Journal article
Exposure to Organophosphate Ester Flame Retardants and Plasticizers during Pregnancy and Autism-Related Outcomes in the ECHO Cohort
Environmental health perspectives, Forthcoming
07 May 2026
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Abstract
BACKGROUND: Organophosphate ester flame retardants and plasticizers (OPEs) have myriad uses in industry and consumer products. Increasing human exposure to OPEs has raised concerns about their potential effects on child neurodevelopment during the pregnancy. Objective: We investigated whether OPE urinary concentrations during pregnancy were associated with child’s autism-related outcomes. METHODS: We included 4159 mother–child pairs from 15 cohorts in the NIH Environmental influences on Child Health Outcomes (ECHO) Consortium, with children born from 2006–2020 (median age [interquartile range]: 6 [4,10] years). Nine OPE biomarkers were measured in urine samples collected mid- to late pregnancy. Dilution-adjusted biomarkers were modeled continuously, categorically (high [>median], moderate [≤median], nondetect), or as detect/nondetect depending on their detection frequency. We assessed child autism-related traits via a) parent report on the Social Responsiveness Scale (SRS) and b) clinical autism diagnosis. We examined associations of OPEs with child outcomes, including modification by child sex, using generalized estimating equations to account for clustering by ECHO cohort. RESULTS: Compared with nondetectable concentrations, high exposure to bis(butoxyethyl) phosphate (BBOEP) was associated with higher autistic trait scores (adj-β 0.97, 95% confidence interval [CI]: 0.42, 1.52) and greater odds of autism diagnosis (adjusted odds ratio [adj-OR]: 1.27, 95% CI: 1.07, 1.50). Bis(1-chloro-2-propyl) phosphate (BCPP) showed associations with autistic trait scores (BCPP adj-β for high exposure vs nondetect: 0.34, 95% CI: −0.46, 1.13; BCPP adj-β for moderate exposure vs nondetect: 0.72, 95% CI: 0.24, 1.20). High exposure to bis(2-chloroethyl) phosphate (BCETP) was associated with lower odds of autism diagnosis (adj-OR: 0.76, 95% CI: 0.60, 0.95). Other OPEs showed no associations in adjusted models. Associations between BBOEP and higher autistic trait scores were stronger in males than females. DISCUSSION: Prenatal exposure to OPEs, specifically BCPP and BBOEP, may be associated with a higher risk of autism diagnosis and related traits in childhood.
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Details
- Title
- Exposure to Organophosphate Ester Flame Retardants and Plasticizers during Pregnancy and Autism-Related Outcomes in the ECHO Cohort
- Creators
- Jennifer L. Ames - Kaiser PermanenteAssiamira Ferrara - Kaiser PermanenteJuanran Feng - Kaiser PermanenteStacey Alexeeff - Kaiser PermanenteLyndsay A. Avalos - Kaiser PermanenteEmily S. Barrett - Rutgers, The State University of New JerseyTheresa M. Bastain - University of Southern CaliforniaDeborah H. Bennett - University of California, DavisJessie P. Buckley - University of North Carolina at Chapel HillCourtney C. Carignan - Michigan State UniversityPatricia Cintora - University of Illinois Urbana-ChampaignAkhgar Ghassabian - New York UniversityMonique M. Hedderson - Kaiser PermanenteIxel Hernandez-Castro - University of Southern CaliforniaKurunthachalam Kannan - New York State Department of HealthMargaret R. Karagas - Dartmouth CollegeCatherine J. Karr - University of WashingtonJordan R. Kuiper - George Washington UniversityDonghai Liang - Emory UniversityKristen Lyall - Drexel UniversityCindy T. McEvoy - Oregon Health & Science UniversityRachel Morello-Frosch - University of California, BerkeleyThomas G. O’Connor - University of RochesterJiwon Oh - University of California, DavisAlicia K. Peterson - Kaiser PermanenteLesliam Quiros-Alcala - Johns Hopkins UniversitySheela Sathyanarayana - Seattle Children's HospitalSusan Schantz - University of Illinois Urbana-ChampaignRebecca J. Schmidt - University of California, DavisAnne P. Starling - University of North Carolina at Chapel HillTracey J. Woodruff - University of California, San FranciscoHeather E. Volk - Johns Hopkins UniversityYeyi Zhu - Kaiser PermanenteLisa A. Croen - Kaiser Permanente
