Association of prenatal parabens exposure with adverse pregnancy outcomes: the role of prenatal depressive symptoms

Background Parabens (PBs) are common endocrine-disrupting preservatives linked to adverse pregnancy outcomes, while prenatal depressive symptoms are also prevalent and harmful. Their combined effects remain poorly understood. Objective To examine individual and joint associations of prenatal PBs exposure with adverse pregnancy outcomes (APOs) and to assess modification by maternal depressive symptoms. Methods A prospective cohort of 934 mother-infant pairs from Ningxia, China, was analyzed. Maternal serum concentrations of five PBs were measured by HPLC-MS/MS. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. APOs included small vulnerable newborns, macrosomia, fetal distress, and asphyxia. Logistic regression and quantile g-computation were used, with stratified and interaction analyses. Results In the overall cohort, propylparaben (PrP) was significantly associated with fetal distress (OR = 1.25, 95% CI: 1.05–1.49), while mixed PBs exposure increased the risk of macrosomia (OR = 1.62, 95% CI: 1.06–2.48). Quantile g-computation revealed that ethylparaben (EtP), PrP, and heptylparaben (HeP) were the primary contributors to the mixture effect on macrosomia. Maternal depressive symptoms significantly modified these associations: among women with depressive symptoms ( n = 418), PrP was associated with overall APOs (OR = 1.21, 95% CI: 1.03–1.41), and EtP was linked to small vulnerable newborns (OR = 1.20, 95% CI: 1.04–1.38). In contrast, no significant associations were observed in women without significant depressive symptoms. Interaction analyses confirmed significant effect modification by depressive symptoms for PrP ( P -int = 0.049) and EtP ( P -int = 0.024). Conclusion Prenatal PBs exposure is associated with increased APOs risk, particularly among women with depressive symptoms, underscoring the importance of integrating environmental and mental health considerations into prenatal care.