ArticleEnvironmental advances2026
Prenatal exposure to DEHTP replacement metabolites and odds of preeclampsia and gestational hypertension in a diverse nulliparous U.S. cohort.
Article in Environmental advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Prenatal exposure to phthalate metabolites is associated with adverse pregnancy outcomes (APOs); however, it is unknown whether replacement phthalate compounds, such as di-2-ethylhexyl terephthalate (DEHTP), are safer alternatives. Methods: We examined associations between prenatal exposure to phthalate metabolites, replacement phthalate metabolites, and APOs using data from a nested case-control study (n = 2,040) within the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort. Cases included 1,020 participants with preeclampsia (PE), new-onset gestational hypertension (GHTN), or spontaneous preterm birth (sPTB), matched 1:1 to controls by clinical site, maternal age, and infant sex. Twelve phthalate metabolites, including DEHTP metabolites mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and mono-2-ethyl-5-hydroxyhexyl terephthalate (MEHHTP), were measured in urine samples across pregnancy (total = 5,265). We used multivariable conditional logistic regression to evaluate associations between specific gravity-adjusted geometric mean metabolite concentrations and each outcome, with metabolites modeled by quartiles and continuously. Infant sex and self-reported race and ethnicity were Results: Higher concentrations of MEHHTP increased the overall odds of PE (adjusted OR [aOR], highest vs. lowest quartile: 1.90; 95% CI: 1.07-3.36). MECPTP was most strongly associated with PE among participants carrying infant girls (aOR, highest vs. lowest quartile: 6.49; 95% CI: 2.03-18.43), and with GHTN among non-Hispanic White participants (aOR, highest vs. lowest quartile: 2.50; 95% CI: 1.17-5.36). Conclusion: These results indicate that prenatal exposure to DEHTP metabolites may be associated with APOs, specifically PE, and highlight the need for continued research and monitoring of these replacement compounds.
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