Prenatal exposure to nonpersistent endocrine disruptors and early childhood BMI: single pollutant and mixture analyses from the ECHO Program

Exposure to non-persistent endocrine-disrupting chemicals (EDCs), including phenols and phthalates, has been linked to obesity risk. While many studies focus on single-chemical exposures, mixture effects on child adiposity remain unclear. To assess associations of prenatal phenol and phthalate exposures, singly and as mixtures, with early childhood BMI in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program. We included 586 mother–child pairs from three ECHO sites with 23 phenols and phthalate metabolites measured in maternal urine during pregnancy, and child BMI z -scores (BMIZ) at 2–5 years. Associations were estimated using covariate-adjusted single-pollutant linear regression and two mixture methods: Bayesian Weighted Quantile Sum (BWQS) and Bayesian Kernel Machine Regression (BKMR). Sex-specific effects were examined in stratified models. No associations were observed between the overall prenatal EDC mixture and BMIZ. In single-pollutant models, MBzP (highest tertile) was inversely associated with BMIZ ( β = −0.36, 95% CI: −0.63, −0.08), while MEP (second tertile) was positively associated ( β = 0.27, 95% CI: 0.01, 0.53). Among boys, MBP (second tertile) was positively associated ( β = 0.45, 95% CI: 0.11, 0.79). We found no strong evidence for mixture effects, though some individual compounds showed non-linear and sex-specific associations. Using a 23-analyte panel of phenols and phthalate metabolites, and complementary (BKMR, BWQS) alongside single-pollutant and sex-stratified models, this study strengthens inference and addresses limitations of prior research. Prenatal exposure to ubiquitous, short-lived endocrine-disrupting phthalates showed non-monotonic, sex-specific associations with early childhood BMI in single-pollutant models. These findings contribute to the limited evidence base on mixture effects of endocrine-disrupting chemicals in early-life obesity risk.

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Journal
Pediatric Research
Published
2026-10-06
DOI
https://doi.org/10.1038/s41390-026-05466-7
Primary Topic
Effects and risks of endocrine disrupting chemicals
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article
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article

Prenatal exposure to nonpersistent endocrine disruptors and early childhood BMI: single pollutant and mixture analyses from the ECHO Program

Sheela Sathyanarayana, Monique M. Hedderson, Diane Catellier, Casper G. Bendixsen et al.
Pediatric Research
Effects and risks of endocrine disrupting chemicals
article

Prenatal exposure to nonpersistent endocrine disruptors and early childhood BMI: single pollutant and mixture analyses from the ECHO Program

Sheela Sathyanarayana, Monique M. Hedderson, Diane Catellier, Casper G. Bendixsen, Diane R. Gold, Katherine Rivera‐Spoljaric, Cristiane S. Duarte, Ravi V. Shah, James E. Gern, Viren A. D’Sa, Daniel J. Jackson, Carole Ober, Brianna F. Moore, Sheryl Magzamen, Gurjit K. Khurana Hershey, JOHN A. JUN. MCLEAN, Dennis R. Ownby, Tina V. Hartert, Kohei Hasegawa, Jonathan E. Posner, José F. Cordero, Christine M. Seroogy, Lisa Croen, Anne P. Starling, Edward M. Zoratti, Rebecca J. Schmidt, Lisa P. Jacobson, John D. Meeker, Akram N. Alshawabkeh, Suman R. Das, Monica McGrath, L. Kristin Newby, Susan V. Lynch, Traci A. Bekelman, Christine L.M. Joseph, Emily Ho, Assiamira M. Ferrara, Courtney K. Blackwell, Meyer Kattan, Greta N. Wilkening, Leonardo Trasande, Alison E. Hipwell, Leonard B. Bacharier, Jane E. Freedman, Catherine J. Karr, Carlos A. Camargo, Meghan H. Shilts, Christine Cole Johnson, Claudia I. Lugo-Candelas, Zhongzheng Niu, Richard C Gershon, Shohreh F. Farzan, Simon Alexander Mallal, P. Brian Smith, Anne Marie Singh, Maxwell Armand Mansolf, John Ainsworth, Michelle Macy, Julie B. Schweitzer, Frank D. Gilliland, Kaja Z. LeWinn, Jin‐Shei Lai, David Cella, Dorothy Nakiwala, Deborah H. Bennett, Anne Lang Dunlop, L S Adair, Priya Duggal, Patricia A. Brennan, Daphne Koinis Mitchell, GLORISA J. CANINO, Rima Habre, Christine W. Hockett, Dana Dabelea, Nicole R. Bush, Sean Deoni, Ashley F. Sullivan, Rachel Miller, Catherine Monk, Janine M. LaSalle, Tenneill Murray, Patrick Ryan, Robert F. Lemanske, John Meeker, Hans-Georg Mueller, Deborah J. Rinehart, Emily Knapp, Wei Perng, George T. O’Connor, Emily S. Barrett, Amy Elliott, Amii Kress, Christian Douglas, Irva Hertz-Picciotto, Zhaozhong Zhu, Robert A. Wood
article en

