Maternal exposure to endocrine disrupting chemicals (EDCs) and preterm birth: A systematic review, meta-analysis, and meta-regression analysis

Environ Pollut. 2022 Jan 1;292(Pt A):118264. doi: 10.1016/j.envpol.2021.118264. Epub 2021 Oct 1.


Preterm birth is the second most common cause of death in children under 5 years of age. The etiology of preterm birth has not yet been elucidated. Although maternal exposure to endocrine disrupting chemicals (EDCs) may increase the risk for preterm birth, associations have not been confirmed. We performed a meta-analysis to elucidate the relationships between maternal exposure to EDCs and preterm birth. A systematic search of PubMed, Ovid-EMBASE, and the Cochrane Library (CENTRAL) for relevant published studies providing quantitative data on the association between maternal EDC exposure and preterm birth in humans was conducted in July 2021. To calculate the overall estimates, we pooled the adjusted regression coefficients with 95% confidence intervals (CIs) from each study by the inverse variance method. A total of 59 studies were included. The pooled results indicated that maternal exposure to metals (OR, 1.23; 95% CI, 1.17 to 1.29) and phthalates (OR, 1.31; 95% CI, 1.21 to 1.42) was related to an increased risk for preterm birth. Specifically, maternal exposure to lead, cadmium, chromium, copper and manganese appeared to be correlated with an elevated risk for preterm birth. Additionally, maternal exposure to monoethyl phthalate (MEP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), monobenzyl phthalate (MBzP), and di (2-ethylhexyl) phthalate (DEHP) was also associated with preterm birth. In conclusion, maternal exposure to metals and phthalates may increase the risk for preterm birth based on current evidence.

Keywords: Endocrine disrupting chemicals; Maternal exposure; Preterm birth.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Child
  • Child, Preschool
  • Endocrine Disruptors*
  • Environmental Exposure
  • Environmental Pollutants*
  • Female
  • Humans
  • Infant, Newborn
  • Maternal Exposure
  • Phthalic Acids* / toxicity
  • Pregnancy
  • Premature Birth* / chemically induced
  • Premature Birth* / epidemiology
  • Regression Analysis


  • Endocrine Disruptors
  • Environmental Pollutants
  • Phthalic Acids