Dominant Pathways of Bisphenol Compound Exposure among Pregnant Women: A Cohort-Based Assessment

Dominant Pathways of Bisphenol Compound Exposure among Pregnant Women: A Cohort-Based Assessment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dominant Pathways of Bisphenol Compound Exposure among Pregnant Women: A Cohort-Based Assessment Zhao-hui Huang, An-hui Zhang, Min Zhu, Qian Zhai, Lianjie Dou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8837774/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Bisphenol A (BPA) and its substitutes are widely detected in human populations, raising concerns about their health impacts, particularly for vulnerable groups such as pregnant women. This study aimed to characterize the internal exposure levels of BPA, bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF) among 1,258 pregnant women from the Wuhu Birth Cohort in China and to identify their primary exposure pathways. Serum concentrations were determined using ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC–MS/MS). Mixed exposure to bisphenols was prevalent, with detection rates of 100% for BPS, 98.9% for BPAF, 84.0% for BPF, and 85.1% for BPA. BPA showed the highest median concentration (238.8 ng/g). Correlation and regression analyses consistently identified dietary intake as the dominant exposure route. Consumption of pork (adjusted odds ratio [aOR] = 2.806, 95% CI: 2.031–3.877) and poultry (aOR = 1.755, 95% CI: 1.064–2.895) was significantly associated with elevated BPA exposure risk. Egg intake was related to higher BPS exposure (aOR = 1.517, 95% CI: 1.058–2.174), while wheat product consumption was linked to higher BPF exposure (aOR = 1.524, 95% CI: 1.123–2.070). Dermal contact and inhalation pathways did not show consistent associations with serum bisphenol levels. The results demonstrate widespread co-exposure to BPA and its substitutes in Chinese pregnant women, with diet as a key modifiable exposure pathway. These findings support the need for targeted dietary interventions and underscore the importance of updating health risk assessments to account for mixed bisphenol exposures. Bisphenols Pregnant Women Exposure Assessment Exposure Pathways Introduction Bisphenols (BPs) constitute a prevalent class of endocrine-disrupting chemicals (EDCs), with human exposure occurring through multiple routes, including oral ingestion, dermal contact, and inhalation. Their widespread presence in human biological matrices—such as urine, serum, breast milk, and cord blood—underscores pervasive and continuous environmental exposure(Lee et al., 2018; Zhou et al., 2022). Structurally, BPs exhibit hormone-like activity, primarily functioning as estrogen receptor agonists or androgen receptor antagonists, thereby interfering with normal endocrine signaling. Among them, bisphenol A (BPA), the most historically manufactured and extensively utilized analog, has been widely studied. Accumulating evidence indicates that BPA exerts multi-system biological toxicity, with particular concern directed toward its neurodevelopmental effects. Epidemiological and experimental studies suggest that maternal BPA exposure during pregnancy may disrupt neurobehavioral development in offspring and is associated with an increased risk of behavioral disorders, including depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD)-like behaviors(Braun, Kalkbrenner, et al., 2014; Casas et al., 2015; Lin, Lee, Chuang, & Shih, 2023; Pan et al., 2019; Williams et al., 2025). In light of these documented health risks, regulatory measures in many countries have restricted BPA use in certain consumer products, leading to the rapid adoption of structural analogs as replacements. Bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF) have emerged as common substitutes in plastics, food packaging, and other commercial applications (Czarny-Krzymińska, Krawczyk, & Szczukocki, 2023; Wang et al., 2023). However, while toxicological and exposure data on BPA are substantial, the human exposure pathways and health implications of these substitutes remain poorly characterized. Pregnant women represent a particularly vulnerable population due to physiological changes and the potential for transplacental and lactational transfer of contaminants, which may affect fetal and infant development. Importantly, recent studies highlight that human exposure to bisphenols is not uniform across analogs and may involve complex metabolic and excretion patterns. For instance, while BPA is predominantly excreted as glucuronide conjugates, BPF is mainly sulfated, and BPS and BPAF often remain in free forms—a factor that complicates exposure assessment and risk evaluation if conjugation efficiency is not considered. Furthermore, sex-specific differences in metabolism and exposure have been reported, emphasizing the need for demographic-specific analyses(England-Mason et al., 2024; Singh et al., 2024). Despite these advances, systematic evaluation of primary exposure pathways and source-specific contributions among pregnant women remains limited, particularly in population-based cohorts. To address these knowledge gaps, this study utilized data from a Chinese birth cohort to: (1) quantify internal exposure levels of BPA and its major substitutes (BPS, BPF, BPAF) in pregnant women using advanced biomonitoring; (2) identify dominant exposure pathways through integrated questionnaire-based exposure assessment and chemical analysis; and (3) assess potential health risks based on established safety thresholds. The findings are expected to provide a scientific basis for developing targeted exposure-reduction strategies, refining risk assessment frameworks, and informing public health policies for this sensitive subpopulation. Materials and Methods Study Population This study employed a cohort design, with participants drawn from the Wuhu Birth Cohort Study in Anhui Province, China(Dou et al., 2024 ). Inclusion criteria were: confirmed pregnancy; intention to continue the pregnancy to delivery; plan to deliver locally; willingness to cooperate with follow-up. Exclusion criteria included: unwillingness to participate; presence of significant mental illness or other severe organic diseases; occurrence of spontaneous abortion, stillbirth, or fetal death; pre-pregnancy diagnosis of diabetes or hypertension. The study protocol was approved by the Ethics Committee of Anhui Medical University (No. 