- Publication Details
- Environmental health perspectives, Forthcoming
- Publisher
- ACS Publications
- Number of pages
- 15
- Grant note
- U.S. Department of Health and Human Services: U24OD023319
We thank our Environmental influences on Child Health Outcomes (ECHO) Program colleagues; the medical, nursing, and program staff; as well as the children and families participating in the ECHO cohorts. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with cofunding from the Office of Behavioral and Social Science Research (Measurement Core), U24OD035523 (Lab Core), ES0266542 (HHEAR), U24ES026539 (HHEAR Barbara O'Brien), U2CES026533 (HHEAR Lisa Peterson), U2CES026542 (HHEAR Patrick Parsons, Kannan Kurunthacalam), U2CES030859 (HHEAR Manish Arora), U2CES030857 (HHEAR Timothy R. Fennell, Susan J. Sumner, Xiuxia Du), U2CES026555 (HHEAR Susan L. Teitelbaum), U2CES026561 (HHEAR Robert O. Wright), U2CES030851 (HHEAR Heather M. Stapleton, P. Lee Ferguson), UG3/UH3OD023251 (Akram Alshawabkeh), UH3OD023320 and UG3OD035546 (Judy Aschner), UH3OD023332 (Clancy Blair, Leonardo Trasande), UG3/UH3OD023253 (Carlos Camargo), UG3/UH3OD023248 and UG3OD035526 (Dana Dabelea), UG3/UH3OD023313 (Daphne Koinis Mitchell), UH3OD023328 (Cristiane Duarte), UH3OD023318 (Anne Dunlop), UG3/UH3OD023279 (Amy Elliott), UG3/UH3OD023289 (Assiamira Ferrara), UG3/UH3OD023282 (James Gern), UH3OD023287 (Carrie Breton), UG3/UH3OD023365 (Irva Hertz-Picciotto), UG3/UH3OD023244 (Alison Hipwell), UG3/UH3OD023275 (Margaret Karagas), UH3OD023271 and UG3OD035528 (Catherine Karr), UH3OD023347 (Barry Lester), UG3/UH3OD023389 (Leslie Leve), UG3/UH3OD023344 (Debra MacKenzie), UH3OD023268 (Scott Weiss), UG3/UH3OD023288 (Cynthia McEvoy), UG3/UH3OD023342 (Kristen Lyall), UG3/UH3OD023349 (Thomas O'Connor), UH3OD023286 and UG3OD035533 (Emily Oken), UG3/UH3OD023348 (Mike O'Shea), UG3/UH3OD023285 (Jean Kerver), UG3/UH3OD023290 (Julie Herbstman), UG3/UH3OD023272 (Susan Schantz), UG3/UH3OD023249 (Joseph Stanford), UG3/UH3OD023305 (Leonardo Trasande), UG3/UH3OD023337 (Rosalind Wright), UG3OD035508 (Sheela Sathyanarayana), UG3OD035509 (Anne Marie Singh), UG3OD035513 and UG3OD035532 (Annemarie Stroustrup), UG3OD035516 and UG3OD035517 (Tina Hartert), UG3OD035518 (Jennifer Straughen), UG3OD035519 (Qi Zhao), UG3OD035521 (Katherine Rivera-Spoljaric), UG3OD035527 (Emily S Barrett), UG3OD035540 (Monique Marie Hedderson), UG3OD035543 (Kelly J Hunt), UG3OD035537 (Sunni L Mumford), UG3OD035529 (Hong-Ngoc Nguyen), UG3OD035542 (Hudson Santos), UG3OD035550 (Rebecca Schmidt), UG3OD035536 (Jonathan Slaughter), UG3OD035544 (Kristina Whitworth), and K99/R00ES032481 (Jennifer Ames). The sponsor, NIH, participated in the overall design and implementation of the ECHO Program, which was funded as a cooperative agreement between NIH and grant awardees. The sponsor approved the Steering Committee-developed ECHO protocol and its amendments including COVID-19 measures. The sponsor had no access to the central database, which was housed at the ECHO Data Analysis Center. Data management and site monitoring were performed by the ECHO Data Analysis Center and Coordinating Center. All analyses for scientific publication were performed by the study statistician, independently of the sponsor. The lead author wrote all drafts of the manuscript and made revisions based on coauthors and the ECHO Publications Committee (a subcommittee of the ECHO Operations Committee) feedback without input from the sponsor. The study sponsor did not review or approve the manuscript for submission to the journal. Select deidentified data from the ECHO Program are available through NICHD's Data and Specimen Hub (DASH). Information on study data not available on DASH, such as some Indigenous datasets, can be found on the ECHO study DASH webpage.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001760134600001
- Other Identifier
- 991022179540604721