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Liu J, Gao D, Wang H, Li Y, Chen M, Ma Q, Wang X, Cui M, Chen L, Zhang Y, Guo T, Yuan W, Ma T, Jiang J, Dong Y, Zou Z, Ma J. Long-term exposure to exogenous phthalate, masculinity and femininity trait, and gender identity in children: a Chinese 3-year longitudinal cohort study. Environ Health 2023; 22:81. [PMID: 38012654 PMCID: PMC10683128 DOI: 10.1186/s12940-023-01031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Phthalate esters (PAEs) are known to have hormone-like properties, and there is a growing trend of children expressing a gender identity different from assigned sex. However, there has been limited research in the potential links between PAEs exposure and gender identity. METHODS A total of 571 children (278 boys) completed the follow-up from Oct 2017 to Oct 2020 in Childhood Blood Pressure and Environmental Factors (CBPEF) cohort in Xiamen, China. Urinary PAE metabolites were measured at three time of visits using ultraperformance liquid chromatography-tandem mass spectrometry. The Children's Sex Role Inventory scale was used to assess gender identity (masculinity, femininity, androgyny and undifferentiated), and Tanner definition was used to define puberty timing. Generalized linear models and log-binomial regression were used to assess the relationships between PAEs exposure, gender trait scores and gender identity. RESULTS Overall, the concentration of most PAEs in more than 90% of participants was above the limit of detection values. In visit 1, there were 10.1% boys with femininity and 11.3% girls with masculinity; while these figures increased to 10.8% and 12.3% during follow-up, respectively. Early puberty onset accounted for 24.8% and 25.6% among boys and girls. Long-term exposure to mono-2-ethylhexyl phthalate (MEHP) (β = 1.20, 95%CI = 0.13, 2.28), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (β = 1.25, 95%CI = 0.22, 2.28) and mono-2-ethyl-5-oxohexyl phthalate (MEOHP) (β = 1.40, 95%CI = 0.24, 2.56) was associated with the increased differences of femininity trait scores in boys who enter puberty earlier, prolonged exposure to di(2-ethylhexyl) phthalate (DEHP) might also have such a positive impact (β = 1.38, 95%CI = 0.36, 2.41). For gender identity, persistent exposure to low molecular weight phthalates (LMWP) was negatively associated with undifferentiated type among boys entering puberty earlier (RR = 0.18, 95%CI = 0.05, 0.75, P < 0.05), and most of the PAE metabolites exposures showed risk ratios > 1 for their femininity. CONCLUSION Long-term exposure to PAEs increase the femininity trait scores in boys with early onset of puberty. Although the mechanisms remain to be determined, environmental pollution might have subtle, yet measurable effects on childhood gender identity. Reducing these chemicals exposure has important public implications on gender development.
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Affiliation(s)
- Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Di Gao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Yanhui Li
- School of Nursing, Peking University, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Mengjie Cui
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Tongjun Guo
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Wen Yuan
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Jianuo Jiang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China.
