Prenatal exposure to mixtures of phthalates and phenols and body mass index and blood pressure in Spanish preadolescents

Environ Int. 2022 Nov:169:107527. doi: 10.1016/j.envint.2022.107527. Epub 2022 Sep 15.


Background: Pregnant women are simultaneously exposed to several non-persistent endocrine-disrupting chemicals, which may influence the risk of childhood obesity and cardiovascular diseases later in life. Previous prospective studies have mostly examined single-chemical effects, with inconsistent findings. We assessed the association between prenatal exposure to phthalates and phenols, individually and as a mixture, and body mass index (BMI) and blood pressure (BP) in preadolescents.

Methods: We used data from the Spanish INMA birth cohort study (n = 1,015), where the 1st and 3rd- trimester maternal urinary concentrations of eight phthalate metabolites and six phenols were quantified. At 11 years of age, we calculated BMI z-scores and measured systolic and diastolic BP. We estimated individual chemical effects with linear mixed models and joint effects of the chemical mixture with hierarchical Bayesian kernel machine regression (BKMR). Analyses were stratified by sex and by puberty status.

Results: In single-exposure models, benzophenone-3 (BP3) was nonmonotonically associated with higher BMI z-score (e.g. Quartile (Q) 3: β = 0.23 [95% CI = 0.03, 0.44] vs Q1) and higher diastolic BP (Q2: β = 1.27 [0.00, 2.53] mmHg vs Q1). Methyl paraben (MEPA) was associated with lower systolic BP (Q4: β = -1.67 [-3.31, -0.04] mmHg vs Q1). No consistent associations were observed for the other compounds. Results from the BKMR confirmed the single-exposure results and showed similar patterns of associations, with BP3 having the highest importance in the mixture models, especially among preadolescents who reached puberty status. No overall mixture effect was found, except for a tendency of higher BMI z-score and lower systolic BP in girls.

Conclusions: Prenatal exposure to UV-filter BP3 may be associated with higher BMI and diastolic BP during preadolescence, but there is little evidence for an overall phthalate and phenol mixture effect.

Keywords: Benzophenone-3; Blood pressure (BP); Body mass index (BMI); Parabens; Phenols; Phthalates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bayes Theorem
  • Blood Pressure
  • Body Mass Index
  • Child
  • Cohort Studies
  • Environmental Pollutants* / adverse effects
  • Environmental Pollutants* / analysis
  • Female
  • Humans
  • Parabens / adverse effects
  • Parabens / analysis
  • Pediatric Obesity*
  • Phenol
  • Phenols / analysis
  • Phenols / toxicity
  • Phthalic Acids* / toxicity
  • Pregnancy
  • Prenatal Exposure Delayed Effects*


  • Environmental Pollutants
  • Parabens
  • Phenols
  • Phthalic Acids
  • Phenol
  • phthalic acid