20180081) and the Ethics Committee of Wuhu Maternity and Child Health Care Hospital (No. 20220003). The study was conducted in strict accordance with relevant ethical principles and regulations, and all participants provided written informed consent. Survey Methods During the second-trimester prenatal check-up, a self-designed Maternal and Infant Health Record Form was used to collect information. The form included: 1) General maternal demographics; 2) Frequency of use of daily life products during weeks 14–27 of pregnancy (covering 11 items: shampoo, hair dye, cold perm lotion, lipstick, nail polish, hair styling products, whitening cream, mosquito repellent/mosquito coil, air freshener, detergents [dishwashing liquid, laundry detergent], disinfectants [hand sanitizer, disinfectant solution]. Usage frequency was categorized into 4 levels); 3) Dietary frequency in the week preceding sample collection (covering 20 food items: rice, wheat products, fresh vegetables, fresh fruits, beef/lamb, pork, poultry, fish/shrimp and other aquatic products, eggs, dairy products, legumes and their products, nuts [e.g., walnuts, peanuts], fried foods, pickled vegetables/salted cabbage, animal offal, garlic, tea [brewed, not bottled iced tea], coffee, cola, milk tea. Frequency was categorized into 5 levels); 4) Indoor activity duration, including continuous office work hours on workdays and time spent primarily indoors on rest days. During the first-trimester check-up, the same investigator used the same equipment to measure maternal height (to the nearest 0.1 cm) and weight (to the nearest 0.1 kg). Pre-pregnancy weight was self-reported. Pre-pregnancy Body Mass Index (BMI) was calculated as: pre-pregnancy weight (kg) / height (m)². Pre-pregnancy BMI was categorized as: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 23.9), overweight/obese (BMI ≥ 24). Quantification of Serum Bisphenols Daily, research team members collected leftover serum samples from the hospital laboratory after routine clinical tests. Samples were matched with cohort participant information, then aliquoted into 1.5 mL polypropylene cryovials and stored at -20°C in a biobank. This method utilized residual clinical samples, enhancing resource efficiency. Concentrations of BPA, BPAF, BPS, and BPF in maternal serum were determined using a validated method based on liquid-liquid extraction coupled with ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), as previously described(Dou et al., 2024 ; Z. Huang et al., 2022 ). Briefly, serum samples (200 µL) were spiked with stable isotope-labeled internal standards (¹³C-labeled BPA, BPS, BPF, BPAF) and extracted. Chromatographic separation was achieved on a Shimadzu Nexera X2 UHPLC system with an Agilent ZORBAX SB-Phenyl column, coupled to an AB SCIEX Triple Quad 5500 mass spectrometer operated in negative electrospray ionization mode. Quantification employed matrix-matched calibration curves with a weighting factor of 1/x². The method detection limits (MDL, S/N = 3) were 66.67 pg/mL for BPA, 0.83 pg/mL for BPAF, 1.67 pg/mL for BPS, and 33.33 pg/mL for BPF. Values below the MDL were imputed as MDL/√2(Kim et al., 2022 ). Comprehensive quality assurance/quality control (QA/QC) procedures were implemented, including the analysis of procedural blanks, matrix-spiked quality control samples (with mean recoveries of 91.89-100.23% and precision RSDs < 7.57%), and assessment of matrix effects (94.77-100.29%). Full methodological details, including instrumental parameters, complete QA/QC data, and the step-by-step protocol, are provided in Supplementary Material 1. Statistical Analysis Data analysis was performed using IBM SPSS Statistics 22.0. Comparisons of categorical variables between groups were conducted using the Pearson chi-square test. For comparisons of means across multiple groups for continuous variables, analysis of variance (ANOVA) was used. Spearman rank correlation analysis was employed to assess the bivariate associations between exposure variables (dietary frequency, product use frequency) and serum bisphenol concentrations (Z-score transformed). To identify factors associated with high bisphenol exposure (defined as concentrations above the 75th percentile for each compound), multivariate binary logistic regression models were constructed. Variables with P < 0.1 in univariate analysis were included in the initial model (Model a), and a subsequent model (Model b) was adjusted for potential confounders: maternal age, household income, education level, and pre-pregnancy BMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A two-sided P-value < 0.05 was considered statistically significant. Results and Discussion Internal Exposure to Bisphenol Compounds among Pregnant Women Bisphenol A (BPA) and its substitutes, including bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF), are known endocrine-disrupting chemicals with potential impacts on fetal neurodevelopment and other health outcomes (Braun, Kalkbrenner, et al., 2014 ; Braun, Lanphear, et al., 2014 ; Lin et al., 2023 ). In this cohort of 1,258 pregnant women, mixed exposure to bisphenols was prevalent. BPS was detected in all serum samples (100%), followed by BPAF (98.9%), BPF (84.0%), and BPA (85.1%) (Table 1 ). The median concentration was highest for BPA (238.8 ng/g), with a maximum level reaching 7796.0 ng/g, indicating potential for sporadic high-level exposure. BPF showed the next highest median concentration (108.2 ng/g), while BPS and BPAF levels were comparatively lower. The near-ubiquitous detection of BPS and BPAF alongside BPA reflects a shifting exposure landscape in the post-BPA-restriction era, underscoring the need for risk assessments that consider mixed exposures (Braun, Kalkbrenner, et al., 2014 ; Braun, Lanphear, et al., 2014 ; Chen et al., 2016 ; Lin et al., 2023 ; Rochester & Bolden, 2015 ). Table 1 Detection Results of Bisphenols in Pregnant Women (ng/g) Bisphenols Detection frequency Minimum Maximum Mean Median BPAF 98.9 <LOD 110.8 10.5 8.5 BPS 100.0 3.3 369.8 27.2 20.5 BPF 84.0 <LOD 1302.2 165.0 108.2 BPA 85.1 <LOD 7796.0 497.4 238.8 ΣBPs 100 84.4 7947.9 700.0 445.8 Dominant Exposure Pathways Identified for Bisphenols Dietary Intake as the Primary Route Spearman correlation and multivariate logistic regression analyses consistently identified dietary intake as the dominant exposure pathway for bisphenols, particularly for BPA and total bisphenols (ΣBPs). Consumption frequency of pork (r = 0.101, P < 0.01 for BPA) and fresh vegetables (r = 0.078, P < 0.01 for BPA and ΣBPs) in the past week showed significant positive correlations with serum levels (Table 2 ). Logistic regression confirmed strong associations: pregnant women consuming pork 4–8 times per week had 2.8-fold higher odds (aOR = 2.806, 95% CI: 2.031–3.877) of high BPA exposure compared to those consuming it ≤ 3 times per week (Table 5 ). High poultry consumption (> 9 times/week) was also associated with elevated BPA (aOR = 1.755, 95% CI: 1.064–2.895) and ΣBPs exposure. These findings align with the extensive use of bisphenols in food-contact materials like plastic packaging and epoxy resin can linings, where animal-derived foods may become contaminated during processing, storage, or via bioaccumulation (Liao & Kannan, 2014 ; Vrachnis et al., 2021 ). A recent study in elderly Chinese also reported a positive correlation between blood BPA and meat intake (Duan et al., 2025 ), supporting our results. Table 2 Correlation between Dietary Frequency in the Past Week and Bisphenols Levels Dietary Item in the Past Week BPAF BPS BPF BPA ΣBPs Rice 0.034 0.018 -0.008 0.028 0.025 Wheat and its products -0.025 -0.024 0.033 -0.028 0.003 Fresh vegetables -0.036 -0.006 0.005 0.078** 0.078** Fresh fruits -0.018 0.009 -0.032 0.028 0.021 Beef/Mutton -0.032 -0.022 -0.041 0.020 0.000 Pork -0.017 0.020 -0.011 0.101** 0.079** Poultry -0.010 -0.013 0.014 0.024 0.040 Fish/Shrimp and other aquatic products -0.040 -0.020 -0.014 -0.010 -0.008 Eggs -0.037 0.057* 0.025 0.054 0.078** Dairy products -0.005 0.028 -0.045 0.053 0.036 Legumes and their products -0.011 -0.018 -0.010 0.060* 0.034 Nuts (e.g., walnuts, peanuts) -0.007 -0.024 0.000 0.033 0.019 Fried foods -0.014 0.000 -0.029 0.007 -0.028 Pickled vegetables/Salted cabbage 0.037 -0.011 0.032 0.019 0.014 Animal offal 0.004 -0.01 0.019 0.052 0.045 Garlic -0.025 -0.004 -0.007 0.029 0.018 Tea (brewed) -0.046 -0.013 0.014 -0.007 0.017 Coffee -0.067* 0.037 0.049 -0.022 -0.011 Cola 0.000 0.027 -0.009 -0.017 -0.017 v -0.049 -0.027 -0.048 -0.066* -0.077** Note : Bisphenols levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * P < 0.05, ** P 9 times. Table 5 Analysis Results of Pathways Associated with High Bisphenols Exposure during Pregnancy Exposure 总人数 高水平占比(%) OR (95% CI )a OR (95% CI )b BPAF Coffee intake frequency in the past week No intake 1231 25.5 1 1 ≥1 time/week 27 3.7 0.112(0.015,0.831)** 0.118(0.016,0.874)** BPS Egg intake frequency in the past week ≤ 3 times/week 51 20.2 1 1 4–8 times/week 92 25.3 1.345(0.913,1.981) 1.402(0.948,2.074) >9 times/week 172 26.8 1.449(1.018,2.064)* 1.517(1.058,2.174)* BPF Wheat product intake frequency in the past week ≤3 times/week 669 22.6 1 4–8 times/week 303 30.7 1.541(1.136,2.092)** 1.524(1.123,2.07)** >9 times/week 286 24.8 1.111(0.802,1.538) 1.088(0.784,1.508) Coffee intake frequency in the past week No intake 1231 24.6 1 ≥ 1 time/week 27 44.4 2.436(1.121,5.297)* 2.465(1.13,5.375)* BPA Pork consumption frequency in the past week ≤3 times/week 519 17.0 1 4–8 times/week 397 35.0 2.806(2.031,3.877)** 2.806(2.031,3.877)** >9 times/week 342 25.7 1.414(0.955,2.092) 1.414(0.955,2.092) Poultry consumption frequency in the past week ≤3 times/week 909 24.1 1 4–8 times/week 248 23.8 0.762(0.536,1.084) 0.762(0.536,1.084) >9 times/week 101 36.6 1.755(1.064,2.895)* 1.755(1.064,2.895)* ΣBPs Pork consumption frequency in the past week ≤3 times/week 519 19.7 1 4–8 times/week 397 31.5 1.914(1.396,2.623)** 1.913(1.394,2.625)** >9 times/week 342 25.7 1.219(0.836,1.778) 1.219(0.836,1.779) Poultry consumption frequency in the past week ≤3 times/week 909 23.9 1 4–8 times/week 248 25.0 0.897(0.635,1.268) 0.904(0.639,1.28) >9 times/week 101 35.6 1.798(1.089,2.968)* 1.748(1.056,2.891)* Note : a Variables with P < 0.1 in univariate analysis were included; b: Adjusted for maternal age, household income, educational level, and pre-pregnancy BMI. High-level exposure was defined as a concentration above the 75 th percentile for each bisphenol compound. OR : odds ratio; CI : confidence interval. * P < 0.05, ** P 9 times/week: aOR = 1.517, 95% CI: 1.058–2.174). Given BPS's common use in thermal paper (e.g., receipts), this association may indicate hand-to-mouth transfer after handling such materials, which could contaminate food items like eggs during handling or packaging(Liao et al., 2012 ). High BPF exposure was linked to wheat product intake (4–8 times/week: aOR = 1.524, 95% CI: 1.123–2.070) and coffee consumption (≥ 1 time/week: aOR = 2.465, 95% CI: 1.130–5.375), possibly reflecting BPF's use in certain epoxy coatings for food containers or beverage packaging. Conversely, coffee intake was negatively associated with high BPAF exposure (aOR = 0.118, 95% CI: 0.016–0.874), the reasons for which warrant further investigation but may relate to consumption habits or beverage components affecting metabolism. Limited Associations with Non-Dietary Pathways In contrast to dietary intake, non-dietary pathways showed minimal associations in our analysis. The frequency of using personal care products (shampoo, cosmetics, detergents) showed no consistent significant correlation with any bisphenol compound, except for weak negative correlations between nail polish/whitening cream use and BPS levels (Table 3 ). Similarly, inhalation-related factors, including mosquito repellent/air freshener use and indoor activity duration, showed no significant correlations with serum bisphenol concentrations (Table 4 ). This lack of association does not completely negate the relevance of dermal or inhalation routes but suggests that, within this cohort and based on our assessment methods, their contribution to internal exposure may be substantially lower than that of dietary intake. Potential explanations include limitations in self-reported frequency data, variability in dermal absorption efficiency, or relatively lower environmental air concentrations of these compounds compared to dietary loading. Table 3 Correlation between Frequency of Personal Care Product Use during Pregnancy and Bisphenol Levels Personal Care Product Use during Pregnancy BPAF BPS BPF BPA BPs Shampoo 0.026 0.053 0.011 0.02 0.024 Hair dye -0.02 0.003 0.02 0.01 0.027 Cold wave lotion -0.032 -0.019 0.04 0.008 0.03 Lipstick -0.032 0.004 0.022 0.005 0.016 Nail polish 0.001 − .060* -0.036 0.026 -0.006 Hair styling products -0.012 