Title : Maternal phthalate burden as a predictor of gestational diabetes and adverse birth outcomes
Abstract:
Background: Gestational Diabetes Mellitus (GDM) represents a transient diabetogenic condition that poses health risks for both mother and fetus. Emerging evidence suggests that exposure to phthalates, endocrine-disrupting chemicals encountered through dietary, behavioural, and residential sources, significantly increases the likelihood of developing GDM, with nearly half of all GDM cases potentially linked to these xenobiotic compounds. Phthalate-induced oxidative stress may alter fetal development, thereby predisposing offspring to several complications later in life.
Aim: This study aimed to investigate the relationship between maternal phthalate exposure and physiology in neonates born to GDM mothers, compared with healthy controls belonging to the northern districts of Tamil Nadu.
Methods: Urinary phthalate concentrations were quantified in both GDM and non-GDM pregnant women prior to delivery. Neonates born at or beyond 35+0/7 weeks of gestation underwent comprehensive cardiac evaluation using 2-dimensional echocardiography and electrocardiography within 72 hours of birth. Neonatal blood pressure and body weight were also recorded. Exclusion criteria of the study consisted of mothers with pre-existing diabetes mellitus and neonates requiring respiratory support for more than 48 hours.
Results: Significantly elevated urinary phthalate levels were observed among GDM mothers compared to controls. These levels correlated with notable alterations in neonatal 2-D echocardiographic and electrocardiographic parameters, as well as variations in blood pressure profiles. Furthermore, macrosomia occurred more frequently among infants of GDM mothers.
Conclusion: The findings indicate that increased maternal phthalate exposure in GDM is associated with measurable deviations in neonatal cardiovascular physiology. Maternal urinary phthalate concentrations may thus serve as early predictive biomarkers for assessing long-term cardiovascular risk in infants exposed in utero. Therefore, analyzing the maternal urinary phthalate concentrations can help in early screening and triaging of the burden of GDM patients.
