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Prenatal exposure to persistent and non-persistent chemical mixtures and associations with adverse birth outcomes in the Atlanta African American Maternal-Child Cohort

Abstract

Background

African Americans (AAs) experience higher rates of preterm birth and fetal growth restriction relative to other pregnant populations. Differential in utero exposure to environmental chemicals may partially explain these health disparities, as AAs are disproportionately exposed to environmental hazards.

Objective

We examined the individual and mixture effects of non-persistent chemicals and persistent organic pollutants (POPs) on gestational age at birth and birthweight for gestational age z-scores within a prospective cohort of pregnant AAs.

Methods

First-trimester serum and urine samples obtained from participants within the Atlanta African American Maternal-Child cohort were analyzed for 43 environmental chemicals, including per-and polyfluoroalkyl substances (PFAS), polybrominated diphenyl ethers (PBDEs), organochlorine pesticides, pyrethroid insecticides, phthalates, bisphenol A, nicotine, and the primary metabolite of delta-9-tetrahydrocannabinol. Linear regression was used to estimate individual associations between chemicals and gestational age and birthweight z-scores (N ranging from 107 to 523). Mixture associations were estimated using quantile g-computation, principal component (PC) analyses, and hierarchical Bayesian kernel machine regression among complete cases (N = 86).

Results

Using quantile g-computation, increasing all chemical exposures by one quantile was modestly associated with a reduction in gestational age (mean change per quartile increase = −0.47, 95% CI = −1.56, 0.61) and birthweight z-scores (mean change per quartile increase = −0.49, 95% CI = −1.14, 0.15). All PCs were associated with a reduction in birthweight z-scores; associations were greatest in magnitude for the two PCs reflecting exposure to combined tobacco, insecticides, PBDEs, and phthalates. In single pollutant models, we observed inconsistent and largely non-significant associations.

Signifance

We conducted multiple targeted exposure assessment methods to quantify levels of environmental chemicals and leveraged mixture methods to quantify their joint effects on gestational age and birthweight z-scores. Our findings suggest that prenatal exposure to multiple classes of persistent and non-persistent chemicals is associated with reduced gestational age and birthweight z-scores in AAs.

Impact

African Americans (AAs) experience higher rates of preterm birth and fetal growth restriction relative to other pregnant populations. Differential in utero exposure to environmental chemicals may partially explain these health disparities, as AAs are disproportionately exposed to environmental hazards. In the present study, we analyzed serum and urine samples for levels of 43 environmental chemicals. We used quantile g-computation, principal component analysis, and BKMR to assess associations between chemical exposure mixtures and adverse birth outcomes. Our findings suggest that prenatal exposure to multiple classes of chemicals is associated with reduced birthweight z-scores, a proxy for fetal growth, in AAs.

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Fig. 1
Fig. 2: Change in birth outcomes in association with an interquartile range increase in individual chemicals, estimated using linear regression within the Atlanta African American Maternal–Child cohort, 2016–2020 (N = 86).
Fig. 3: Adjusted differences in birth outcomes in relation to principal component scores and one quartile increase in the chemical mixture, estimated using quantile g-computation among pregnant women in the Atlanta African American Maternal–Child cohort, 2016–2020 (N = 86).

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Data availability

Per Emory University Institutional Review Board approval, the data that support the findings of this study are restricted for transmission to those outside the primary investigative team. Data sharing with investigators outside the team requires IRB approval. Requests may be submitted to the Anne Dunlop, MD, MPH (amlang@emory.edu).

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Acknowledgements

We would like to thank all the study participants who participated in this study, and the clinical health care providers and staff at the prenatal recruiting sites for helping with data and sample collection and logistics and sample chemical analyses in the laboratory, especially Nathan Mutic, Estefani Ignacio Gallegos, Nikolay Patrushev, Kristi Maxwell Logue, Castalia Thorne, Shirleta Reid, and Cassandra Hall. We would also like to thank Che-Jung Chang for her assistance with data analysis. This work was supported by the National Institute of Health (NIH) research grants [R01NR014800, R01MD009064, R24ES029490, R01MD009746, R21ES032117], NIH Center Grants [P50ES026071, P30ES019776, UH3OD023318, U2CES026560, U2CES026542, U2COD023375], and Environmental Protection Agency (USEPA) center grant [83615301]. Funding for Stephanie M. Eick was additionally provided from the JPB Environmental Health Fellowship.

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SME (Conceptualization, formal analysis, investigation, methodology, writing). YT (Data curation, formal analysis, methodology, resources, writing – review & editing). KRT (formal analysis, methodology, writing – review & editing). PBR (Investigation, resources, data curation, writing – review & editing, project administration, funding acquisition). DBB (Investigation, resources, data curation, writing – review & editing, project administration, funding acquisition). AK (Methodology, writing– review & editing). JAE (Writing– review & editing). PP (Data curation, methodology, writing – review & editing). PED (Data curation, methodology, writing – review & editing). VY (Data curation, methodology, writing – review & editing). GEL (Data curation, methodology, writing – review & editing). PAB (Investigation, resources, data curation, writing – review & editing, project administration, funding acquisition). EJC (Investigation, resources, data curation, writing – review & editing, project administration, funding acquisition). ALD (Investigation, resources, data curation, writing – review & editing, project administration, funding acquisition). DL (Conceptualization, methodology, investigation, writing – review & editing, supervision, funding acquisition).

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Correspondence to Stephanie M. Eick or Donghai Liang.

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Eick, S.M., Tan, Y., Taibl, K.R. et al. Prenatal exposure to persistent and non-persistent chemical mixtures and associations with adverse birth outcomes in the Atlanta African American Maternal-Child Cohort. J Expo Sci Environ Epidemiol (2023). https://doi.org/10.1038/s41370-023-00530-4

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