0.031 0.018 0.019 0.021 Whitening cream 0.016 − .057* 0.029 0.002 0.014 Detergents -0.034 -0.029 0.006 -0.052 -0.025 Disinfectants -0.019 -0.004 0.002 0.025 0.03 Note : Bisphenol levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * P < 0.05, ** P < 0.01. The frequency of use for personal care products was categorized into four levels: For shampoo, the levels were ≥ once per 3 days, once every 2 days, once daily, and twice daily. For hair dye and cold wave lotion, the levels were almost never, once every six months, once every two months, and once monthly. For all other products, the levels were almost never, once per week, several times per week, and daily. Table 4 Correlation between Frequency of Inhalation-Related Exposures during Pregnancy and Bisphenols Levels Inhalation-Related Exposure during Pregnancy BPAF BPS BPF BPA BPs Frequency of mosquito repellent use -0.033 0.039 -0.013 -0.019 -0.012 Frequency of air freshener use -0.025 0.001 -0.018 0.021 -0.001 Duration of continuous office work -0.049 -0.042 -0.001 0.025 0.013 Mainly staying indoors on rest days 0.019 -0.01 0.021 0.022 0.026 Note : Bisphenol levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * P < 0.05, ** P < 0.01. The frequency of mosquito repellent and air freshener use was categorized as: almost never, once per week, several times per week, and daily. Implications for Risk Assessment and Public Health The widespread co-exposure to BPA and its substitutes, particularly the high detection rates of BPS and BPAF, highlights a critical public health issue. Toxicological studies indicate that these analogs, such as BPS and BPAF, also exhibit endocrine-disrupting properties, with potencies comparable to BPA in some assays (M. Huang, Liu, Fu, Jiang, & Yang, 2020 ; Ullah et al., 2018 ). Therefore, the health implications of this mixed exposure profile, especially for pregnant women and fetal development, require urgent attention. Our study clearly identifies dietary intake—specifically of pork, poultry, and eggs—as the dominant and modifiable exposure pathway for BPA and total bisphenols. This provides a direct target for intervention. Prenatal health education should emphasize practical strategies to reduce exposure, such as encouraging consumption of fresh, minimally processed foods, reducing the use of plastic containers for storing or heating food (particularly fatty foods), and advocating for alternatives to canned goods where possible. Limitations and Future Directions Several limitations should be considered. The cross-sectional design precludes causal inference between dietary habits and bisphenol levels. Self-reported data are subject to recall bias. Serum concentrations represent an integrated measure of exposure, metabolism, and excretion, which may attenuate associations with specific transient exposures. Finally, the single-region cohort may limit generalizability. Future longitudinal studies with repeated biomonitoring, coupled with detailed environmental and dietary sampling, are needed to confirm these pathways, elucidate temporal dynamics, and identify precise contamination sources in the food chain. Conclusion This cohort study demonstrates that pregnant women in the study region are widely exposed to a mixture of BPA and its major substitutes (BPS, BPF, BPAF). Dietary intake is the dominant exposure pathway, with pork, poultry, and eggs identified as significant dietary sources associated with elevated internal levels of BPA and total bisphenols. Exposure profiles differ across analogs, implying distinct environmental sources. These findings underscore the importance of targeted dietary interventions to reduce bisphenol exposure in this vulnerable population and highlight the necessity for ongoing surveillance and health risk assessment that accounts for mixed exposures to bisphenol analogs. Declarations Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics Approval The authors declare that they have strictly followed all the valid national rules and ethical principles for vertebrate research approved by the Ethics Committee of Anhui Medical University (No. 20180081) and the Ethics Committee of Wuhu Maternity and Child Health Care Hospital (No. 20220003).. Authors’ contributions Zhao-hui Huang, An-hui Zhang contributed to conceptualization, writing—review and editing, funding acquisition and project administration. Min Zhu, Qian Zhai, Lian-jie Dou contributed to investigation, methodology, data curation. Jin-yu Mei contributed to conceptualization, supervision, resources, project administration, writing – review & editing. Data availability All data supporting the findings of the present study is available from the corresponding author on reasonable request. Acknowledgments The authors acknowledge all the participants and staff involved in the study. Funding for this work was provided by grants from the "Maternal and Infant Nutrition and Health Research Project" of the Maternal and Child Health Center of the Chinese Center for Disease Control and Prevention (2022FYH019) . References Braun JM, Kalkbrenner AE, Just AC, Yolton K, Calafat AM, Sjödin A, Lanphear BP (2014) Gestational exposure to endocrine-disrupting chemicals and reciprocal social, repetitive, and stereotypic behaviors in 4- and 5-year-old children: the HOME study. Environ Health Perspect 122(5):513–520. https://doi.org/10.1289/ehp.1307261 Braun JM, Lanphear BP, Calafat AM, Deria S, Khoury J, Howe CJ, Venners SA (2014) Early-life bisphenol a exposure and child body mass index: a prospective cohort study. 