on atopic dermatitis symptoms.
  • To analyze phthalate mixture effects during different trimesters of pregnancy.

Main Methods:

  • Analysis of 558 mother-child pairs from the PROGRESS birth cohort in Mexico City.
  • Measurement of maternal urinary phthalate metabolites during the 2nd and 3rd trimesters.
  • Assessment of atopic dermatitis and allergic rhinitis symptoms using the ISAAC survey at ages 4-8 years.
  • Application of Weighted Quantile Sum Regression (WQS) and modified Poisson models for sex-specific association analysis.

Main Results:

  • Child sex significantly modified the association between 2nd trimester phthalate mixture exposure and atopic dermatitis symptoms at ages 4-6 and 6-8 years.
  • Higher phthalate concentrations were positively associated with symptoms in males, whereas associations were negative in females.
  • No sex-specific associations were observed for 3rd trimester phthalate exposures, but individual metabolite analyses confirmed sex-modification for 2nd trimester exposures.

Conclusions:

  • Prenatal phthalate exposure during early pregnancy is associated with childhood atopic dermatitis symptoms.
  • The association between phthalate exposure and atopic dermatitis is sex-specific, with differing effects observed in males and females.
  • These findings highlight the importance of considering sex as a modifier in environmental health research related to phthalates and atopic diseases.
Abstract

Keywords:
allergic rhinitisallergyatopic dermatitisatopic diseasesenvironmentphthalates

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