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Peer-reviewedCC BYJAMA Network Open

Gestational Exposure to 10 Classes of Priority Chemicals and Birth Outcomes in the ECHO Cohort

  • Jessie Poulin Buckley1
  • Diana C. Pacyga1
  • Xiaoshuang Xun2
  • Dana Boyd Barr3
  • Emily S. Barrett4,5
  • Theresa M. Bastain6,7
  • Deborah H. Bennett8,5
  • Joseph M. Braun9
  • C Vanesa Padilla Breton6,7
  • Courtney C. Carignan10,11
  • Lisa Croen12,5
  • A W Dunlop13,5
88 more authors
  • Shohreh F. Farzan6,5
  • Assiamira M. Ferrara12,5
  • Frank D. Gilliland6,5
  • Julie Beth Herbstman14,5
  • Margaret Rita Karagas15,5
  • Catherine J Karr16,17,5
  • Jordan R. Kuiper18
  • John D. Meeker19,5
  • Rachel L. Miller20,5
  • Rachel A. Morello-Frosch21,22,5
  • Thomas G. O’Connor23,24,25
  • Jiwon Oh8
  • Perera Fp14
  • Christina A. Porucznik26,5
  • Megan E. Romano15
  • Sheela Sathyanarayana27,5
  • Susan L. Schantz28,5
  • Rebecca J. Schmidt8,29,5
  • Allison R. Sherris16
  • Leonardo Trasande30,31,32,5
  • Heather E. Volk33,5
  • Deborah J. Watkins19
  • Qi Zhao34,5
  • Yeyi Zhu12,5
  • Zhongmin Li35
  • Edo D. Pellizzari36
  • Kurunthachalam Kannan35
  • Tracey J. Woodruff37,38,39,5
  • P Brian Smith5
  • Laura Kristin Newby5
  • Linda Adair5
  • Lisa P. Jacobson5
  • Diane Catellier5
  • Monica McGrath5
  • Christian E. Douglas5
  • Priya Duggal5
  • Emily Knapp5
  • Amii Kress5
  • Courtney K. Blackwell5
  • Maxwell Armand Mansolf5
  • Jin-Shei Lai5
  • Emily Ho5
  • David F Cella5
  • Richard C Gershon5
  • Michelle Macy5
  • Suman R. Das5
  • Jane E. Freedman5
  • Simon A. Mallal5

60 listed; 100 in total.

39 affiliations
  1. 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  3. 3Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
  4. 4Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, Piscataway, New Jersey
  5. 5for the Environmental influences on Child Health Outcomes (ECHO) Cohort Consortium
  6. 6Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
  7. 7School of Public Health, Washington University in St Louis, St Louis, Missouri
  8. 8Department of Public Health Sciences, University of California, Davis
  9. 9Department of Epidemiology, Brown University, Providence, Rhode Island
  10. 10Department of Food Science and Human Nutrition, Michigan State University, East Lansing
  11. 11Department of Pharmacology and Toxicology, Michigan State University, East Lansing
  12. 12Division of Research, Kaiser Permanente Northern California, Pleasanton
  13. 13Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
  14. 14Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
  15. 15Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
  16. 16Department of Environmental & Occupational Health Sciences, University of Washington, Seattle
  17. 17Department of Pediatrics, University of Washington, Seattle
  18. 18Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, DC
  19. 19Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor
  20. 20Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
  21. 21Department of Environmental Science, Policy and Management, University of California, Berkeley
  22. 22School of Public Health, University of California, Berkeley
  23. 23Department of Neuroscience, University of Rochester, Rochester, New York
  24. 24Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
  25. 25Department of Psychiatry, University of Rochester, Rochester, New York
  26. 26Department of Family Medicine and Public Health, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
  27. 27Department of Pediatrics and Seattle Children’s Research Institute, University of Washington, Seattle
  28. 28Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana
  29. 29MIND Institute, University of California Davis, Davis
  30. 30Department of Pediatrics, Grossman School of Medicine, New York University, New York
  31. 31Department of Population Health, Grossman School of Medicine, New York University, New York
  32. 32Wagner School of Public Service, New York University, New York
  33. 33Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  34. 34Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis
  35. 35Wadsworth Center, New York State Department of Health, Albany
  36. 36RTI Fellows Program, Research Triangle Institute, Research Triangle Park, North Carolina
  37. 37Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
  38. 38Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
  39. 39Woods Institute, Doerr School of Sustainability, Stanford University, Stanford, California
Open at sourceDOICite

