| Objective This study aims to evaluate the levels of phthalate esters(PAEs)in pregnant women and explore their influencing factors.The effects of exposure to PAEs and their metabolites on hypertensive disorder complicating pregnancy(HDCP)during pregnancy are also analyzed.Method Pregnant women who participated in the Guangxi Birth Defect Cohort Study(? 22 weeks)were recruited.Personal information including general demographic characteristics,pregnancy status,smoking habits,alcohol intake,family medical history,and physical activity were gathered during a face-to-face questionnaire.Maternal blood samples were collected during their first prenatal examination and kept at-80 degree Celsius.In the middle and late pregnancy,the pregnant women's weight,blood pressure,liver and kidney function,thyroid function and disease information were followed up,and the delivery information was followed during childbirth.Then,LLE-GC-MS was used to detect the levels of 5 phthalate esters(BBP,DBP,DEHP,DEP and DMP)and 4 phthalate metabolites(MBP,MEHP,MEP and MMP).Cross-sectional analysis was used to analyze the exposure levels of PAEs and their influencing factors.As the PAEs and their metabolite concentrations were not normally distributed,the median and the interquartile range(IQR)were used to describe their distribution characteristics.The Nonparametric rank sum test was used to analyze the difference in the levels of PAEs and their metabolites among the pregnant women.After the PAEs and their metabolite concentrations were log10-transformed,a multiple linear regression analysis was conducted to explore the influencing factors of PAEs.Nested case-control study was conducted to analyze the relationship between the exposure of PAEs and the risk of HDCP.Pregnant women with HDCP were recruited in the case group,and pregnant women without HDCP were recruited in the control group.Multiple linear regression models were used to analyze the relationship between PAEs and their metabolite concentrations and maternal blood pressure during pregnancy.Multivariate logistic regression models were used to investigate the relationship between PAEs and their metabolites with HDCP.Statistical analysis was performed using SPSS,Version24.0.All the p-values were two-sided and p-values < 0.05 was considered to be statistically significant.Results1.The final sample size of this study was 950.The average age of the participants was 28.5±5.5 years,the average gestational week was 13.9±3.8 weeks,and the average body mass index(BMI)was 21.1±3.1 kg/m2.The detection rate and median concentration of BBP in maternal serum was 85.6% and 0.64 ng/ml respectively;that of DBP was 99.8% and 17.09 ng/ml respectively;that of DEHP was 100.00% and 78.26 ng/ml respectively;that of DEP was 71.0% and0.62 ng/ml respectively;that of DMP was 62.0% and 0.25 ng/ml respectively;that of MBP was 84.5% and 2.19 ng/ml respectively;that of MEHP was 94.0%and 4.09 ng/ml respectively;that of MEP was 40.4% and below the limit of detection(LOD)respectively;and that of MMP was 7.1% and below the LOD respectively.2.Influencing factors of PAEs and their metabolites in maternal serum: Multiple linear regression analysis showed that the influencing factors of BBP were occupational toxic substances and house renovation;that of DEHP were their occupation,BMI,pregnancy week,smoking habits,and the presence of factories near their home;that of DEP were smoking habits,alcohol intake,and home ventilation;that of DMP were smoking habits and home ventilation;that of MBP was smoking habits;and that of MEHP were smoking habits and the use of cosmetics.3.Relationship between exposure levels of PAEs and their metabolites in pregnant women with maternal blood pressure at < 20 weeks gestation: In multiple linear regression models,DEHP concentrations were positively associated with maternal systolic blood pressure(SBP)and diastolic blood pressure(DBP)(SBP ? = 5.24,95%CI:2.42~8.06;DBP ? = 5.94,95%CI:3.83~8.06).DMP concentrations were also positively associated with maternal SBP and DBP(SBP ? = 2.96,95%CI:1.72~4.19;DBP ? = 2.56,95%CI:1.63~3.49).While BBP concentrations were negatively associated with maternal DBP(? =-1.61,95%CI:-2.96~-0.27).4.Relationship between exposure levels of PAEs and their metabolites in pregnant women with maternal blood pressure at ? 20 weeks gestation: In multiple linear regression models,DBP concentrations were positively associated with maternal DBP(? = 2.82,95%CI:0.80~4.84).DEHP concentrations were positively associated with maternal SBP and DBP(SBP ? = 7.20,95%CI: 4.28~10.12;DBP ? = 6.96,95%CI:4.57~9.36).DMP concentrations were also positively associated with maternal SBP and DBP(SBP ? = 5.44,95%CI:4.18~6.71;DBP ? = 4.37,95%CI:3.32~5.41).While MEHP concentrations were negatively associated with maternal DBP(? =-1.72,95%CI:-3.08~-0.36).5.Relationship between exposure levels of PAEs and their metabolites in pregnant women with HDCP: In multivariate logistic regression models,DEHP(OR =25.39,95%CI: 9.07~71.11),DEP(OR = 4.48,95%CI:1.17~17.10)and DMP(OR = 14.54,95%CI : 7.37 ~ 28.69)increased the risk of pregnancy with chronic hypertension,while MEHP reduced the risk of pregnancy with chronic hypertension.DBP(OR = 3.21,95%CI:1.00~10.29),DEHP(OR = 9.40,95%CI:2.64~33.49),DEP(OR = 27.22,95%CI:7.22~102.57)and DMP(OR = 34.25,95%CI:17.17~68.32)increased the risk of pregnancy with chronic hypertension,while MEHP reduced the risk of chronic hypertension combined with preeclampsia,while BBP reduced the risk of chronic hypertension combined with preeclampsia.DMP increased the risk of gestational hypertension.DBP(OR = 2.32,95%CI:1.06~5.10),DEHP(OR =14.12,95%CI:6.03~33.08),DEP(OR = 3.98,95%CI:1.41~11.23)and DMP(OR = 29.90,95%CI:14.29~62.58)were independent risk factors for preeclampsia-eclampsia,while BBP was negatively associated with preeclampsia-eclampsia(OR = 0.35,95%CI:0.18~0.66).Conclusion1.The pregnant women were generally exposed to PAEs,with DEHP and DBP at higher exposure levels,and DMP,DEP and BBP at lower exposure levels.2.Factors that will increase the exposure level of PAEs in pregnant women include occupational hazard exposures,house renovations,occupations,BMI,smoking habits,alcohol intake,use of cosmetics,and home ventilation conditions.3.The exposure of PAEs during pregnancy was closely related to HDCP.DBP,DEHP,DEP and DMP increased the risk of HDCP,while BBP and MEHP decreased the risk of HDCP. |
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