Prenatal Phthalate Exposure and Child Weight and Adiposity from in Utero to 6 Years of Age

Kelly K. Ferguson, Paige A. Bommarito, Olufunmilayo Arogbokun, Emma M. Rosen, Alexander P. Keil, Shanshan Zhao, Emily S. Barrett, Ruby H.N. Nguyen, Nicole R. Bush, Leonardo Trasande, Thomas F. McElrath, Shanna H. Swan, Sheela Sathyanarayana

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16 Scopus citations


BACKGROUND: Prenatal phthalate exposure has been associated with lower birth weight but also higher weight in childhood. Few studies have examined weight or adiposity from birth to childhood and thus cannot assess growth trajectories associated with exposure.

OBJECTIVE: We assessed associations between maternal phthalate exposures in pregnancy and child weight and adiposity measured prenatally through childhood (3-6 years of age).

METHODS: Within The Infant Development and the Environment Study (TIDES), a prospective pregnancy cohort, we analyzed a panel of phthalate metabolites in urine collected at two visits from early and late gestation ( N = 780 ). We estimated average phthalate metabolite associations with child weight z -scores from ∼ 20 wk gestation (estimated by ultrasound), birth, and 1, 3, 4, and 6 years of age using linear mixed-effects (LME) models. We also modeled associations with adiposity z -scores from birth (weight for length) and 1, 3, 4, and 6 years of age [body mass index (BMI)] using LME models.

RESULTS: For weight, we observed inverse associations between several phthalate metabolites and birth weight z -scores, but no associations were observed with postnatal weight z -scores in LME models. Regarding adiposity, we observed inverse associations between phthalate metabolites and weight-for-length z -scores at birth, but positive associations were observed with BMI z -scores at 3-4 years of age in LME models. For example, mono-ethyl phthalate was associated with a 0.17-unit decrease in birth weight-for-length z -score [95% confidence interval (CI): - 0.29 , - 0.05 ] and a 0.18-unit increase in 4-years-of-age BMI z -score (95% CI: 0.04, 0.32).

DISCUSSION: We observed associations between prenatal exposure to phthalates and lower weight at birth but not at childhood follow-up visits. However, for adiposity, we observed an interesting pattern of association with low adiposity at delivery as well as high adiposity at 3-4 years of age. Although it is not clear from our results whether these associations occur within the same children, such a pattern of adiposity in early life has been linked to cardiometabolic disease in adulthood and deserves special attention as an outcome in the study of prenatal exposures in the developmental origins of health and disease.

Original languageEnglish (US)
Article number047006
JournalEnvironmental health perspectives
Issue number4
StatePublished - Apr 2022

Bibliographical note

Funding Information:
This research was supported in part by the Intramural Research Program of the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH; ZIAES103313 to K.K.F.); by the following NIEHS/NIH grants: R01ES016863 (S.H.S.), R01ES025169 (S.H.S.), P30ES023515, R01ES016863-02S4, and P30 ES005022; and by the NIH Office of the Director (UG3/UH3 OD023305 to L.T.).

Publisher Copyright:
© 2022, Public Health Services, US Dept of Health and Human Services. All rights reserved.


  • Adiposity
  • Adult
  • Birth Weight
  • Child
  • Environmental Exposure
  • Environmental Pollutants/metabolism
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Obesity
  • Phthalic Acids/urine
  • Pregnancy
  • Prenatal Exposure Delayed Effects/epidemiology
  • Prospective Studies

PubMed: MeSH publication types

  • Research Support, N.I.H., Intramural
  • Journal Article
  • Research Support, N.I.H., Extramural


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