Abstract

Importance: Gestational environmental chemical exposures are widespread. Some chemicals are known to adversely affect birth outcomes, but many remain understudied. Objective: To evaluate associations of gestational exposure to a priori identified chemicals in 10 classes with birth outcomes in a large, diverse US cohort. Design, Setting, and Participants: In the prospective Environmental influences on Child Health Outcomes Cohort study, 5318 mother-child pairs were enrolled from January 1, 2000, to December 31, 2021, with data on gestational urinary chemical concentrations, gestational age at birth, and birth weight. Statistical analysis was performed from January 2024 to February 2026. Exposures: In single, midgestation (median, 25 weeks [IQR, 21-30 weeks]) urine samples, concentrations of 113 analytes (chemicals or their metabolites) from 10 chemical classes were simultaneously measured: fungicides and herbicides (n = 11), insecticides (n = 20), halogenated phenols (n = 5), organophosphate esters (n = 10), benzophenones (n = 6), bisphenols (n = 14), parabens (n = 6), antimicrobials (n = 2), phthalates or alternative plasticizers (n = 32), and polycyclic aromatic hydrocarbons (PAHs) (n = 7). Main Outcomes and Measures: Linear mixed-effects regression models with a random effect for site were used to estimate covariate-adjusted differences in gestational age at birth (days) and birth weight-for-gestational age (BW-GA) z scores per IQR increase in urinary analyte concentrations. In secondary analyses, odds ratios (ORs) for preterm birth and small for gestational age (SGA) were estimated. Results: In the sample of 5318 mother-child pairs, most infants (2667 female [50%]; median gestational age at birth, 39.0 weeks [IQR, 38.0-40.0 weeks]) were born to college-educated (67% [3218 of 4785]), parous (56% [2815 of 5007]) mothers (median age at delivery, 30.7 years [IQR, 26.1-34.3 years]). A total of 43 of 113 analytes (38%) were detected in 50% or more of samples. Multiple phthalates or alternative plasticizers were associated with younger gestational age at birth or lower BW-GA z scores; for example, summed diisononyl phthalate metabolites were associated with a 0.6-day (95% CI, -1.0 to -0.1 days) younger gestational age (preterm birth OR, 1.16 [95% CI, 1.01-1.34]), and summed phthalate or alternative plasticizers were associated with a 0.06 (95% CI, -0.11 to -0.02) lower BW-GA z score (SGA OR, 1.09 [95% CI, 0.93-1.27]). Two halogenated phenols, benzophenone 8, bisphenol F, and several PAHs were associated with lower BW-GA z scores; for example, 1- and 9-hydroxphenanthrene were associated with a 0.04 (95% CI, -0.08 to -0.01) lower BW-GA z score (SGA OR, 1.13 [95% CI, 1.01-1.27]). Conclusions and Relevance: This large cohort study of diverse US pregnancies found widespread exposure to 10 classes of environmental chemicals, many of which were associated with differences in gestational age at birth or lower BW-GA z scores. These findings indicate that reducing gestational exposure to chemicals, particularly phthalates or alternative plasticizers and PAHs, could promote healthy deliveries and better child outcomes.

