Prenatal paraben exposure and pregnancy complications: The moderating role of psychological anxiety

OBJECTIVE: This study aimed to investigate the individual and combined effects of prenatal parabens (PBs) exposure on pregnancy complications and to determine whether pregnancy-related anxiety modifies these associations. METHODS: We conducted a prospective cohort study including 934 mother-infant pairs recruited from a tertiary hospital in Ningxia, China. Maternal serum concentrations of five PBs, such as methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), butylparaben (BuP), and hexylparaben (HeP), were quantified using high-performance liquid chromatography-tandem mass spectrometry. Pregnancy-related anxiety was assessed with the Pregnancy-related Anxiety Questionnaire. Pregnancy complications were defined as gestational anemia, hypertensive disorders of pregnancy (HDP), and gestational diabetes mellitus (GDM). Binary logistic regression and quantile g-computation were applied to estimate the individual and mixture effects of PBs exposure. Stratified analyses and interaction terms were used to evaluate effect modification by pregnancy-related anxiety. RESULTS: Higher maternal serum concentrations of EtP (OR = 1.14, 95% CI: 1.05-1.25), PrP (OR = 1.12, 95% CI: 1.01-1.24), and BuP (OR = 1.22, 95% CI: 1.03-1.44) were significantly associated with an increased risk of overall pregnancy complications. EtP (OR = 1.13, 95% CI: 1.01-1.28) and BuP (OR = 1.28, 95% CI: 1.01-1.62) were positively associated with HDP. In addition, MeP (OR = 1.32, 95% CI: 1.08-1.60), EtP (OR = 1.24, 95% CI: 1.08-1.42), and PrP (OR = 1.39, 95% CI: 1.16-1.66) were significantly associated with GDM. Quantile g-computation further indicated that mixed PBs exposure was positively associated with GDM, with varying contributions across individual congeners. A significant interaction was observed between pregnancy-related anxiety and EtP exposure. Among women reporting pregnancy-related anxiety, BuP remained significantly associated with pregnancy complications. Moreover, mixture exposure was associated with an elevated risk of gestational anemia (95% CI: 1.06-6.87), and both EtP (95% CI: 1.12-2.22) and BuP (95% CI: 1.08-3.43) showed significant positive associations with gestational anemia. Sensitivity analyses supported the robustness of these findings. CONCLUSION: Prenatal exposure to EtP and BuP was positively associated with gestational anemia, particularly among pregnant women experiencing pregnancy-related anxiety. These findings highlight the importance of considering psychological factors when evaluating the health impacts of endocrine-disrupting chemical mixtures during pregnancy.