Systematic evidence map on the association between exposure to personal care products and fetal growth

Exposure to environmental chemicals can influence fetal growth, and these alterations are associated with adverse health outcomes across the lifespan. Personal care products (PCPs) are frequently used by women of reproductive age, including many chemicals known to adversely impact fetal development. Given the high number of chemicals in PCPs, a class-based approach of grouping these chemicals by common characteristic(s) (e.g., chemical structure, mode of action) may support future hazard identification evaluations.

To develop a systematic evidence map (SEM) identifying and characterizing the scientific literature on gestational exposure to PCPs or their chemical constituents and fetal growth to support potential chemical class-based assessments.

Following standardized systematic review methodology, three databases were searched for relevant human and experimental animal studies through June 2024. Study characteristics were extracted and summarized in interactive visualizations and text.

Of the four main chemical classes assessed, phthalates and phenols were most frequently studied (40% and 30% of studies, respectively), followed by per- and polyfluoroalkyl substances (PFAS), and parabens. Few studies evaluated product use. Birthweight was the most frequently assessed outcome (approximately 99% of studies). Many human studies evaluated potential modifying factors of health (% of studies), such as infant sex (58%), race and ethnicity (7%), and socioeconomic status (1%).

Given the availability of well-studied "anchor" chemicals within related chemical groups, this SEM supports the feasibility of class-based approaches to evaluate the association between phthalates, PFAS, phenols, and parabens and fetal growth. Further research on PCPs and fetal growth should address areas of uncertainty, including data gaps on potential effect modifiers, such as socioeconomic status.