ESPEYB21 2. Antenatal and Neonatal Endocrinology Important Associations with Growth (3 abstracts)
2.9. The associations between maternal and fetal exposure to endocrine- disrupting chemicals (EDC) and asymmetric fetal growth restriction: a prospective cohort study
Hong S , Kang BS , Kim O , Won S , Kim HS , Wie JH , Shin JE , Choi SK , Jo YS , Kim YH , Yang M , Kang H , Lee D-W , Park IY , Park JS & Ko HS
Front. Public Health. 2024; 12:1351786. doi: 10.3389/fpubh.2024.1351786
Brief Summary: This prospective cohort study of 146 mother-neonate pairs determined fetal-maternal exposure to EDCs from October 2021 – October 2022 and examined their associations with fetal growth parameters. Fetal exposure to bisphenol-A (BPA) showed a linear association with asymmetric fetal growth patterns.
Their definition of fetal growth restriction (FGR) when assessed by transabdominal ultrasonography at 38.3 weeks gestational age was a fetal abdominal circumference (AC) or an estimated fetal weight < 10th percentile1. Asymmetry was defined as a head circumference (HC)/AC ratio > 95th percentile2. This type of asymmetric growth restriction is typically seen in placental insufficiency when the fetal adaptation to chronic malnutrition and hypoxia spares brain growth.
Creatinine-adjusted maternal EDC exposure was assessed at the time of delivery in maternal urine and cord blood samples. They measured BPA levels as well as monoethyl phthalates (MEPs) and perfluorooctanoic acid (PFOA) by ultra-performance liquid chromatography-tandem mass spectrometry. Multiple maternal demographic characteristics and socioeconomic status indicators were collected as well as pre-conception and pregnancy habits and medical conditions that could influence fetal growth. Median age of delivery was 38.6 weeks (IQR 38.0 -39.6) with 6.2% delivered < 37 weeks. A birth weight (BW) < 2500 g was seen in 6.8%, and 0.7 % had a BW > 4000 g. Female to male ratio was 60:40.
Linear associations were observed between maternal urine and cord blood levels of BPA and MEP, but not PFOA. There was no difference in levels of any EDC between the FGR and non-FGR groups. Conversely, a positive linear association was observed between cord blood BPA and the AH/AC ratio both before and after adjusting for several potential confounders.
Although previous work on the association of fetal exposure to BPA and BW has been controversial, this EDC is known to impact on placental development, likely by induction of oxidative stress. BPA levels have also been associated with the antiangiogenic factor sFLT-1/PIGF, a marker of placental insufficiency. This is the first study of the impact of BPA on asymmetric fetal growth, a hallmark of placental dysfunction.
References: 1. Society for Maternal-Fetal Medicine (SMFM)Martins JG, Biggio JR, Abuhamad A. Society for maternal-fetal medicine consult series# 52: diagnosis and management of fetal growth restriction:(replaces clinical guideline number 3, April 2012). Am J Obstet Gynecol. (2020) 223:B2–B17. doi: 10.1016/j.ajog.2020.05.010.2. Campbell S, Thoms A. Ultrasound measurement of the fetal head to abdomen circumference ratio in the assessment of growth retardation. Br J Obstet Gynaecol. (1977) 84:165–74. doi: 10.1111/j.1471-0528.1977.tb12550.x
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ESPE Yearbook of Paediatric Endocrinology
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