Exposure to Organophosphate Ester Flame Retardants and Plasticizers during Pregnancy and Autism-Related Outcomes in the ECHO Cohort.

Authors

Jennifer L Ames, Assiamira Ferrara, Juanran Feng, Stacey Alexeeff, Lyndsay A Avalos, Emily S Barrett, Theresa M Bastain, Deborah H Bennett, Jessie P Buckley, Courtney C Carignan, Patricia Cintora, Akhgar Ghassabian, Monique M Hedderson, Ixel Hernandez-Castro, Kurunthachalam Kannan, Margaret R Karagas, Catherine J Karr, Jordan R Kuiper, Donghai Liang, Kristen Lyall, Cindy T McEvoy, Rachel Morello-Frosch, Thomas G O'Connor, Jiwon Oh, Alicia K Peterson, Lesliam Quiros-Alcala, Sheela Sathyanarayana, Susan Schantz, Rebecca J Schmidt, Anne P Starling, Tracey J Woodruff, Heather E Volk, Yeyi Zhu, Lisa A Croen, ECHO Cohort Consortium

Published in

Environmental health perspectives. Volume 134. Issue 4. Pages 423-437. Aug 04, 2026. Epub May 07, 2026.

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.

PMID:
42564610
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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