Prenatal phthalate exposure and neurodevelopmental delay in early childhood (1 to 3 years): An Environmental influences on Child Health Outcomes (ECHO) study

Authors

Seonyoung Park, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
Kristen McArthur, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Emily Barrett, Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA.
José F. Cordero, Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA.
Taylor Etzel, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Akhgar Ghassabian, Division of Environmental Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY 10016, USA; Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA.
Jordan Kuiper, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20037, USA.
John D. Meeker, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
Sara S. Nozadi, Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA.
Brandon Rennie, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87106, USA.
Jenna Sprowles, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA; ICF, Durham, NC 27713, USA.
Anne P. Starling, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Emily Zimmerman, Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA.
Monica McGrath, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Deborah J. Watkins, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. Electronic address: debjwat@umich.edu.

Document Type

Journal Article

Publication Date

1-22-2026

Journal

Environment international

Volume

208

DOI

10.1016/j.envint.2026.110100

Keywords

Mixture; Neurodevelopment; Phthalates; Sex-specificity

Abstract

Phthalates are widely used in consumer products and are recognized as endocrine disruptors. Prenatal exposure to phthalates has been associated with various adverse health outcomes, including preterm birth and impaired fetal growth, and growing attention is being paid to their potential impact on child neurodevelopment. However, previous epidemiological studies examining prenatal phthalate exposure and child neurodevelopment have produced inconsistent or inconclusive findings, and evidence on phthalate mixtures remains limited. In this study, we utilized data from the Environmental influences on Child Health Outcomes (ECHO) Cohort to investigate associations between urinary biomarkers of prenatal phthalate exposure, both individually and as a mixture, and likelihood of neurodevelopmental delay (NDD) in offspring at ages 1 to 3 years. This study included 2378 pregnant person-child dyads from 10 ECHO cohorts who had measurements of NDD odds assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Our single-pollutant analyses revealed mixed findings. Higher prenatal exposure to certain phthalates was associated with higher odds of NDD across multiple domains, including motor and problem-solving skills, with evidence of effect modification by child sex. Conversely, we observed negative associations between specific prenatal phthalate concentrations and lower odds of NDD, particularly in communication domain. From mixture analyses, however, no significant associations were observed between the overall phthalate mixture and NDD odds in most domains, except for negative association for the personal-social domain. Further investigation into the biological mechanisms underlying these relationships, as well as more detailed evaluations of phthalate mixtures, will help advance our understanding of how prenatal phthalate exposure may influence early childhood neurodevelopment.

APA Citation

Park, Seonyoung; McArthur, Kristen; Barrett, Emily; Cordero, José F.; Etzel, Taylor; Ghassabian, Akhgar; Kuiper, Jordan; Meeker, John D.; Nozadi, Sara S.; Rennie, Brandon; Sprowles, Jenna; Starling, Anne P.; Zimmerman, Emily; McGrath, Monica; and Watkins, Deborah J., "Prenatal phthalate exposure and neurodevelopmental delay in early childhood (1 to 3 years): An Environmental influences on Child Health Outcomes (ECHO) study" (2026). GW Authored Works. Paper 8535.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8535

Department

Environmental and Occupational Health