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Chemosphere 209:508–516. https://doi.org/10.1016/j.chemosphere.2018.06.089 Vrachnis N, Loukas N, Vrachnis D, Antonakopoulos N, Zygouris D, Kοlialexi A, Iliodromiti Z (2021) A Systematic Review of Bisphenol A from Dietary and Non-Dietary Sources during Pregnancy and Its Possible Connection with Fetal Growth Restriction: Investigating Its Potential Effects and the Window of Fetal Vulnerability. Nutrients 13(7). https://doi.org/10.3390/nu13072426 Wang H, Gao R, Liang W, Wei S, Zhou Y, Wang Z, Zeng F (2023) Large-scale biomonitoring of bisphenol analogues and their metabolites in human urine from Guangzhou, China: Implications for health risk assessment. Chemosphere 338:139601. https://doi.org/10.1016/j.chemosphere.2023.139601 Williams K, Puvvula J, Holmes JH, Yang W, Veasey S, Liu J, Chen A (2025) Associations Between Gestational Polybrominated Diphenyl Ether (PBDE) Serum Concentrations and Child Sleep Outcomes from Ages 2 to 8 Years. Environ Res 122756. https://doi.org/10.1016/j.envres.2025.122756 Zhou J, Chen XH, Zhang DD, Jin MC, Zhuang L, Du Y (2022) Determination of multiple bisphenol analogues and their metabolites in human serum by liquid chromatography tandem mass spectrometry. Environ Pollut 312:120092. https://doi.org/10.1016/j.envpol.2022.120092 Supplementary Files Sup1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 Apr, 2026 Reviewers invited by journal 11 Apr, 2026 Editor assigned by journal 11 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8837774","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589547848,"identity":"ea31f7c7-59a8-4cb4-9ee9-e60d913bfa30","order_by":0,"name":"Zhao-hui Huang","email":"","orcid":"","institution":"Anhui provincial center for women and child health","correspondingAuthor":false,"prefix":"","firstName":"Zhao-hui","middleName":"","lastName":"Huang","suffix":""},{"id":589547852,"identity":"897c505b-a3a4-448f-91b9-9a1b5fed5ceb","order_by":1,"name":"An-hui Zhang","email":"","orcid":"","institution":"Wuhu maternal and child health care hospital","correspondingAuthor":false,"prefix":"","firstName":"An-hui","middleName":"","lastName":"Zhang","suffix":""},{"id":589547855,"identity":"30d55f41-ab62-4767-8c3e-3f07f9b508bc","order_by":2,"name":"Min Zhu","email":"","orcid":"","institution":"Wuhu maternal and child health care hospital","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Zhu","suffix":""},{"id":589547861,"identity":"cdf180cf-1134-4333-8237-2193e75c0346","order_by":3,"name":"Qian Zhai","email":"","orcid":"","institution":"Anhui provincial center for mother and child health","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Zhai","suffix":""},{"id":589547865,"identity":"656a07bd-6faa-49da-adbf-b57a8bd6b1ff","order_by":4,"name":"Lianjie Dou","email":"","orcid":"","institution":"Anhui Provincial CDC: Anhui Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Lianjie","middleName":"","lastName":"Dou","suffix":""},{"id":589547867,"identity":"e7e34868-fc81-4bc2-a3d6-a39e7d8ee102","order_by":5,"name":"Jinyu Mei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACxgaDBCDFz8AD5RKtRbKBeC1QYHCAWC267c0NBQ93HE7cfPzs0c08DDayGw4wP3uAT4vZmYMNBolnDiduO5OXdpuHIc14wwE2cwO8Wm4kArW0AbUcyDEDajmcuOEAD5sEXi33H0K0bO5/A9LynwgtNxghWjZIgG05QISWM2CHpRvPuPHG7OYcg2TjmYfZzPBrOX78meHPNmvZ/v4csxtvKuxk+443P8OrBQjYgOHTDGWDgoqZgHqQkgcMDHWElY2CUTAKRsHIBQDKcVIK75dQ0gAAAABJRU5ErkJggg==","orcid":"","institution":"Second Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jinyu","middleName":"","lastName":"Mei","suffix":""}],"badges":[],"createdAt":"2026-02-10 07:27:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8837774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8837774/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102962335,"identity":"4e589c64-33e2-4b8c-a235-d4b5c7e0830a","added_by":"auto","created_at":"2026-02-19 04:07:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1072046,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8837774/v1/00a84de4-d9a9-4f3e-81b4-02a110959818.pdf"},{"id":102755641,"identity":"622fe9bc-c0dc-46a4-8285-0f4716093a59","added_by":"auto","created_at":"2026-02-16 09:45:06","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":25750,"visible":true,"origin":"","legend":"","description":"","filename":"Sup1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8837774/v1/6f11702c535346b0c0d3b8e4.docx"}],"financialInterests":"","formattedTitle":"Dominant Pathways of Bisphenol Compound Exposure among Pregnant Women: A Cohort-Based Assessment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBisphenols (BPs) constitute a prevalent class of endocrine-disrupting chemicals (EDCs), with human exposure occurring through multiple routes, including oral ingestion, dermal contact, and inhalation. Their widespread presence in human biological matrices\u0026mdash;such as urine, serum, breast milk, and cord blood\u0026mdash;underscores pervasive and continuous environmental exposure(Lee et al., 2018; Zhou et al., 2022). Structurally, BPs exhibit hormone-like activity, primarily functioning as estrogen receptor agonists or androgen receptor antagonists, thereby interfering with normal endocrine signaling. Among them, bisphenol A (BPA), the most historically manufactured and extensively utilized analog, has been widely studied. Accumulating evidence indicates that BPA exerts multi-system biological toxicity, with particular concern directed toward its neurodevelopmental effects. Epidemiological and experimental studies suggest that maternal BPA exposure during pregnancy may disrupt neurobehavioral development in offspring and is associated with an increased risk of behavioral disorders, including depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD)-like behaviors(Braun, Kalkbrenner, et al., 2014; Casas et al., 2015; Lin, Lee, Chuang, \u0026amp; Shih, 2023; Pan et al., 2019; Williams et al., 2025). In light of these documented health risks, regulatory measures in many countries have restricted BPA use in certain consumer products, leading to the rapid adoption of structural analogs as replacements. Bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF) have emerged as common substitutes in plastics, food packaging, and other commercial applications (Czarny-Krzymińska, Krawczyk, \u0026amp; Szczukocki, 2023; Wang et al., 2023). However, while toxicological and exposure data on BPA are substantial, the human exposure pathways and health implications of these substitutes remain poorly characterized. Pregnant women represent a particularly vulnerable population due to physiological changes and the potential for transplacental and lactational transfer of contaminants, which may affect fetal and infant development.\u003c/p\u003e\n\u003cp\u003eImportantly, recent studies highlight that human exposure to bisphenols is not uniform across analogs and may involve complex metabolic and excretion patterns. For instance, while BPA is predominantly excreted as glucuronide conjugates, BPF is mainly sulfated, and BPS and BPAF often remain in free forms\u0026mdash;a factor that complicates exposure assessment and risk evaluation if conjugation efficiency is not considered. Furthermore, sex-specific differences in metabolism and exposure have been reported, emphasizing the need for demographic-specific analyses(England-Mason et al., 2024; Singh et al., 2024). Despite these advances, systematic evaluation of primary exposure pathways and source-specific contributions among pregnant women remains limited, particularly in population-based cohorts.