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Xueyuan Road 38, Beijing, China
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Sethuram S, Raymond S, Wang C, Barrett ES, Bush NR, Nguyen R, Sathyanarayana S, Swan SH, Evans SF. Early prenatal sex steroids and sex-typed play behavior at 4 years of age. Psychoneuroendocrinology 2023; 156:106288. [PMID: 37480735 DOI: 10.1016/j.psyneuen.2023.106288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 07/24/2023]
Abstract
During pregnancy, estrogens and testosterone influence brain development, resulting in sex-typical behavioral phenotypes. Prenatal testosterone exposure is associated with more male-typical behaviors in rodents, monkeys, and humans; however, few studies have examined the relationship between maternal sex hormones within the normal range and sex-dimorphic behaviors. In this study, we examined associations between prenatal estrogens and testosterone and sex-typical play in The Infant Development and the Environment Study (TIDES), a multicenter pregnancy cohort. We collected prenatal serum during the first trimester (mean=11.1 ± 2.6 weeks) and assessed child play behavior using the maternally completed Pre-School Activities Inventory (PSAI) at a mean age of 4.5 ± 0.3 years. This analysis includes mother-child pairs with complete data on hormones, play behavior, and covariates (n = 192 boys and 207 girls). No associations were seen between testosterone and PSAI scores in boys or girls or between estrogens and PSAI scores in boys. In girls, we observed an inverse relationship between feminine PSAI scores and both estradiol (E2) and estriol (E3) in multivariable linear regression analyses (E2: -0.11 [95% CI -0.20, -0.02]; E3: -0.44 [95% CI -0.83,-0.04]). Because the relationship between sex hormones and PSAI scores appeared nonlinear, we fit piecewise regression models to better fit the data and identify inflection points (point at which there is a significant change in slope). Piecewise regression analyses yielded inverse associations between masculine PSAI scores and estrone (E1) at values of E1 > 1340 pg/mL and E2 at values of E2 > 2870 pg/mL in girls. Further studies are needed to better understand the role of prenatal sex steroids on sexually dimorphic behavior.
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Affiliation(s)
- Swathi Sethuram
- Department of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA.
| | - Samantha Raymond
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Wang
- Clinical and Translational Science Institute, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Nicole R Bush
- Departments of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, CA, USA
| | - Ruby Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Felice Evans
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mustieles V, Rolland M, Pin I, Thomsen C, Sakhi AK, Sabaredzovic A, Muckle G, Guichardet K, Slama R, Philippat C. Early-Life Exposure to a Mixture of Phenols and Phthalates in Relation to Child Social Behavior: Applying an Evidence-Based Prioritization to a Cohort with Improved Exposure Assessment. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87006. [PMID: 37556305 PMCID: PMC10411634 DOI: 10.1289/ehp11798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Previous studies aiming at relating exposure to phenols and phthalates with child social behavior characterized exposure using one or a few spot urine samples, resulting in substantial exposure misclassification. Moreover, early infancy exposure was rarely studied. OBJECTIVES We aimed to examine the associations of phthalates and phenols with child social behavior in a cohort with improved exposure assessment and to a priori identify the chemicals supported by a higher weight of evidence. METHODS Among 406 mother-child pairs from the French Assessment of Air Pollution exposure during Pregnancy and Effect on Health (SEPAGES) cohort, 25 phenols/phthalate metabolites were measured in within-subject pools of repeated urine samples collected at the second and third pregnancy trimesters (∼ 21 samples/trimester) and at 2 months and 1-year of age (∼ 7 samples/period). Social behavior was parent-reported at 3 years of age of the child using the Social Responsiveness Scale (SRS). A structured literature review of the animal and human evidence was performed to prioritize the measured phthalates/phenols based on their likelihood to affect social behavior. Both adjusted linear regression and Bayesian Weighted Quantile Sum (BWQS) regression models were fitted. False discovery rate (FDR) correction was applied only to nonprioritized chemicals. RESULTS Prioritized compounds included bisphenol A, bisphenol S, triclosan (TCS), diethyl-hexyl phthalate (Σ DEHP ), mono-ethyl phthalate (MEP), mono-n -butyl phthalate (MnBP), and mono-benzyl phthalate (MBzP). With the exception of bisphenols, which showed a mixed pattern of positive and negative associations in pregnant mothers and neonates, few prenatal associations were observed. Most associations were observed with prioritized chemicals measured in 1-y-old infants: Each doubling in urinary TCS (β = 0.78 ; 95% CI: 0.00, 1.55) and MEP (β = 0.92 ; 95% CI: - 0.11 , 1.96) concentrations were associated with worse total SRS scores, whereas MnBP and Σ DEHP were associated with worse Social Awareness (β = 0.25 ; 95% CI: 0.01, 0.50) and Social Communication (β = 0.43 ; 95% CI: - 0.02 , 0.89) scores, respectively. BWQS also suggested worse total SRS [Beta 1 = 1.38 ; 95% credible interval (CrI): - 0.18 , 2.97], Social Awareness (Beta 1 = 0.37 ; 95% CrI: 0.06, 0.70), and Social Communication (Beta 1 = 0.91 ; 95% CrI: 0.31, 1.53) scores per quartile increase in the mixture of prioritized compounds assessed in 1-y-old infants. The few associations observed with nonprioritized chemicals did not remain after FDR correction, with the exception of benzophenone-3 exposure in 1-y-old infants, which was suggestively associated with worse Social Communication scores (corrected p = 0.07 ). DISCUSSION The literature search allowed us to adapt our statistical analysis according to the weight of evidence and create a corpus of experimental and epidemiological knowledge to better interpret our findings. Early infancy appears to be a sensitive exposure window that should be further investigated. https://doi.org/10.1289/EHP11798.
