First- and Third-Trimester Urinary Phthalate Metabolites in the Development of Hypertensive Diseases of Pregnancy.

Sabrina M Bedell,Ashley Santilli,Nicole R Bush,Kelly K Ferguson,Emily S Barrett,Ruby H.N Nguyen,Sheela Sathyanarayana,Grace R Lyden,Shanna H Swan,Thomas F Mcelrath

doi:10.3390/ijerph182010627

Abstract

The purpose of this study was to determine whether maternal urinary phthalate metabolite concentrations are associated with the development of higher blood pressure or pregnancy-induced hypertension (PIH). Participants were women without chronic hypertension who enrolled in The Infant Development and the Environment Study, a prospective pregnancy cohort conducted at four U.S. academic medical centers from 2010–2012. Prenatal records were reviewed to obtain blood pressure measurements and diagnoses of PIH (gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome, defined as hemolysis, elevated liver enzymes, and low platelet count). Complete-case analyses used multivariable linear and logistic regression for analysis of blood pressure measurements and PIH diagnoses, respectively. In the final dataset (N = 668), higher concentrations of first-trimester monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP) and third-trimester mono-isobutyl phthalate (MiBP) were significantly associated with a medical chart diagnosis of PIH. First-trimester mono-n-butyl phthalate (MBP) and MEP along with the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) were each associated with increased systolic blood pressure across pregnancy. In conclusion, several phthalate metabolite concentrations were significantly associated with PIH and greater increases in systolic blood pressure across pregnancy.

Highlights

Hypertensive disease in pregnancy represents a major contributor to maternal morbidity and mortality in the U.S and worldwide, and the incidence of these diseases isInt
When we examined whether the timing and level of phthalate metabolites in pregnancy had an effect on pregnancy-induced hypertension (PIH) diagnosis in our multicenter cohort, we observed higher concentrations of first-trimester monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP), and higher concentrations of third-trimester
Our primary aim was to determine the odds of incident PIH, but we explored the extent to which these phthalate metabolites associated differently in the subsample of pregnant women who had chronic hypertension and who were excluded from our primary analyses

Summary

Introduction

Hypertensive disease in pregnancy represents a major contributor to maternal morbidity and mortality in the U.S and worldwide, and the incidence of these diseases isInt. Hypertensive disease in pregnancy represents a major contributor to maternal morbidity and mortality in the U.S and worldwide, and the incidence of these diseases is. Res. Public Health 2021, 18, 10627 increasing [1,2,3]. Public Health 2021, 18, 10627 increasing [1,2,3] The etiology of this rise is likely multifactorial, though older age at parturition, higher rates of obesity, and number of comorbidities appear to play key roles [4,5]

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