\u003c/p\u003e\n\u003cp\u003eTo address these knowledge gaps, this study utilized data from a Chinese birth cohort to: (1) quantify internal exposure levels of BPA and its major substitutes (BPS, BPF, BPAF) in pregnant women using advanced biomonitoring; (2) identify dominant exposure pathways through integrated questionnaire-based exposure assessment and chemical analysis; and (3) assess potential health risks based on established safety thresholds. The findings are expected to provide a scientific basis for developing targeted exposure-reduction strategies, refining risk assessment frameworks, and informing public health policies for this sensitive subpopulation.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThis study employed a cohort design, with participants drawn from the Wuhu Birth Cohort Study in Anhui Province, China(Dou et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Inclusion criteria were: confirmed pregnancy; intention to continue the pregnancy to delivery; plan to deliver locally; willingness to cooperate with follow-up. Exclusion criteria included: unwillingness to participate; presence of significant mental illness or other severe organic diseases; occurrence of spontaneous abortion, stillbirth, or fetal death; pre-pregnancy diagnosis of diabetes or hypertension. The study protocol was approved by the Ethics Committee of Anhui Medical University (No. 20180081) and the Ethics Committee of Wuhu Maternity and Child Health Care Hospital (No. 20220003). The study was conducted in strict accordance with relevant ethical principles and regulations, and all participants provided written informed consent.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eSurvey Methods\u003c/h3\u003e\n\u003cp\u003eDuring the second-trimester prenatal check-up, a self-designed Maternal and Infant Health Record Form was used to collect information. The form included: 1) General maternal demographics; 2) Frequency of use of daily life products during weeks 14–27 of pregnancy (covering 11 items: shampoo, hair dye, cold perm lotion, lipstick, nail polish, hair styling products, whitening cream, mosquito repellent/mosquito coil, air freshener, detergents [dishwashing liquid, laundry detergent], disinfectants [hand sanitizer, disinfectant solution]. Usage frequency was categorized into 4 levels); 3) Dietary frequency in the week preceding sample collection (covering 20 food items: rice, wheat products, fresh vegetables, fresh fruits, beef/lamb, pork, poultry, fish/shrimp and other aquatic products, eggs, dairy products, legumes and their products, nuts [e.g., walnuts, peanuts], fried foods, pickled vegetables/salted cabbage, animal offal, garlic, tea [brewed, not bottled iced tea], coffee, cola, milk tea. Frequency was categorized into 5 levels); 4) Indoor activity duration, including continuous office work hours on workdays and time spent primarily indoors on rest days.\u003c/p\u003e \u003cp\u003eDuring the first-trimester check-up, the same investigator used the same equipment to measure maternal height (to the nearest 0.1 cm) and weight (to the nearest 0.1 kg). Pre-pregnancy weight was self-reported. Pre-pregnancy Body Mass Index (BMI) was calculated as: pre-pregnancy weight (kg) / height (m)². Pre-pregnancy BMI was categorized as: underweight (BMI \u0026lt; 18.5), normal weight (18.5 ≤ BMI \u0026lt; 23.9), overweight/obese (BMI ≥ 24).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eQuantification of Serum Bisphenols\u003c/h2\u003e \u003cp\u003eDaily, research team members collected leftover serum samples from the hospital laboratory after routine clinical tests. Samples were matched with cohort participant information, then aliquoted into 1.5 mL polypropylene cryovials and stored at -20°C in a biobank. This method utilized residual clinical samples, enhancing resource efficiency. Concentrations of BPA, BPAF, BPS, and BPF in maternal serum were determined using a validated method based on liquid-liquid extraction coupled with ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), as previously described(Dou et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Z. Huang et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Briefly, serum samples (200 µL) were spiked with stable isotope-labeled internal standards (¹³C-labeled BPA, BPS, BPF, BPAF) and extracted. Chromatographic separation was achieved on a Shimadzu Nexera X2 UHPLC system with an Agilent ZORBAX SB-Phenyl column, coupled to an AB SCIEX Triple Quad 5500 mass spectrometer operated in negative electrospray ionization mode. Quantification employed matrix-matched calibration curves with a weighting factor of 1/x². The method detection limits (MDL, S/N = 3) were 66.67 pg/mL for BPA, 0.83 pg/mL for BPAF, 1.67 pg/mL for BPS, and 33.33 pg/mL for BPF. Values below the MDL were imputed as MDL/√2(Kim et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Comprehensive quality assurance/quality control (QA/QC) procedures were implemented, including the analysis of procedural blanks, matrix-spiked quality control samples (with mean recoveries of 91.89-100.23% and precision RSDs \u0026lt; 7.57%), and assessment of matrix effects (94.77-100.29%). Full methodological details, including instrumental parameters, complete QA/QC data, and the step-by-step protocol, are provided in \u003cb\u003eSupplementary Material 1.