Association between prenatal phthalate exposure and gestational metabolic syndrome parameters: a systematic review of epidemiological studies

Environ Sci Pollut Res Int. 2021 May;28(17):20921-20938. doi: 10.1007/s11356-021-13120-4. Epub 2021 Mar 5.


The relationship of intrauterine phthalate exposure with gestational metabolic syndrome (GMS) parameters is inconsistently reported. We performed a systematic review to evaluate the association between prenatal phthalate exposure and GMS parameters. A literature search was performed in three databases. According to the defined PECOS statement, eligible studies were identified. The method and result for each study was qualitatively summarized with great emphasis on study design and exposure assessment. Fourteen studies were included in the present systematic review. Two studies used one-spot serum sample for evaluation of phthalate exposure, while others used 1-4 urine samples. Concentrations of phthalate metabolites varied substantially, and the levels in serum were greatly lower than those in urine. These studies observed no interstudy or intrastudy consistency for association between phthalates and GMS in pregnant women cross-sectionally or longitudinally, regardless of phthalates species or GMS indicator. Most reported associations were not significantly different from null result. Besides, positive and negative relationships also existed. The current epidemiological data do not support the hypothesis that prenatal exposure to phthalates increases GMS risk.

Keywords: Gestational metabolic syndrome; Phthalate; Prenatal exposure; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Environmental Pollutants*
  • Epidemiologic Studies
  • Female
  • Humans
  • Metabolic Syndrome* / chemically induced
  • Metabolic Syndrome* / epidemiology
  • Phthalic Acids*
  • Pregnancy


  • Environmental Pollutants
  • Phthalic Acids
  • phthalic acid