Maternal Phthalates Exposure and Blood Pressure during and after Pregnancy in the PROGRESS Study

Haotian Wu, Allison Kupsco, Allan Just, Antonia M. Calafat, Emily Oken, Joseph M. Braun, Alison P. Sanders, Adriana Mercado-Garcia, Alejandra Cantoral, Ivan Pantic, Martha M. Téllez-Rojo, Robert O. Wright, Andrea A. Baccarelli, Andrea L. Deierlein

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Phthalate exposure is ubiquitous and may affect biological pathways related to regulators of blood pressure. Given the profound changes in vasculature during pregnancy, pregnant women may be particularly susceptible to the potential effects of phthalates on blood pressure. OBJECTIVES: We examined associations of phthalate exposure during pregnancy with maternal blood pressure trajectories from mid-pregnancy through 72 months postpartum. METHODS: Women with singleton pregnancies delivering a live birth in Mexico City were enrolled during the second trimester (n = 892). Spot urine samples from the second and third trimesters were analyzed for 15 phthalate metabolites. Blood pressure and covariate data were collected over nine visits through 72 months postpartum. We used linear, logistic, and linear mixed models; latent class growth models (LCGMs); and Bayesian kernel machine regression to estimate the relationship of urinary phthalate biomarkers with maternal blood pressure. RESULTS: As a joint mixture, phthalate biomarker concentrations during pregnancy were associated with higher blood pressure rise during mid-to-late gestation. With respect to individual biomarkers, second trimester concentrations of monobenzyl phthalate (MBzP) and di(2-ethylhexyl) phthalate bio-markers (∑DEHP) were associated with higher third trimester blood pressure. Two trajectory classes were identified by LCGM, characterized by increasing blood pressure through 72 months postpartum (“increase–increase”) or decreased blood pressure through 18 months postpartum with a gradual increase thereafter (“decrease–increase”). Increasing exposure to phthalate mixtures during pregnancy was associated with higher odds of being in the increase–increase class. Similar associations were observed for mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and dibutyl phthalate (∑DBP) biomarkers. When specific time periods were examined, we observed specific temporal relationships were observed for ∑DEHP, MECPTP, MBzP, and ∑DBP. DISCUSSION: In our cohort of pregnant women from Mexico City, exposure to phthalates and phthalate biomarkers was associated with higher blood pressure during late pregnancy, as well as with long-term changes in blood pressure trajectories.

Original languageEnglish (US)
Article number127007
JournalEnvironmental health perspectives
Issue number12
StatePublished - Dec 2021


  • Bayes Theorem
  • Blood Pressure
  • Environmental Exposure
  • Environmental Pollutants/toxicity
  • Female
  • Humans
  • Maternal Exposure
  • Phthalic Acids/urine
  • Pregnancy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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