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. 2020 Oct:143:105970.
doi: 10.1016/j.envint.2020.105970. Epub 2020 Jul 30.

A combined cohort analysis of prenatal exposure to phthalate mixtures and childhood asthma

Margaret A Adgent  1 , Kecia N Carroll  2 , Marnie F Hazlehurst  3 , Christine T Loftus  4 , Adam A Szpiro  5 , Catherine J Karr  6 , Emily S Barrett  7 , Kaja Z LeWinn  8 , Nicole R Bush  9 , Frances A Tylavsky  10 , Kurunthachalam Kannan  11 , Sheela Sathyanarayana  12
Affiliations

A combined cohort analysis of prenatal exposure to phthalate mixtures and childhood asthma

Margaret A Adgent et al. Environ Int. 2020 Oct.

Abstract

Background: Previous studies of prenatal phthalate exposure and childhood asthma are inconsistent. These studies typically model phthalates as individual, rather than co-occurring, exposures. We investigated whether prenatal phthalates are associated with childhood wheeze and asthma using a mixtures approach.

Methods: We studied dyads from two prenatal cohorts in the ECHO-PATHWAYS consortium: CANDLE, recruited 2006-2011 and TIDES, recruited 2011-2013. Parents reported child respiratory outcomes at age 4-6 years: ever asthma, current wheeze (symptoms in past 12 months) and current asthma (two affirmative responses from ever asthma, recent asthma-specific medication use, and/or current wheeze). We quantified 11 phthalate metabolites in third trimester urine and estimated associations with child respiratory outcomes using weighted quantile sum (WQS) logistic regression, using separate models to estimate protective and adverse associations, adjusting for covariates. We examined effect modification by child sex and maternal asthma.

Results: Of 1481 women, most identified as White (46.6%) or Black (44.6%); 17% reported an asthma history. Prevalence of ever asthma, current wheeze and current asthma in children was 12.3%, 15.8% and 12.3%, respectively. Overall, there was no adverse association with respiratory outcomes. In sex-stratified analyses, boys' phthalate index was adversely associated with all outcomes (e.g., boys' ever asthma: adjusted odds ratio per one quintile increase in WQS phthalate index (AOR): 1.42; 95% confidence interval (CI): 1.08, 1.85, with mono-ethyl phthalate (MEP) weighted highest). Adverse associations were also observed in dyads without maternal asthma history, driven by MEP and mono-butyl phthalate (MBP), but not in those with maternal asthma history. We observed protective associations between the phthalate index and respiratory outcomes in analysis of all participants (e.g., ever asthma: AOR; 95% CI: 0.81; 0.68, 0.96), with di(2-ethylhexyl)phthalate (DEHP) metabolites weighted highest.

Conclusions: Results suggest effect modification by child sex and maternal asthma in associations between prenatal phthalate mixtures and child asthma and wheeze.

Keywords: Asthma; Mixtures; Phthalate; Pregnancy; Prenatal; Respiratory.

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Conflict of interest statement

Declaration of Competing Interest

The authors declared that there is no conflict of interest.

Figures

Fig. 1.
Fig. 1.. Odds ratios (95% confidence intervals) and weights from weighted quantile sum regression for maternal urinary phthalate index and childhood asthma/wheeze, (a) adverse and (b) protective associations.
Models are adjusted for maternal age, race, ethnicity, education, prenatal smoking, pre-pregnancy BMI, asthma history, parity, birth year, study site and child sex.
Fig. 2.
Fig. 2.. a-c. Stratified odds ratios (95% confidence intervals) and weights from weighted quantile sum regression for maternal urinary phthalate index and childhood a) current wheeze, b) current asthma, c) ever wheeze by child sex.
Adverse and protective models are shown. Models are adjusted for maternal race, ethnicity, age, education, prenatal smoking, pre-pregnancy BMI, parity, asthma history, birth year, and study site.
Fig. 3.
Fig. 3.. a-c. Stratified odds ratios (95% confidence intervals) and weights from weighted quantile sum regression for maternal urinary phthalate index and childhood a) current wheeze, b) current asthma, c) ever wheeze by maternal asthma.
Adverse and protective models are shown. Models are adjusted for maternal race, ethnicity, age, education, prenatal smoking, pre-pregnancy BMI, parity, child sex, birth year, and study site.
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