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Understanding the role of environmental pollutants on preterm births in Puerto Rico: The PROTECT approach

José F Cordero1, Carmen M Vélez2, Zaira Rosario3

  • 1Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30606, USA.

Current Problems in Pediatric and Adolescent Health Care
|June 27, 2026
PubMed

Insights

Environmental chemical exposures, including phthalates and pesticides, are linked to preterm birth (PTB) in Puerto Rico. Reducing these exposures before conception is crucial for lowering PTB rates.

Area of Science:

  • Environmental Health
  • Reproductive Health
  • Toxicology

Background:

  • Preterm birth (PTB) is a major global health concern, with Puerto Rico reporting the highest U.S. rate in 2006.
  • High PTB rates were not explained by healthcare factors, suggesting environmental exposures as potential contributors.

Purpose of the Study:

  • To investigate the association between diverse chemical exposures and PTB risk in a cohort of pregnant individuals in northwest Puerto Rico.
  • To explore the biological mechanisms, such as inflammation and oxidative stress, underlying PTB and adverse pregnancy outcomes.

Main Methods:

  • Recruited and followed a cohort of pregnant individuals in northwest Puerto Rico.
  • Measured levels of various chemicals (phthalates, pesticides, metals) in participants.
  • Analyzed associations between chemical exposures, biological mechanisms, and PTB.

Main Results:

  • Participants exhibited high levels of multiple chemicals, with significant associations found between most tested chemicals and PTB.
  • Drinking water, personal care products, and household items were identified as primary exposure sources.
  • Inflammation and oxidative stress were identified as key biological mechanisms mediating adverse pregnancy outcomes via endocrine disruption.

Conclusions:

  • Environmental chemical exposures are significantly associated with preterm birth and adverse pregnancy outcomes in Puerto Rico.
  • Reducing exposure to common chemicals in consumer products before conception is a critical priority to decrease PTB rates.
  • Further research is needed to understand the role of specific chemicals and to develop effective intervention strategies.

Keywords:
ChemicalsEnvironmentHealth disparitiesPregnancyPreterm birthPuerto RicoReport back

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