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using IBM SPSS Statistics 22.0. Comparisons of categorical variables between groups were conducted using the Pearson chi-square test. For comparisons of means across multiple groups for continuous variables, analysis of variance (ANOVA) was used. Spearman rank correlation analysis was employed to assess the bivariate associations between exposure variables (dietary frequency, product use frequency) and serum bisphenol concentrations (Z-score transformed). To identify factors associated with high bisphenol exposure (defined as concentrations above the 75th percentile for each compound), multivariate binary logistic regression models were constructed. Variables with P \u0026lt; 0.1 in univariate analysis were included in the initial model (Model a), and a subsequent model (Model b) was adjusted for potential confounders: maternal age, household income, education level, and pre-pregnancy BMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A two-sided P-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Results and Discussion","content":"\u003ch2\u003eInternal Exposure to Bisphenol Compounds among Pregnant Women\u003c/h2\u003e\u003cp\u003eBisphenol A (BPA) and its substitutes, including bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF), are known endocrine-disrupting chemicals with potential impacts on fetal neurodevelopment and other health outcomes (Braun, Kalkbrenner, et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Braun, Lanphear, et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Lin et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In this cohort of 1,258 pregnant women, mixed exposure to bisphenols was prevalent. BPS was detected in all serum samples (100%), followed by BPAF (98.9%), BPF (84.0%), and BPA (85.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The median concentration was highest for BPA (238.8 ng/g), with a maximum level reaching 7796.0 ng/g, indicating potential for sporadic high-level exposure. BPF showed the next highest median concentration (108.2 ng/g), while BPS and BPAF levels were comparatively lower. The near-ubiquitous detection of BPS and BPAF alongside BPA reflects a shifting exposure landscape in the post-BPA-restriction era, underscoring the need for risk assessments that consider mixed exposures (Braun, Kalkbrenner, et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Braun, Lanphear, et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Chen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lin et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rochester \u0026amp; Bolden, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetection Results of Bisphenols in Pregnant Women (ng/g)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBisphenols\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003eDetection frequency\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c4\" style=\"text-align: left;\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c5\" style=\"text-align: left;\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c6\" style=\"text-align: left;\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBPAF\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e98.9\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003e\u0026lt;LOD\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c4\"\u003e \u003cp\u003e110.8\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBPS\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c4\"\u003e \u003cp\u003e369.8\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBPF\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003e\u0026lt;LOD\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c4\"\u003e \u003cp\u003e1302.2\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c5\"\u003e \u003cp\u003e165.0\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c6\"\u003e \u003cp\u003e108.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBPA\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e85.1\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003e\u0026lt;LOD\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c4\"\u003e \u003cp\u003e7796.0\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c5\"\u003e \u003cp\u003e497.4\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c6\"\u003e \u003cp\u003e238.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eΣBPs\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c3\" style=\"text-align: left;\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c4\"\u003e \u003cp\u003e7947.9\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c5\"\u003e \u003cp\u003e700.0\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c6\"\u003e \u003cp\u003e445.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\n\u003ch3\u003eDominant Exposure Pathways Identified for Bisphenols\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDietary Intake as the Primary Route\u003c/h2\u003e \u003cp\u003eSpearman correlation and multivariate logistic regression analyses consistently identified dietary intake as the dominant exposure pathway for bisphenols, particularly for BPA and total bisphenols (ΣBPs). Consumption frequency of pork (r\u0026thinsp;=\u0026thinsp;0.101, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for BPA) and fresh vegetables (r\u0026thinsp;=\u0026thinsp;0.078, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for BPA and ΣBPs) in the past week showed significant positive correlations with serum levels (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Logistic regression confirmed strong associations: pregnant women consuming pork 4\u0026ndash;8 times per week had 2.8-fold higher odds (aOR\u0026thinsp;=\u0026thinsp;2.806, 95% CI: 2.031\u0026ndash;3.877) of high BPA exposure compared to those consuming it \u0026le;\u0026thinsp;3 times per week (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e). High poultry consumption (\u0026gt;\u0026thinsp;9 times/week) was also associated with elevated BPA (aOR\u0026thinsp;=\u0026thinsp;1.755, 95% CI: 1.064\u0026ndash;2.895) and ΣBPs exposure. These findings align with the extensive use of bisphenols in food-contact materials like plastic packaging and epoxy resin can linings, where animal-derived foods may become contaminated during processing, storage, or via bioaccumulation (Liao \u0026amp; Kannan, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Vrachnis et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A recent study in elderly Chinese also reported a positive correlation between blood BPA and meat intake (Duan et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), supporting our results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between Dietary Frequency in the Past Week and Bisphenols Levels\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietary Item in the Past Week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBPAF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBPF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBPA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΣBPs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWheat and its products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.078**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.078**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh