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.