Unraveling Plastic-Related Chemical Exposures during Pregnancy and Their Associations with Pregnancy Outcomes Using Suspect Screening Analysis

Plastic production has increased sharply in recent decades, releasing numerous chemicals through degradation and additive leaching. We evaluated prenatal exposure to plastic-related chemicals and their associations with pregnancy outcomes using suspect screening analysis in 200 pregnant participants recruited between 13 and 27 weeks of gestation. We detected 441 chemicals in maternal serum samples (9 identified at confidence level 1 and 432 tentatively identified at level 2), using liquid chromatography–quadrupole time-of-flight mass spectrometry (LC-QTOF/MS) with an in-house database of 5267 plastic-related chemicals. We compiled the in-house database with predicted spectra and RTs for 4272 chemicals without available spectra, improving the reliability of suspect screening. Three level 1 chemicals─1,3-diphenylguanidine, undecanedioic acid, and 1-octyl-2-pyrrolidone─and 230 level 2 chemicals have not been widely reported, with fewer than 10 publications in the existing literature. Among level 1 chemicals, an interquartile range increase in acetyl tributyl citrate, progesterone, diisobutyl phthalate, 8-hydroxyquinoline, and PFOS was associated with higher odds of preterm birth. PFOS and undecanedioic acid were associated with increased odds of gestational diabetes mellitus (GDM) in logistic regression models adjusted for maternal age and race/ethnicity. We observed associations between four level 2 chemicals and GDM, and eight were associated with gestational hypertension. Exposure levels varied significantly by education, race/ethnicity, and nativity, with higher PFOS observed in participants with higher educational attainment and in non-Hispanic White groups. Our findings highlight novel chemical exposures and their associations with pregnancy complications, raising concerns about gaps in the monitoring of plastic-related chemicals and their potential impacts on maternal health.