Prenatal exposure to mixtures of persistent endocrine-disrupting chemicals and birth size in a population-based cohort of British girls

Marks, Kristin J.; Howards, Penelope P.; Smarr, Melissa M.; Flanders, W. Dana; Northstone, Kate; Daniel, Johnni H.; Sjödin, Andreas; Calafat, Antonia M.; Hartman, Terryl J.

doi:10.1097/ede.0000000000001351

Cited by 30Effects and risks of endocrine disrupting chemicalsToxic Organic Pollutants ImpactPer- and polyfluoroalkyl substances research

Prenatal exposure to mixtures of persistent endocrine-disrupting chemicals and birth size in a population-based cohort of British girls

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Marks, Kristin J., Howards, Penelope P., Smarr, Melissa M., Flanders, W. Dana, Northstone, Kate, Daniel, Johnni H., Sjödin, Andreas, Calafat, Antonia M. +1 more·2021·Epidemiology

DOI 10.1097/ede.0000000000001351PMC PMC8159871

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Abstract

Background: Previous studies of endocrine-disrupting chemicals have examined one of these chemicals at a time in association with an outcome; studying mixtures better approximates human experience. We investigated the association of prenatal exposure to mixtures of persistent endocrine disruptors (perfluoroalkyl and polyfluoroalkyl substances [PFAS], polychlorinated biphenyls [PCBs], and organochlorine pesticides) with birth size among female offspring in the Avon Longitudinal Study of Parents and Children (ALSPAC), based in the United Kingdom in 1991–1992. Methods: We quantified concentrations of 52 endocrine-disrupting chemicals in maternal serum collected during pregnancy at median 15-week gestation. Birth weight, crown-to-heel length, and head circumference were measured at birth; ponderal index and small for gestational age were calculated from these. We used repeated holdout Weighted Quantile Sum (WQS) regression and Bayesian kernel machine regression to examine mixtures in 313 mothers. Results: Using WQS regression, all mixtures (each chemical class separately and all three together) were inversely associated with birth weight. A one-unit increase in WQS index (a one-decile increase in chemical concentrations) for all three classes combined was associated with 55 g ( β = −55 g, 95% confidence interval [CI] = −89, −22 g) lower birth weight. Associations were weaker but still inverse using Bayesian kernel machine regression. Under both methods, PFAS were the most important contributors to the association with birth weight. We also observed inverse associations for crown-to-heel length. Conclusions: These results are consistent with the hypothesis that prenatal exposure to mixtures of persistent endocrine-disrupting chemicals affects birth size.

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Research investigating the joint effects of PFAS mixture on anthropometric measures at birth remains limited.
“However, research investigating the joint effects of PFAS mixture on anthropometric measures at birth remains limited (Luo et al., 2021; Marks et al., 2021; Eick et al., 2022a; Hu et al., 2021a).”
From Associations between in utero exposure of per- and polyfluoroalkyl substances (PFAS) mixture and anthropometry measures at birth (2025) · cites this paper as Marks et al., 2021

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Authors: Marks, K. J., Howards, P. P., Smarr, M. M., Flanders, W. D., Northstone, K., Daniel, J. H., Sjödin, A., Calafat, A. M., & Hartman, T. J.
Affiliations: Centers for Disease Control and Prevention (US)
Emory University (US)
University of Bristol (GB)
Corresponding author: Marks, Kristin J.
ORCID: Marks, Kristin J.
Howards, Penelope P.
Smarr, Melissa M.
Flanders, W. Dana
Northstone, Kate
Sjödin, Andreas
Calafat, Antonia M.
Hartman, Terryl J.
Venue: Epidemiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2021-03-24
Volume: 32
Issue: 4
Pages: 573-582
ISSN: 1044-3983 (ISSN-L)
DOI: 10.1097/ede.0000000000001351
PMC: PMC8159871
OpenAlex: W3138814018
Cited by: 30
References: 47
Citations by year: 2026: 5 · 2025: 8 · 2024: 5 · 2023: 6 · 2022: 2 · 2021: 4
FWCI: 1.69
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Epidemiology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Wellcome Trust (217065/Z/19/Z, 102215)
National Institutes of Health (CC999999)
Medical Research Council (MC_PC_15018, MC_PC_19009)
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
Keywords: endocrine disruptors, chemical mixtures, prenatal exposure, birth weight, birth size, per- and polyfluoroalkyl substances, polychlorinated biphenyls, organochlorine pesticides, maternal serum, small for gestational age, head circumference, Avon Longitudinal Study of Parents and Children
MeSH terms: Bayes Theorem, Child, Environmental Pollutants, Female, United Kingdom, Humans, Infant, Newborn, Longitudinal Studies, Pregnancy, Prenatal Exposure Delayed Effects, Maternal Exposure, Endocrine Disruptors

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Prenatal exposure to mixtures of persistent endocrine-disrupting chemicals and birth size in a population-based cohort of British girls

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