Association Between Phthalate Exposure in Pregnancy and Gestational Diabetes: A Chinese Cross-Sectional Study

Qiu-Xia Liang; Yan Lin; Xiao-Min Fang; Yun-He Gao; Fei Li

doi:10.2147/IJGM.S335895

Association Between Phthalate Exposure in Pregnancy and Gestational Diabetes: A Chinese Cross-Sectional Study

Int J Gen Med. 2022 Jan 6:15:179-189. doi: 10.2147/IJGM.S335895. eCollection 2022.

Authors

Qiu-Xia Liang¹, Yan Lin¹, Xiao-Min Fang², Yun-He Gao³, Fei Li⁴

Affiliations

¹ Department of Delivery Room, Guangzhou Women and Children Medical Center, Guangzhou, 510623, People's Republic of China.
² Fundus Surgery Department, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
³ Department of Obstetrics Clinic, Guangzhou Women and Children Medical Center, Guangzhou, 510623, People's Republic of China.
⁴ Department of Laboratory Medicine, Guangzhou Women and Children Medical Center, Guangzhou, 510623, People's Republic of China.

Abstract

Objective: The present study aims to explore the association between phthalate exposure and the risk of gestational diabetes mellitus (GDM).

Materials and methods: A total of 11 plasticizer metabolites were measured in patient morning urine using high-performance liquid chromatography. Furthermore, fasting blood glucose and fasting insulin were detected in first-trimester blood samples. The chemical concentration was described using the median, the metabolite concentration difference between the GDM and control groups was compared using the bootstrap method, and the correlations of the fasting blood glucose, fasting insulin, insulin resistance index, and phthalic acid ester (PAE) metabolites were analyzed using Spearman correlation analysis. The multivariate logistic regression model and predictive probability map were performed to help assess the linearity and nature of any dose-response relationship.

Results: Of the 224 women recruited for the present study, 200 met the inclusion criteria. Their measured outcomes and biomonitoring data were examined for the presence of chemicals. The results showed that the patients in the GDM group had higher mono-(2-ethylhexyl) phthalate (MEHP) and methylerythritol cyclophosphane concentrations in their bodies than the patients in the control group. Statistically significant MEHP-GDM associations were also observed (P < 0.001). The GDM and MEHP dose-response relationships were different among pregnant women aged <35 years and those aged >35 years (P < 0.001). Furthermore, gestational age >28 weeks exhibited similar changes to those aged ≤28 weeks (P = 0.059).

Conclusion: The findings of the present study add to the growing body of evidence supporting phthalate exposure as a GDM risk factor.

Keywords: association; dose-response relationships; gestational diabetes; phthalate exposure.

Grants and funding

We thank Dr. Hui-Ying Liang (Guangzhou Women and Children Medical Center) for his statistical programming support during the analysis and Dr. He-Xing Wang (Fudan university) for the coordination and processing of urine sample analyses. We are also grateful to the Pediatric Research Institute of Guangzhou Women and Children Medical Center (IP-2016-011) for funding the study team.