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Association of phthalate exposure during early pregnancy with fetal growth and the effect modification by gestational

Nian Wu1, Zhongmei Hu2, Xinyi Xiao3

  • 1School of Public Health, Zunyi Medical University, No.6 Xuefu Xilu, Zunyi, 563006, China; Key Laboratory of Maternal and Child Health and Exposure Science , Guizhou Provincial Department of Education, China; Pingba District Center for Disease Control and Prevention, Anshun, 561100, China.

International Journal of Hygiene and Environmental Health
|May 22, 2026
PubMed

Insights

First-trimester exposure to phthalates (PAEs) is linked to impaired fetal growth. Pregnancy stress may worsen these effects, impacting fetal development.

Area of Science:

  • Environmental Health
  • Reproductive Toxicology
  • Prenatal Development

Background:

  • Phthalates (PAEs) are endocrine-disrupting chemicals with widespread exposure.
  • Prenatal exposure to environmental chemicals can impact fetal growth and development.
  • Pregnancy stress is a known factor influencing maternal and fetal health outcomes.

Purpose of the Study:

  • To investigate the association between first-trimester phthalates (PAEs) exposure and fetal growth parameters.
  • To explore whether first-trimester pregnancy stress modifies the relationship between PAEs exposure and fetal growth.

Main Methods:

  • A cohort of 704 pregnant women in their first trimester was analyzed.
  • Fetal growth parameters (e.g., HC, AC, FL, EFW, PT) were measured using ultrasonography.
  • Urinary concentrations of nine PAE metabolites were quantified; pregnancy stress was self-reported; statistical analyses included linear regression and Bayesian Kernel Machine Regression (BKMR).

Main Results:

  • Specific PAE metabolites (MEOHP, MBzP, MEP) were associated with reduced fetal growth metrics (HC, AC, FL).
  • Higher total PAE mixture concentrations were linked to lower femur length (FL) Z-scores.
  • Gestational stress was associated with reduced placental thickness (PT) and significantly modified PAE-fetal growth associations.

Conclusions:

  • First-trimester exposure to phthalates (PAEs) is associated with impaired fetal growth.
  • Gestational stress may amplify the adverse effects of PAEs on fetal development.
  • These findings highlight the importance of reducing PAE exposure during pregnancy, especially under stressful conditions.
Abstract

Keywords:
Effect modificationFetal growthPhthalatesgestational stress

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