Maternal Exposure to Environmental Chemicals may play role in Pediatric Liver Disease Interview with:

Vishal Midya, PhD, MStat Postdoctoral Researcher Icahn School of Medicine at Mount Sinai

Dr. Midya

Dania Valvi, MD MPH PhD
Assistant Professor
Department of Environmental Medicine and Public Health
Co-Director, MS in Epidemiology
Icahn School of Medicine at Mount Sinai
Email: [email protected]  What is the background for this study?   

Response: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children in the U.S., Europe and other world regions, currently affecting 1 in every 10 children, and 1 in every 3 children with obesity in the U.S. The rate of pediatric NAFLD has more than doubled in recent decades following the epidemic rates also noted for childhood obesity. There is increasing interest in the role that environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals (EDCs) cause liver injury and damage; but, until now, the potential effects of prenatal EDC mixture exposures in pediatric NAFLD had not been studied.  What are the main findings?

Response: In this study, we measured 45 chemicals in the blood or urine from 1,108 pregnant women from six European countries and found that maternal exposure to several environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals commonly used in consumer and industrial products increases risk for NAFLD in the child. Environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals are known to interfere with the hormone systems and pass through the placenta from the mother to the fetus altering fetal programming and development. Examples of chemicals we investigated include perfluoroalkyl substances (PFAS), also known as “forever chemicals”, used in nonstick cookware and food packaging, and polybrominated diphenyl ethers (PBDEs) used as flame retardants in furniture and infant products. Other chemical classes we studied include pesticides, plastics, and toxic metals. When the children reached the ages of 6 to 11 years old, we measured the levels of liver enzymes and cytokeratin-18 that indicate risk for NAFLD in the children’s blood, finding elevated levels of those biomarkers in children who had been more highly exposed to environmental chemicals, and especially to persistent organochlorine pesticides, PFAS, PBDEs, and metals, during pregnancy. What should readers take away from your report?

Response: It is important to be aware of the health risks that endocrine-disrupting chemicals pose for the mother and the developing fetus and possible ways to avoid these exposures. Some effective ways in reducing exposure to EDCs in pregnancy and early childhood include avoiding the use of products that contain them, such as plastic containers, bottles, packaging and toys, canned food and beverages, fast/processed foods, non-stick cookware, pesticides and cosmetics, and consuming fresh and organic foods whenever possible. However, EDCs are ubiquitous in consumer products and the environment, and there are many sources of exposure that are beyond the control of individuals. Therefore, policy changes are sorely needed, such as banning the use of EDCs in consumer products and requiring companies to disclose what chemicals are in a product. This would let consumers make informed choices for their health. What recommendations do you have for future research as a result of this work?

Response: NAFLD is now diagnosed in children as young as 2 years of age, and NAFLD in childhood is associated with increased risk for severe chronic liver disease later in adulthood. We need more research and longitudinal studies to elucidate the potential effects of early life EDC exposures on pediatric NAFLD and its progression to more severe liver diseases such as non-alcoholic steatohepatitis (NASH), liver cirrhosis and liver cancer. We also need further research to understand how environmental chemical exposures may interact with our genes, diet and social factors in the development of pediatric liver disease. This information will be informative in designing more effective early life prevention and intervention strategies to reverse the current NAFLD epidemic in children and subsequently adults in the future. Is there anything else you would like to add?

 Response: We are deeply grateful to all researchers and research staff of the HELIX consortium and all the participating families in the HELIX cohorts. This study was funded by the U.S. National Institute of Environmental Health Sciences (NIEHS) and the European Community’s Seventh Framework Programme.


Midya V, Colicino E, Conti DV, et al. Association of Prenatal Exposure to Endocrine-Disrupting Chemicals With Liver Injury in Children. JAMA Netw Open. 2022;5(7):e2220176. doi:10.1001/jamanetworkopen.2022.20176

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Last Updated on July 6, 2022 by Marie Benz MD FAAD