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Prenatal phthalates, gestational weight gain, and long-term weight changes among Mexican women

Deierlein, Andrea L; Wu, Haotian; Just, Allan C; Kupsco, Allison J; Braun, Joseph M; Oken, Emily; Soria-Contreras, Diana C; Cantoral, Alejandra; Pizano, Ma Luisa; McRae, Nia; Téllez-Rojo, Martha M; Wright, Robert O; Baccarelli, Andrea A
BACKGROUND:Phthalates are endocrine disrupting chemicals that may influence weight status; however, few studies have considered weight gain during pregnancy and subsequent long-term weight changes in women. OBJECTIVE:To determine associations of prenatal phthalate exposure with maternal weight during pregnancy and through up to seven years post-delivery. METHODS:We analyzed 15 urinary phthalate biomarker concentrations during the 2nd and 3rd trimesters among 874 pregnant women enrolled in the Programming Research in Obesity, Growth Environment and Social Stress Study in Mexico City. We examined three time-specific maternal weight outcomes: gestational weight gain (between 2nd and 3rd trimesters), short-term weight (between 3rd trimester and 12 months post-delivery), and long-term weight (between 18 months and 6-7 years post-delivery). We used Bayesian Kernel Machine Regression (BKMR) to estimate associations for the total phthalate mixture, as well as multivariable linear mixed models for individual phthalate biomarkers. RESULTS:As a mixture, 2nd trimester urinary phthalate biomarker concentrations were associated with somewhat lower gestational weight gain between the 2nd and 3rd trimesters (interquartile range, IQR, difference: -0.07 standard deviations, SD; 95% credible interval, CrI: -0.20, 0.06); multivariable regression and BKMR models indicated that this inverse association was primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP). Prenatal (2nd and 3rd trimesters) urinary phthalate mixture concentrations were positively associated with maternal weight change through 12 months postpartum (IQR difference: 0.11 SD; 95% CrI: 0.00, 0.23); these associations persisted from 18 months to 6-7 years follow-up (IQR difference: 0.07 SD; 95% CrI: 0.04, 0.10). Postpartum weight changes were associated with mono-3-carboxypropyl phthalate (MCPP) and MECPTP. CONCLUSIONS:Prenatal phthalate exposure was inversely associated with gestational weight gain and positively associated with long-term changes in maternal weight. Further investigation is required to understand how phthalates may influence body composition and whether they contribute to the development of obesity and other cardiometabolic diseases in women.
PMCID:8976769
PMID: 35101400
ISSN: 1096-0953
CID: 5476202

Personal Care and Household Cleaning Product Use among Pregnant Women and New Mothers during the COVID-19 Pandemic

Deierlein, Andrea L; Grayon, Alexis R; Zhu, Xiaotong; Sun, Yanwen; Liu, Xun; Kohlasch, Kaelyn; Stein, Cheryl R
This study examined product use among pregnant women and new mothers in New York City during the COVID-19 pandemic (July 2020-June 2021). Women reported use of personal care and household cleaning products within the previous month, changes in antibacterial product use, receipt of healthcare provider advice, and opinions on environmental chemicals (n = 320). On average, women used 15 personal care products and 7 household cleaning products. Non-Hispanic Black women used nearly two more personal care products; non-Hispanic Black women, those with a college degree, and essential workers used 1-3 more household cleaning products. Women who were Hispanic or reported their race and ethnicity as Other were two times more likely to use antibacterial personal care products. Non-Hispanic Black, Hispanic, and women who reported their race and ethnicity as Other were 1.5 times more likely to increase antibacterial product use during the pandemic. Nearly all women agreed that environmental chemicals pose health risks and are impossible to avoid, while less than one quarter received advice regarding product use. Product use is a modifiable source of chemical exposures. Results from this study suggest that women may have increased their product use during the pandemic. Healthcare providers may use the current focus on health hygiene to promote discussion and assessment of environmental chemical exposures with patients.
PMCID:9104147
PMID: 35565038
ISSN: 1660-4601
CID: 5215092

Prenatal maternal phthalate exposures and trajectories of childhood adiposity from four to twelve years

