Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression
- PMID: 37728908
- PMCID: PMC10512164
- DOI: 10.1001/jamapsychiatry.2023.3542
Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression
Abstract
Importance: Postpartum depression (PPD) affects up to 20% of childbearing individuals, and a significant limitation in reducing its morbidity is the difficulty in modifying established risk factors. Exposure to synthetic environmental chemicals found in plastics and personal care products, such as phenols, phthalates, and parabens, are potentially modifiable and plausibly linked to PPD and have yet to be explored.
Objective: To evaluate associations of prenatal exposure to phenols, phthalates, parabens, and triclocarban with PPD symptoms.
Design, setting, and participants: This was a prospective cohort study from 5 US sites, conducted from 2006 to 2020, and included pooled data from 5 US birth cohorts from the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) consortium. Participants were pregnant individuals with data on urinary chemical concentrations (phenols, phthalate metabolites, parabens, or triclocarban) from at least 1 time point in pregnancy and self-reported postnatal depression screening assessment collected between 2 weeks and 12 months after delivery. Data were analyzed from February to May 2022.
Exposures: Phenols (bisphenols and triclosan), phthalate metabolites, parabens, and triclocarban measured in prenatal urine samples.
Main outcomes and measures: Depression symptom scores were assessed using the Edinburgh Postnatal Depression Scale (EPDS) or the Center for Epidemiologic Studies Depression Scale (CES-D), harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale. Measures of dichotomous PPD were created using both sensitive (EPDS scores ≥10 and CES-D scores ≥16) and specific (EPDS scores ≥13 and CES-D scores ≥20) definitions.
Results: Among the 2174 pregnant individuals eligible for analysis, nearly all (>99%) had detectable levels of several phthalate metabolites and parabens. PPD was assessed a mean (SD) of 3 (2.5) months after delivery, with 349 individuals (16.1%) and 170 individuals (7.8%) screening positive for PPD using the sensitive and specific definitions, respectively. Linear regression results of continuous PROMIS depression T scores showed no statistically significant associations with any chemical exposures. Models examining LMW and HMW phthalates and di (2-ethylhexyl) phthalate had estimates in the positive direction whereas all others were negative. A 1-unit increase in log-transformed LMW phthalates was associated with a 0.26-unit increase in the PROMIS depression T score (95% CI, -0.01 to 0.53; P = .06). This corresponded to an odds ratio (OR) of 1.08 (95% CI, 0.98-1.19) when modeling PPD as a dichotomous outcome and using the sensitive PPD definition. HMW phthalates were associated with increased odds of PPD (OR, 1.11; 95% CI, 1.00-1.23 and OR, 1.10; 95% CI, 0.96-1.27) for the sensitive and specific PPD definitions, respectively. Sensitivity analyses produced stronger results.
Conclusions and relevance: Phthalates, ubiquitous chemicals in the environment, may be associated with PPD and could serve as important modifiable targets for preventive interventions. Future studies are needed to confirm these observations.
Conflict of interest statement
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- UH3 OD023285/OD/NIH HHS/United States
- UH3 OD023248/OD/NIH HHS/United States
- P30 ES010126/ES/NIEHS NIH HHS/United States
- U24 OD023382/OD/NIH HHS/United States
- UH3 OD023271/OD/NIH HHS/United States
- UG3 OD023271/OD/NIH HHS/United States
- UG3 OD023251/OD/NIH HHS/United States
- UH3 OD023318/OD/NIH HHS/United States
- P30 ES017885/ES/NIEHS NIH HHS/United States
- U2C OD023375/OD/NIH HHS/United States
- U24 OD023319/OD/NIH HHS/United States
- UH3 OD023251/OD/NIH HHS/United States
- UH3 OD023287/OD/NIH HHS/United States
- UG3 OD035540/OD/NIH HHS/United States
- UH3 OD023305/OD/NIH HHS/United States
- UG3 OD023289/OD/NIH HHS/United States
- UH3 OD023244/OD/NIH HHS/United States
- UH3 OD023328/OD/NIH HHS/United States
- UH3 OD023289/OD/NIH HHS/United States