Abstract
BACKGROUND: Phthalates are one of the most common environmental contaminants and endocrine disruptors. Environmental exposure to phthalates may increase the risk for allergic diseases. However, the existing literature presents conflicting findings regarding the long-term impact of early-life exposure to these substances. METHODS: We searched the Web of Science, PubMed and Google Scholar, Medline and Embase databases for all related publications from 1974 to September 1st, 2024. Ultimately, 22 studies with a total of 16,161 participants were selected. The relative risks (RRs) with 95% confidence intervals (95% CIs) were used to evaluate whether prenatal phthalate exposure is associated with allergic endpoints. To assess statistical heterogeneity across studies, both the Q-test and I (2) statistic were adopted. Publication bias of the included studies was evaluated using Begg's and Egger's tests. Stratified analysis was conducted based on the gender of children, molecular weight of phthalates, disease type, phthalate species, parental exposure period and region. The systematic literature search protocol was formally registered in PROSPERO. RESULTS: Childhood wheeze (RR 1.10, 95% CI: 1.00-1.21), eczema (RR 1.09, 95% CI: 1.01-1.17), and rhinitis (RR 1.05, 95% CI: 1.02-1.09) are potentially associated with prenatal exposure to phthalates, particularly butyl-benzyl phthalate (RR 1.15, 95% CI: 1.06-1.24), di-ethyl-hexyl phthalate (RR 1.08, 95% CI: 1.02-1.15) and di-iso-nonyl phthalate (RR 1.12, 95% CI: 1.02-1.23). CONCLUSION: Maternal phthalate exposure during pregnancy exhibits a significant association with elevated risks of childhood respiratory and allergic manifestations, including wheezing episodes, eczematous dermatitis, and rhinitis symptoms. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-025-00951-3.