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Affiliation(s)
- Vicente Mustieles
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | - Matthieu Rolland
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | - Isabelle Pin
- Pediatric Department, Grenoble Alpes University Hospital, La Tronche, France
| | | | | | | | - Gina Muckle
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, Canada
| | - Karine Guichardet
- Pediatric Department, Grenoble Alpes University Hospital, La Tronche, France
| | - Rémy Slama
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | - Claire Philippat
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
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Özel F, Stratmann M, Lindh C, Gennings C, Bornehag CG, Rüegg J. Prenatal exposure to phthalates and gender-specific play behavior at seven years of age in the SELMA study. ENVIRONMENT INTERNATIONAL 2023; 178:108029. [PMID: 37331180 DOI: 10.1016/j.envint.2023.108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND A growing body of evidence shows that prenatal exposure to phthalates affects child development. Since many phthalates have been shown to alter endocrine signaling, they may influence reproductive development, neurodevelopment, and child behavior. Indeed, a few studies reported associations between prenatal phthalate exposure and gender-specific play behavior. However, evidence for this relationship is limited, and previous findings are based on single phthalates, while human exposure entails mixtures of chemicals. OBJECTIVE We aimed to investigate the associations between prenatal exposure to single phthalates, as well as a phthalate mixture, and gender-specific play behavior. METHODS A total of 715 mother-child pairs from the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study were included. In the median week 10 of pregnancy, phthalate metabolites were measured in urine. Gender-specific play behavior was measured with Preschool Activities Inventory at the age of seven years. Linear and weighted quantile sum regressions were used; data was stratified by sex. Models were adjusted for child and maternal age, maternal education, parental attitudes toward play behavior, and urinary creatinine concentration. RESULTS For boys, single compound analyses revealed negative associations of prenatal exposure to di-isononyl phthalate (DINP) concentrations with masculine (β = -1.44; 95% CI = -2.72, -0.16) and composite (β = -1.43; 95% CI = -2.72, -0.13) scores. Suggestive associations were also observed with a mixture approach identifying DINP as the main contributor of the association of decreased masculine play. Among girls, higher urinary concentrations of 2,4-methyl-7-oxyooctyl-oxycarbonyl-cyclohexane carboxylic acid (MOiNCH) was associated with decreased feminine (β = -1.59; 95% CI = -2.62, -0.57) and masculine scores (β = -1.22; 95% CI = -2.14, -0.29), whereas the mixture analyses did not yield conclusive results for girls. CONCLUSION Our findings suggest associations of prenatal exposure to DINP with decreased masculine play behavior in boys while the results for girls were not fully conclusive.
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Affiliation(s)
- Fatih Özel
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden; Centre for Women's Mental Health during the Reproductive Lifespan - Womher, Uppsala University, Uppsala, Sweden; Department of Health Sciences, Karlstad University, Karlstad, Sweden.
