Background: Phthalates are present in many everyday products such as food containers and personal care items, and medical instruments. Prenatal exposure to phthalates may lead to disruption of pubertal development in girls and boys. We aimed to investigate the effect of early life exposure to phthalate esters on pubertal development. Methods: This study included a birth cohort of 437 women and their children between November 2000 to December 2001, there were 143 children followed at 2, 6, 8,11, and 14 years after birth (2003, 2006, 2009, 2012, and 2016). These women were known to have been exposed to phthalates during pregnancy, and were identified through urine screening during the third trimester. The follow-up examinations for their children included anthropomorphic measurements and evaluation of gender-specific secondary sexual characteristics. A generalized estimating equation model (GEEM) and general linear mixed model (GLMM) analysis were applied. Results: Among the girls, pubic hair development at follow-up was positively associated with maternal urinary concentrations of monoethyl phthalate (MEP) and mono (2-ethyl-5-hydroxyl) phthalate (MEHHP), and total mono (2-ethyl-5-oxohexyl) phthalate (MEHP) at the 5-, 8-, and 11- years stage (p < 0.05 for all). Cervix length, ovary size, Tanner stage, and menarche were all inversely associated with levels of mono-benzyl phthalate (MBzP). Boys' armpit hair development and puberty-related voice changes were positively associated with MBzP; development of pubic hair was positively associated with the maternal total MEHP level. Conclusions: This first through pubertal multiple assessments of 15-year pre-birth cohort follow-up study showed early life exposure to phthalates had positive association with secondary sexual characteristics in general and negative association with sexual organ growth in general.
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