Associations between prenatal phthalate exposure and sex-typed play behavior in preschool age boys and girls

Evans, Sarah; Raymond, Samantha; Sethuram, Swathi; Barrett, Emily S.; Bush, Nicole R.; Nguyen, Ruby H.N.; Sathyanarayana, Sheela; Swan, Shanna H.

doi:10.1016/j.envres.2020.110264

Cited by 7 publications

(3 citation statements)

References 46 publications

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“…However, the literature has been inconsistent as to whether associations for any given phthalate exhibit consistent evidence of sexual dimorphism. For MnBP in particular, several studies have found associations that are stronger in boys, 20,21,23,27,29,32 whereas others have not. 22,25,33,35 We cannot exclude the possibility that interactions by sex are owing to chance, particularly since there is no specific rationale to support sex interactions for MnBP alone as opposed to any of the other phthalates that were measured.…”

Section: Discussionmentioning

confidence: 98%

“…15 There is growing epidemiologic evidence linking prenatal phthalate exposure to emotional and behavioral difficulties in children. [16][17][18][19][20][21][22][23] In prospective birth cohort studies, prenatal maternal phthalate levels have been associated with internalizing behaviors, [19][20][21][22][24][25][26][27] externalizing behaviors, 20,22,24,28,29 attention problems, 24,29 and social or peer relationship problems in the child, 19,21,25,30,31 with some studies showing stronger adverse effects among boys 20,21,27,29,32 and one among girls. 27 However, not all studies find associations between prenatal phthalates and adverse behavioral outcomes, 26,30,33,34 and there is a lack of consistency across studies on the specific phthalate implicated and on the existence and direction of sex-specific associations.…”

Section: Introductionmentioning

confidence: 99%

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Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway

Kamai

Villanger

Nethery

et al. 2021

Environmental Epidemiology

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Prenatal phthalate exposure has been linked to altered neurobehavioral development in both animal models and epidemiologic studies, but whether or not these associations translate to increased risk of neurodevelopmental disorders is unclear. We used a nested case-cohort study design to assess whether maternal urinary concentrations of 12 phthalate metabolites at 17 weeks gestation were associated with criteria for Attention Deficit Hyperactivity Disorder (ADHD) classified among 3-year-old children in the Norwegian Mother, Father and Child Cohort Study (MoBa). Between 2007 and 2011, 260 children in this substudy were classified with ADHD using a standardized, on-site clinical assessment; they were compared with 549 population-based controls. We modeled phthalate levels both linearly and by quintiles in logistic regression models adjusted for relevant covariates and tested for interaction by child sex. Children of mothers in the highest quintile of di-iso-nonyl phthalate (∑DiNP) metabolite levels had 1.70 times the odds of being classified with ADHD compared with those in the lowest quintile (95% confidence interval [CI] = 1.03 to 2.82). In linear models, there was a trend with the sum of di-2-ethylhexyl phthalate metabolites (∑DEHP); each natural log-unit increase in concentration was associated with 1.22 times the odds of ADHD (95% CI = 0.99 to 1.52). In boys, but not girls, mono-n-butyl phthalate exposure was associated with increased odds of ADHD (odds ratio [OR] 1.42; 95% CI = 1.07 to 1.88). Additional adjustment for correlated phthalate metabolites attenuated estimates. These results suggest gestational phthalate exposure may impact the behavior of children as young as 3 years.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway

Kamai

Villanger

Nethery

et al. 2021

Environmental Epidemiology

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“…In addition, play behaviors in children are accepted methods for determining gender identity and are critical factors in diagnosing gender dysphoria [ 14 ]. Limited evidence suggested that maternal urinary concentrations of PAE metabolites during pregnancy may be associated with less masculine gender-related play behaviors and decreased composite scores among preschool-aged boys [ 15 ]–[ 17 ]. In contrast, higher maternal urinary concentrations of MEP may be associated with more typical gender-related play behaviors in both males and females, indicating a possible link between maternal PAEs exposure and gender-related behaviors [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term exposure to exogenous phthalate, masculinity and femininity trait, and gender identity in children: a Chinese 3-year longitudinal cohort study

Liu,

Gao,

Wang

et al. 2023

Environ Health

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Background Phthalate esters (PAEs) are known to have hormone-like properties, and there is a growing trend of children expressing a gender identity different from assigned sex. However, there has been limited research in the potential links between PAEs exposure and gender identity. Methods A total of 571 children (278 boys) completed the follow-up from Oct 2017 to Oct 2020 in Childhood Blood Pressure and Environmental Factors (CBPEF) cohort in Xiamen, China. Urinary PAE metabolites were measured at three time of visits using ultraperformance liquid chromatography-tandem mass spectrometry. The Children’s Sex Role Inventory scale was used to assess gender identity (masculinity, femininity, androgyny and undifferentiated), and Tanner definition was used to define puberty timing. Generalized linear models and log-binomial regression were used to assess the relationships between PAEs exposure, gender trait scores and gender identity. Results Overall, the concentration of most PAEs in more than 90% of participants was above the limit of detection values. In visit 1, there were 10.1% boys with femininity and 11.3% girls with masculinity; while these figures increased to 10.8% and 12.3% during follow-up, respectively. Early puberty onset accounted for 24.8% and 25.6% among boys and girls. Long-term exposure to mono-2-ethylhexyl phthalate (MEHP) (β = 1.20, 95%CI = 0.13, 2.28), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (β = 1.25, 95%CI = 0.22, 2.28) and mono-2-ethyl-5-oxohexyl phthalate (MEOHP) (β = 1.40, 95%CI = 0.24, 2.56) was associated with the increased differences of femininity trait scores in boys who enter puberty earlier, prolonged exposure to di(2-ethylhexyl) phthalate (DEHP) might also have such a positive impact (β = 1.38, 95%CI = 0.36, 2.41). For gender identity, persistent exposure to low molecular weight phthalates (LMWP) was negatively associated with undifferentiated type among boys entering puberty earlier (RR = 0.18, 95%CI = 0.05, 0.75, P < 0.05), and most of the PAE metabolites exposures showed risk ratios > 1 for their femininity. Conclusion Long-term exposure to PAEs increase the femininity trait scores in boys with early onset of puberty. Although the mechanisms remain to be determined, environmental pollution might have subtle, yet measurable effects on childhood gender identity. Reducing these chemicals exposure has important public implications on gender development.

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Prenatal exposure to phthalates and gender-specific play behavior at seven years of age in the SELMA study

Özel

Stratmann

Lindh

et al. 2023

Environment International

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Associations between prenatal phthalate exposure and sex-typed play behavior in preschool age boys and girls

Cited by 7 publications

References 46 publications

Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway

Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway

Long-term exposure to exogenous phthalate, masculinity and femininity trait, and gender identity in children: a Chinese 3-year longitudinal cohort study

Prenatal exposure to phthalates and gender-specific play behavior at seven years of age in the SELMA study

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