Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY, USA.
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, NY, USA.
Environ Int. 2021 Oct;155:106612. doi: 10.1016/j.envint.2021.106612. Epub 2021 May 6.
Pregnancy induces numerous cardiovascular and metabolic changes. Alterations in these sensitive processes may precipitate long-term post-delivery health consequences. Studies have reported associations between phthalates and metabolic complications of pregnancy, but no study has investigated metabolic outcomes beyond pregnancy.
To examine associations of exposure to phthalates during pregnancy with post-delivery metabolic health.
We quantified 15 urinary phthalate biomarker concentrations during the second and third trimesters among 618 pregnant women from Mexico City. Maternal metabolic health biomarkers included fasting blood measures of glycemia [glucose, insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], % hemoglobin A1c (HbA1c%)] and lipids (total, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, triglycerides), at 4-5 and 6-8 years post-delivery. To estimate the influence of the phthalates mixture, we used Bayesian weighted quantile sum regression and Bayesian kernel machine regression; for individual biomarkers, we used linear mixed models.
As a mixture, higher urinary phthalate biomarker concentrations during pregnancy were associated with post-delivery concentrations of plasma glucose (interquartile range [IQR] difference: 0.13 SD, 95%CrI: 0.05, 0.20), plasma insulin (IQR difference: 0.06 SD, 95%CrI: -0.02, 0.14), HOMA-IR (IQR difference: 0.08 SD, 95% CrI: 0.01, 0.16), and HbA1c% (IQR difference: 0.15 SD, 95%CrI: 0.05, 0.24). Associations were primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and the sum of dibutyl phthalate biomarkers (∑DBP). The phthalates mixture was associated with lower HDL (IQR difference: -0.08 SD, 95%CrI: -0.16, -0.01), driven by ∑DBP and monoethyl phthalate (MEP), and higher triglyceride levels (IQR difference: 0.15 SD, 95%CrI: 0.08, 0.22), driven by MECPTP and MEP. The overall mixture was not associated with total cholesterol and LDL. However, ∑DBP and MEP were associated with lower and higher total cholesterol, respectively, and MECPTP and ∑DBP were associated with lower LDL.
Phthalate exposure during pregnancy is associated with adverse long-term changes in maternal metabolic health. A better understanding of timing of the exact biological changes and their implications on metabolic disease risk is needed.
妊娠会引起许多心血管和代谢变化。这些敏感过程的改变可能会引发分娩后长期的健康后果。研究报告了邻苯二甲酸酯与妊娠代谢并发症之间的关联，但没有研究调查妊娠后代谢结果。
研究妊娠期间邻苯二甲酸酯暴露与产后代谢健康之间的关系。
我们在墨西哥城的 618 名孕妇中，在妊娠第二和第三个三个月期间量化了 15 种尿邻苯二甲酸酯生物标志物浓度。产妇代谢健康生物标志物包括空腹血糖[葡萄糖、胰岛素、胰岛素抵抗稳态模型评估[HOMA-IR]、%糖化血红蛋白（HbA1c%）]和血脂（总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）胆固醇、甘油三酯），在产后 4-5 年和 6-8 年时进行测量。为了估计混合物的影响，我们使用贝叶斯加权分位数和贝叶斯核机器回归；对于个体生物标志物，我们使用线性混合模型。
作为一种混合物，妊娠期间较高的尿邻苯二甲酸酯生物标志物浓度与产后血浆葡萄糖（四分位距[IQR]差异：0.13 SD，95%CrI：0.05，0.20）、血浆胰岛素（IQR 差异：0.06 SD，95%CrI：-0.02，0.14）、HOMA-IR（IQR 差异：0.08 SD，95% CrI：0.01，0.16）和 HbA1c%（IQR 差异：0.15 SD，95%CrI：0.05，0.24）浓度有关。关联主要由单 2-乙基-5-羧基戊基邻苯二甲酸酯（MECPTP）和邻苯二甲酸二丁酯生物标志物总和（∑DBP）驱动。该混合物与较低的高密度脂蛋白（IQR 差异：-0.08 SD，95%CrI：-0.16，-0.01）有关，这主要是由∑DBP 和邻苯二甲酸单乙酯（MEP）驱动的，与较高的甘油三酯水平（IQR 差异：0.15 SD，95%CrI：0.08，0.22）有关，这主要是由 MECPTP 和 MEP 驱动的。总体混合物与总胆固醇和 LDL 无关。然而，∑DBP 和 MEP 分别与较低和较高的总胆固醇有关，而 MECPTP 和∑DBP 与较低的 LDL 有关。
妊娠期间邻苯二甲酸酯暴露与产妇代谢健康的长期不良变化有关。需要更好地了解确切的生物学变化时间及其对代谢疾病风险的影响。
