Case Report: Recurrent gestation-limited intractable abdominal colic with elevated phthalate and paraben biomarkers:...

Recurrent, gestation-limited severe abdominal colic without a conventional diagnosis is rarely described. Endocrine-disrupting chemicals (EDCs) have been associated with adverse reproductive outcomes, but their relevance to recurrent pregnancy-specific gastrointestinal syndromes remains uncertain.

A 35-year-old Chinese woman had five prior pregnancies; four were terminated because of recurrent severe lower abdominal colic, constipation, inability to maintain oral intake, and marked weight loss. Symptoms reproducibly began at 11-12 gestational weeks and resolved within 1-2 weeks after pregnancy termination. Extensive obstetric, gastrointestinal, vascular, autoimmune, genetic, and imaging evaluations were unrevealing. On 14 September 2024, first-morning urine biomonitoring by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) showed creatinine-adjusted monoethyl phthalate 2136.48 μg/g Cr, methylparaben 233.40 μg/g Cr, and propylparaben 53.80 μg/g Cr, all above the laboratory upper reference limits. A multidomain preconception program addressed avoidable EDC exposure, metabolic factors, immune-vascular factors, nutritional deficits, and gut dysbiosis. Repeat first-morning urine testing on 20 July 2025, during early pregnancy and before the historical 11-12-week symptom window, showed the three previously elevated biomarkers below the laboratory limits. The pregnancy was complicated by hyperemesis gravidarum and transient gestational thyrotoxicosis, but the prior intractable abdominal colic did not recur, and a healthy 3.6-kg female infant was delivered vaginally at term on 14 March 2026.

Because biomarkers were not measured during the prior symptomatic pregnancies and the intervention was multifactorial, this case cannot establish temporality or causality. It supports targeted exposure history and selective EDC biomonitoring as a clinically modifiable, hypothesis-generating clue in carefully selected patients with recurrent, unexplained, pregnancy-specific morbidity after standard evaluation has been exhausted.