Kupsco, Allison; Wu, Haotian; Calafat, Antonia M; Kioumourtzoglou, Marianthi-Anna; Cantoral, Alejandra; Tamayo-Ortiz, Marcela; Pantic, Ivan; Pizano-Zárate, Maria Luisa; Oken, Emily; Braun, Joseph M; Deierlein, Andrea L; Wright, Robert O; Téllez-Rojo, Martha M; Baccarelli, Andrea A; Just, Allan C
BACKGROUND/AIM/OBJECTIVE:Adiposity trajectories reflect dynamic process of growth and may predict later life health better than individual measures. Prenatal phthalate exposures may program later childhood adiposity, but findings from studies examining these associations are conflicting. We investigated associations between phthalate biomarker concentrations during pregnancy with child adiposity trajectories. METHODS:We followed 514 mother-child pairs from the Mexico City PROGRESS cohort from pregnancy through twelve years. We measured concentrations of nine phthalate biomarkers in 2nd and 3rd trimester maternal urine samples to create a pregnancy average using the geometric mean. We measured child BMI z-score, fat mass index (FMI), and waist-to-height ratio (WHtR) at three study visits between four and 12 years of age. We identified adiposity trajectories using multivariate latent class growth modeling, considering BMI z-score, FMI, and WHtR as joint indicators of latent adiposity. We estimated associations of phthalates biomarkers with class membership using multinomial logistic regression. We used quantile g-computation to estimate the potential effect of the total phthalate mixture and assessed effect modification by sex. RESULTS:We identified three trajectories of child adiposity, a "low-stable", a "low-high", and a "high-high" group. A doubling of the sum of di (2-ethylhexyl) phthalate metabolites (ΣDEHP), was associated with 1.53 (1.08, 2.19) greater odds of being in the "high-high" trajectory in comparison to the "low-stable" group, whereas a doubling in di-isononyl phthalate metabolites (ΣDiNP) was associated with 1.43 (1.02, 2.02) greater odds of being in the "low-high" trajectory and mono (carboxy-isononyl) phthalate (MCNP) was associated with 0.66 (0.45, 97) lower odds of being in the "low-high" trajectory. No sex-specific associations or mixture associations were observed. CONCLUSIONS:Prenatal concentrations of urinary DEHP metabolites, DiNP metabolites, and MCNP, a di-isodecyl phthalate metabolite, were associated with trajectories of child adiposity. The total phthalate mixture was not associated with early life child adiposity.
PMID: 34563522
ISSN: 1096-0953
CID: 5080262

Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students

Ryan, Rachel A; Murphy, Bridget; Deierlein, Andrea L; Lal, Supriya; Parekh, Niyati; Bihuniak, Jessica D
OBJECTIVE:To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. METHODS:A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. RESULTS:Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14-3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23-4.25). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.
PMID: 34758921
ISSN: 1878-2620
CID: 5050612

Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University

Hussain, Bridget Murphy; Ryan, Rachel; Deierlein, Andrea L.; Lal, Supriya; Bihuniak, Jessica D.; Parekh, Niyati
ISI:000849711400001
ISSN: 1932-0248
CID: 5388742

Maternal Phthalates Exposure and Blood Pressure during and after Pregnancy in the PROGRESS Study

Wu, Haotian; Kupsco, Allison; Just, Allan; Calafat, Antonia M; Oken, Emily; Braun, Joseph M; Sanders, Alison P; Mercado-Garcia, Adriana; Cantoral, Alejandra; Pantic, Ivan; Téllez-Rojo, Martha M; Wright, Robert O; Baccarelli, Andrea A; Deierlein, Andrea L
BACKGROUND:Phthalate exposure is ubiquitous and may affect biological pathways related to regulators of blood pressure. Given the profound changes in vasculature during pregnancy, pregnant women may be particularly susceptible to the potential effects of phthalates on blood pressure. OBJECTIVES:We examined associations of phthalate exposure during pregnancy with maternal blood pressure trajectories from mid-pregnancy through 72 months postpartum. METHODS: RESULTS: DISCUSSION:In our cohort of pregnant women from Mexico City, exposure to phthalates and phthalate biomarkers was associated with higher blood pressure during late pregnancy, as well as with long-term changes in blood pressure trajectories. https://doi.org/10.1289/EHP8562.
PMID: 34935432
ISSN: 1552-9924
CID: 5476192

Pregnancy-related outcomes among women with physical disabilities: A systematic review

Deierlein, Andrea L; Antoniak, Katherine; Chan, Melany; Sassano, Caprice; Stein, Cheryl R
BACKGROUND:Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. OBJECTIVES/OBJECTIVE:To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. DATA SOURCES/METHODS:We searched Medline and CINAHL for articles published January 2009-April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION AND DATA EXTRACTION/METHODS:Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. SYNTHESIS/RESULTS:All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). RESULTS:A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. CONCLUSIONS:Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.
PMID: 34431112
ISSN: 1365-3016
CID: 5006472

The associations of phthalate biomarkers during pregnancy with later glycemia and lipid profiles