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Cite

BibTeXRIS
BibTeX
@article{buckley2026gestational,
  title = {{Gestational Exposure to 10 Classes of Priority Chemicals and Birth Outcomes in the ECHO Cohort}},
  author = {Jessie Poulin Buckley and Diana C. Pacyga and Xiaoshuang Xun and Dana Boyd Barr and Emily S. Barrett and Theresa M. Bastain and Deborah H. Bennett and Joseph M. Braun and C Vanesa Padilla Breton and Courtney C. Carignan and Lisa Croen and A W Dunlop and Shohreh F. Farzan and Assiamira M. Ferrara and Frank D. Gilliland and Julie Beth Herbstman and Margaret Rita Karagas and Catherine J Karr and Jordan R. Kuiper and John D. Meeker and Rachel L. Miller and Rachel A. Morello-Frosch and Thomas G. O’Connor and Jiwon Oh and Perera Fp and Christina A. Porucznik and Megan E. Romano and Sheela Sathyanarayana and Susan L. Schantz and Rebecca J. Schmidt and Allison R. Sherris and Leonardo Trasande and Heather E. Volk and Deborah J. Watkins and Qi Zhao and Yeyi Zhu and Zhongmin Li and Edo D. Pellizzari and Kurunthachalam Kannan and Tracey J. Woodruff and P Brian Smith and Laura Kristin Newby and Linda Adair and Lisa P. Jacobson and Diane Catellier and Monica McGrath and Christian E. Douglas and Priya Duggal and Emily Knapp and Amii Kress and Courtney K. Blackwell and Maxwell Armand Mansolf and Jin-Shei Lai and Emily Ho and David F Cella and Richard C Gershon and Michelle Macy and Suman R. Das and Jane E. Freedman and Simon A. Mallal},
  journal = {JAMA Network Open},
  year = {2026},
  month = jun,
  doi = {10.1001/jamanetworkopen.2026.18883},
  url = {https://doi.org/10.1001/jamanetworkopen.2026.18883},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Gestational Exposure to 10 Classes of Priority Chemicals and Birth Outcomes in the ECHO Cohort
AU  - Jessie Poulin Buckley
AU  - Diana C. Pacyga
AU  - Xiaoshuang Xun
AU  - Dana Boyd Barr
AU  - Emily S. Barrett
AU  - Theresa M. Bastain
AU  - Deborah H. Bennett
AU  - Joseph M. Braun
AU  - C Vanesa Padilla Breton
AU  - Courtney C. Carignan
AU  - Lisa Croen
AU  - A W Dunlop
AU  - Shohreh F. Farzan
AU  - Assiamira M. Ferrara
AU  - Frank D. Gilliland
AU  - Julie Beth Herbstman
AU  - Margaret Rita Karagas
AU  - Catherine J Karr
AU  - Jordan R. Kuiper
AU  - John D. Meeker
AU  - Rachel L. Miller
AU  - Rachel A. Morello-Frosch
AU  - Thomas G. O’Connor
AU  - Jiwon Oh
AU  - Perera Fp
AU  - Christina A. Porucznik
AU  - Megan E. Romano
AU  - Sheela Sathyanarayana
AU  - Susan L. Schantz
AU  - Rebecca J. Schmidt
AU  - Allison R. Sherris
AU  - Leonardo Trasande
AU  - Heather E. Volk
AU  - Deborah J. Watkins
AU  - Qi Zhao
AU  - Yeyi Zhu
AU  - Zhongmin Li
AU  - Edo D. Pellizzari
AU  - Kurunthachalam Kannan
AU  - Tracey J. Woodruff
AU  - P Brian Smith
AU  - Laura Kristin Newby
AU  - Linda Adair
AU  - Lisa P. Jacobson
AU  - Diane Catellier
AU  - Monica McGrath
AU  - Christian E. Douglas
AU  - Priya Duggal
AU  - Emily Knapp
AU  - Amii Kress
AU  - Courtney K. Blackwell
AU  - Maxwell Armand Mansolf
AU  - Jin-Shei Lai
AU  - Emily Ho
AU  - David F Cella
AU  - Richard C Gershon
AU  - Michelle Macy
AU  - Suman R. Das
AU  - Jane E. Freedman
AU  - Simon A. Mallal
PY  - 2026
DA  - 2026/06/17
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.18883
UR  - https://doi.org/10.1001/jamanetworkopen.2026.18883
AB  - Importance: Gestational environmental chemical exposures are widespread. Some chemicals are known to adversely affect birth outcomes, but many remain understudied. Objective: To evaluate associations of gestational exposure to a priori identified chemicals in 10 classes with birth outcomes in a large, diverse US cohort. Design, Setting, and Participants: In the prospective Environmental influences on Child Health Outcomes Cohort study, 5318 mother-child pairs were enrolled from January 1, 2000, to December 31, 2021, with data on gestational urinary chemical concentrations, gestational age at birth, and birth weight. Statistical analysis was performed from January 2024 to February 2026. Exposures: In single, midgestation (median, 25 weeks [IQR, 21-30 weeks]) urine samples, concentrations of 113 analytes (chemicals or their metabolites) from 10 chemical classes were simultaneously measured: fungicides and herbicides (n = 11), insecticides (n = 20), halogenated phenols (n = 5), organophosphate esters (n = 10), benzophenones (n = 6), bisphenols (n = 14), parabens (n = 6), antimicrobials (n = 2), phthalates or alternative plasticizers (n = 32), and polycyclic aromatic hydrocarbons (PAHs) (n = 7). Main Outcomes and Measures: Linear mixed-effects regression models with a random effect for site were used to estimate covariate-adjusted differences in gestational age at birth (days) and birth weight-for-gestational age (BW-GA) z scores per IQR increase in urinary analyte concentrations. In secondary analyses, odds ratios (ORs) for preterm birth and small for gestational age (SGA) were estimated. Results: In the sample of 5318 mother-child pairs, most infants (2667 female [50%]; median gestational age at birth, 39.0 weeks [IQR, 38.0-40.0 weeks]) were born to college-educated (67% [3218 of 4785]), parous (56% [2815 of 5007]) mothers (median age at delivery, 30.7 years [IQR, 26.1-34.3 years]). A total of 43 of 113 analytes (38%) were detected in 50% or more of samples. Multiple phthalates or alternative plasticizers were associated with younger gestational age at birth or lower BW-GA z scores; for example, summed diisononyl phthalate metabolites were associated with a 0.6-day (95% CI, -1.0 to -0.1 days) younger gestational age (preterm birth OR, 1.16 [95% CI, 1.01-1.34]), and summed phthalate or alternative plasticizers were associated with a 0.06 (95% CI, -0.11 to -0.02) lower BW-GA z score (SGA OR, 1.09 [95% CI, 0.93-1.27]). Two halogenated phenols, benzophenone 8, bisphenol F, and several PAHs were associated with lower BW-GA z scores; for example, 1- and 9-hydroxphenanthrene were associated with a 0.04 (95% CI, -0.08 to -0.01) lower BW-GA z score (SGA OR, 1.13 [95% CI, 1.01-1.27]). Conclusions and Relevance: This large cohort study of diverse US pregnancies found widespread exposure to 10 classes of environmental chemicals, many of which were associated with differences in gestational age at birth or lower BW-GA z scores. These findings indicate that reducing gestational exposure to chemicals, particularly phthalates or alternative plasticizers and PAHs, could promote healthy deliveries and better child outcomes.
SN  - 2574-3805
ER  -