| | - Marlene Stratmann
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joëlle Rüegg
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden; Department of Health Sciences, Karlstad University, Karlstad, Sweden
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Zeng G, Zhang Q, Wang X, Wu KH. Low-level plasticizer exposure and all-cause and cardiovascular disease mortality in the general population. Environ Health 2022; 21:32. [PMID: 35264146 PMCID: PMC8905760 DOI: 10.1186/s12940-022-00841-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/22/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Plasticizers, also called phthalates, are a group of chemicals widely used in daily life. A previous report showed no significant association between phthalate metabolite concentrations and mortality. We investigated the association of urinary phthalate levels and individual phthalate metabolite levels with all-cause and cardiovascular disease (CVD) mortality after standardizing the phthalate concentration. METHODS A total of 6,625 participants were recruited from a nationally representative sample of adults aged 40 years or older who were enrolled in the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2014 and were followed up through December 31, 2015. Data were analyzed from January 2021 to June 2021. NHANES-linked updated National Death Index public access files were used to acquire information on mortality status and cause of death. The present study conducted extended follow-up of an earlier analysis. Cox proportional hazard models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of covariate-adjusted creatinine standardization urinary phthalate concentrations with all-cause and CVD mortality after adjusting for demographics, lifestyle factors and comorbidity variables. RESULTS The mean ± standard deviation age of all participants in the final study was 59.9±12.6 years old, and 49.6% of the participants were male. The median follow-up time was 73 months (range 1-157 months). At the censoring date of December 31, 2015, 3,023 participants were identified as deceased (13.4%). A fully adjusted Cox model showed that a urinary di(2-ethylhexyl) phthalate (DEHP) concentration >= 83.4 ng/mL was associated with a slight increase in all-cause mortality (HR 1.27, 95% CI 1.03, 1.57, P for trend= 0.014) and CVD mortality (HR 2.19, 95% CI 1.35, 3.54, P for trend= 0.002). Similarly, urinary mono-2-ethyl-5-carboxypentyl phthalate (MECPP) levels >= 39.2 ng/mL were associated with increased CVD mortality (HR 2.33, 95% CI 1.45, 3.73, P for trend < 0.001). Restricted cubic spline analyses suggested linear associations of DEHP and MECPP levels with all-cause and CVD mortality. CONCLUSION In this large nationally representative sample of American adults, high urinary DEHP and MECPP were significantly associated with all-cause and CVD mortality after adjusting for demographics, lifestyle factors and comorbidity variables.
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Affiliation(s)
- Guowei Zeng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Qi Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kai-Hong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
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Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway. ENVIRONMENTAL EPIDEMIOLOGY (PHILADELPHIA, PA.) 2021; 5:e161. [PMID: 34414345 PMCID: PMC8367074 DOI: 10.1097/ee9.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Prenatal phthalate exposure has been linked to altered neurobehavioral development in both animal models and epidemiologic studies, but whether or not these associations translate to increased risk of neurodevelopmental disorders is unclear. We used a nested case-cohort study design to assess whether maternal urinary concentrations of 12 phthalate metabolites at 17 weeks gestation were associated with criteria for Attention Deficit Hyperactivity Disorder (ADHD) classified among 3-year-old children in the Norwegian Mother, Father and Child Cohort Study (MoBa). Between 2007 and 2011, 260 children in this substudy were classified with ADHD using a standardized, on-site clinical assessment; they were compared with 549 population-based controls. We modeled phthalate levels both linearly and by quintiles in logistic regression models adjusted for relevant covariates and tested for interaction by child sex. Children of mothers in the highest quintile of di-iso-nonyl phthalate (∑DiNP) metabolite levels had 1.70 times the odds of being classified with ADHD compared with those in the lowest quintile (95% confidence interval [CI] = 1.03 to 2.82). In linear models, there was a trend with the sum of di-2-ethylhexyl phthalate metabolites (∑DEHP); each natural log-unit increase in concentration was associated with 1.22 times the odds of ADHD (95% CI = 0.99 to 1.52). In boys, but not girls, mono-n-butyl phthalate exposure was associated with increased odds of ADHD (odds ratio [OR] 1.42; 95% CI = 1.07 to 1.88). Additional adjustment for correlated phthalate metabolites attenuated estimates. These results suggest gestational phthalate exposure may impact the behavior of children as young as 3 years.
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