Wu, Haotian; Just, Allan C; Colicino, Elena; Calafat, Antonia M; Oken, Emily; Braun, Joseph M; McRae, Nia; Cantoral, Alejandra; Pantic, Ivan; Pizano-Zárate, María Luisa; Tolentino, Mary Cruz; Wright, Robert O; Téllez-Rojo, Martha M; Baccarelli, Andrea A; Deierlein, Andrea L
BACKGROUND:Pregnancy induces numerous cardiovascular and metabolic changes. Alterations in these sensitive processes may precipitate long-term post-delivery health consequences. Studies have reported associations between phthalates and metabolic complications of pregnancy, but no study has investigated metabolic outcomes beyond pregnancy. OBJECTIVES:To examine associations of exposure to phthalates during pregnancy with post-delivery metabolic health. DESIGN:We quantified 15 urinary phthalate biomarker concentrations during the second and third trimesters among 618 pregnant women from Mexico City. Maternal metabolic health biomarkers included fasting blood measures of glycemia [glucose, insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], % hemoglobin A1c (HbA1c%)] and lipids (total, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, triglycerides), at 4-5 and 6-8 years post-delivery. To estimate the influence of the phthalates mixture, we used Bayesian weighted quantile sum regression and Bayesian kernel machine regression; for individual biomarkers, we used linear mixed models. RESULTS:As a mixture, higher urinary phthalate biomarker concentrations during pregnancy were associated with post-delivery concentrations of plasma glucose (interquartile range [IQR] difference: 0.13 SD, 95%CrI: 0.05, 0.20), plasma insulin (IQR difference: 0.06 SD, 95%CrI: -0.02, 0.14), HOMA-IR (IQR difference: 0.08 SD, 95% CrI: 0.01, 0.16), and HbA1c% (IQR difference: 0.15 SD, 95%CrI: 0.05, 0.24). Associations were primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and the sum of dibutyl phthalate biomarkers (∑DBP). The phthalates mixture was associated with lower HDL (IQR difference: -0.08 SD, 95%CrI: -0.16, -0.01), driven by ∑DBP and monoethyl phthalate (MEP), and higher triglyceride levels (IQR difference: 0.15 SD, 95%CrI: 0.08, 0.22), driven by MECPTP and MEP. The overall mixture was not associated with total cholesterol and LDL. However, ∑DBP and MEP were associated with lower and higher total cholesterol, respectively, and MECPTP and ∑DBP were associated with lower LDL. CONCLUSIONS:Phthalate exposure during pregnancy is associated with adverse long-term changes in maternal metabolic health. A better understanding of timing of the exact biological changes and their implications on metabolic disease risk is needed.
PMCID:8292182
PMID: 33965768
ISSN: 1873-6750
CID: 5080252

Prenatal urinary concentrations of phthalate metabolites and behavioral problems in Mexican children: The Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) study

Colicino, Elena; de Water, Erik; Just, Allan C; Navarro, Esmeralda; Pedretti, Nicolo Foppa; McRae, Nia; Braun, Joseph M; Schnaas, Lourdes; Rodríguez-Carmona, Yanelli; Hernández, Carmen; Tamayo-Ortiz, Marcela; M Téllez-Rojo, Martha; Deierlein, Andrea L; Calafat, Antonia M; Baccarelli, Andrea; Wright, Robert O; Horton, Megan K
BACKGROUND:Phthalate exposure has been associated with increased childhood behavioral problems. Existing studies failed to include phthalate replacements and did not account for high correlations among phthalates. Phthalates' exposure is higher in Mexico than in U.S. locations, making it an ideal target population for this study. AIM/OBJECTIVE:To examine associations between 15 maternal prenatal phthalate metabolite concentrations and children's behavioral problems. METHODS:-transformed phthalate metabolites and parent-reported 4-6 year old behavior on the Behavior Assessment System for Children (BASC-2), accounting for metabolite correlations. We adjusted for socio-demographic and birth-related factors, and examined associations stratified by sex. RESULTS:Higher prenatal mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) urinary concentrations were associated with increased hyperactivity scores in the overall sample (ß = 0.57, 95% CI = 0.17, 1.13) and in girls (ß = 0.54, 95% CI = 0.16, 1.08), overall behavioral problems in boys (ß =0.58, 95% CI = 0.20, 1.15), and depression scores in boys (ß = 0.44, 95% CI = 0.06, 0.88). Higher prenatal monobenzyl phthalate (MBzP) concentrations were associated with reduced hyperactivity scores in girls (ß = -0.54, 95% CI = -1.08, -0.21). DISCUSSION/CONCLUSIONS:Our findings suggested that prenatal concentrations of phthalates and their replacements altered child neurodevelopment and those associations may be influenced sex.
PMID: 34051199
ISSN: 1096-0953
CID: 4911812

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Juul, Filippa; Vaidean, Georgeta; Lin, Yong; Deierlein, Andrea L; Parekh, Niyati
BACKGROUND:Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. OBJECTIVES/OBJECTIVE:The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. METHODS:The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. RESULTS:During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. CONCLUSIONS:The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.
PMID: 33766258
ISSN: 1558-3597
CID: 4836732