Abstract

Exposure to non-persistent endocrine-disrupting chemicals (EDCs), including phenols and phthalates, has been linked to obesity risk. While many studies focus on single-chemical exposures, mixture effects on child adiposity remain unclear. To assess associations of prenatal phenol and phthalate exposures, singly and as mixtures, with early childhood BMI in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program. We included 586 mother–child pairs from three ECHO sites with 23 phenols and phthalate metabolites measured in maternal urine during pregnancy, and child BMI z -scores (BMIZ) at 2–5 years. Associations were estimated using covariate-adjusted single-pollutant linear regression and two mixture methods: Bayesian Weighted Quantile Sum (BWQS) and Bayesian Kernel Machine Regression (BKMR). Sex-specific effects were examined in stratified models. No associations were observed between the overall prenatal EDC mixture and BMIZ. In single-pollutant models, MBzP (highest tertile) was inversely associated with BMIZ ( β = −0.36, 95% CI: −0.63, −0.08), while MEP (second tertile) was positively associated ( β = 0.27, 95% CI: 0.01, 0.53). Among boys, MBP (second tertile) was positively associated ( β = 0.45, 95% CI: 0.11, 0.79). We found no strong evidence for mixture effects, though some individual compounds showed non-linear and sex-specific associations. Using a 23-analyte panel of phenols and phthalate metabolites, and complementary (BKMR, BWQS) alongside single-pollutant and sex-stratified models, this study strengthens inference and addresses limitations of prior research. Prenatal exposure to ubiquitous, short-lived endocrine-disrupting phthalates showed non-monotonic, sex-specific associations with early childhood BMI in single-pollutant models. These findings contribute to the limited evidence base on mixture effects of endocrine-disrupting chemicals in early-life obesity risk.

Pediatric Research
Rutgers, The State University of New Jersey (US), Boston University (US), Northwestern University (US), University of North Carolina at Chapel Hill (US), University of Southern California (US), Brigham and Women's Hospital (US), Cincinnati Children's Hospital Medical Center (US), Northeastern University (US), Lurie Children's Hospital (US), Gates Foundation (US), Kaiser Permanente (US), University of Wisconsin–Madison (US), Harvard University (US), Johns Hopkins University (US), Emory University (US), Colorado School of Public Health (US), Henry Ford Health System (US), University of Georgia (US), University of Puerto Rico at Río Piedras (PR), University of Pittsburgh (US), Duke University (US), RTI International (US), University of California, San Francisco (US), South Dakota School of Mines and Technology (US), Vanderbilt University (US), University of Washington (US), Washington University in St. Louis (US), Brown University (US), University of Michigan (US), Columbia University Irving Medical Center (US), Avera Health (US), Rhode Island Hospital (US), Denver Health Medical Center (US), University of Manchester (GB), University of Chicago (US), Massachusetts General Hospital (US), Environmental and Occupational Health Sciences Institute (US), Seattle Children's Research Institute (US), Marshfield Clinic Research Foundation (US), Marshfield Clinic Research Institute (US), University of Colorado Anschutz Medical Campus (US), University of Rochester (US), New York University (US), University of Cincinnati (US), University at Buffalo, State University of New York (US), Columbia University (US), University of California, Davis (US), Vanderbilt University Medical Center (US), Colorado State University (US), Icahn School of Medicine at Mount Sinai (US)
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Effects and risks of endocrine disrupting chemicals
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