fruits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeef/Mutton\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.101**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.079**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoultry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFish/Shrimp and other aquatic products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEggs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.057*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.078**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDairy products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegumes and their products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.060*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuts (e.g., walnuts, peanuts)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFried foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePickled vegetables/Salted cabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnimal offal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGarlic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTea (brewed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.067*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCola\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ev\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-0.066*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-0.077**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: Bisphenols levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** P\u0026thinsp;\u0026lt;\u0026thinsp;0.01. Dietary frequency in the past week was categorized into five levels: none, 1\u0026ndash;3 times, 4\u0026ndash;5 times, 6\u0026ndash;8 times, and \u0026gt;\u0026thinsp;9 times.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis Results of Pathways Associated with High Bisphenols Exposure during Pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e总人数\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e高水平占比(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e(95%\u003cem\u003eCI\u003c/em\u003e)a\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e(95%\u003cem\u003eCI\u003c/em\u003e)b\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPAF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoffee intake frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;1 time/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.112(0.015,0.831)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.118(0.016,0.874)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEgg intake frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.345(0.913,1.981)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.402(0.948,2.074)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.449(1.018,2.064)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.517(1.058,2.174)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWheat product intake frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.541(1.136,2.092)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.524(1.123,2.07)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.111(0.802,1.538)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.088(0.784,1.508)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoffee intake frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 time/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.436(1.121,5.297)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.465(1.13,5.375)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePork consumption frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.806(2.031,3.877)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.806(2.031,3.877)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.414(0.955,2.092)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.414(0.955,2.092)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePoultry consumption frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.762(0.536,1.084)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.762(0.536,1.084)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.755(1.064,2.895)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.755(1.064,2.895)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΣBPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePork consumption frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.914(1.396,2.623)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.913(1.394,2.625)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.219(0.836,1.778)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.219(0.836,1.779)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePoultry consumption frequency in the past week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.897(0.635,1.268)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.904(0.639,1.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;9 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.798(1.089,2.968)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.748(1.056,2.891)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e: a Variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analysis were included; b: Adjusted for maternal age, household income, educational level, and pre-pregnancy BMI. High-level exposure was defined as a concentration above the 75\u003csub\u003eth\u003c/sub\u003e percentile for each bisphenol compound. \u003cem\u003eOR\u003c/em\u003e: odds ratio; \u003cem\u003eCI\u003c/em\u003e: confidence interval. * \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eExposure pathways differed among bisphenol analogs, suggesting distinct contamination sources. High BPS exposure was significantly associated with egg consumption (\u0026gt;\u0026thinsp;9 times/week: aOR\u0026thinsp;=\u0026thinsp;1.517, 95% CI: 1.058\u0026ndash;2.174). Given BPS's common use in thermal paper (e.g., receipts), this association may indicate hand-to-mouth transfer after handling such materials, which could contaminate food items like eggs during handling or packaging(Liao et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). High BPF exposure was linked to wheat product intake (4\u0026ndash;8 times/week: aOR\u0026thinsp;=\u0026thinsp;1.524, 95% CI: 1.123\u0026ndash;2.070) and coffee consumption (\u0026ge;\u0026thinsp;1 time/week: aOR\u0026thinsp;=\u0026thinsp;2.465, 95% CI: 1.130\u0026ndash;5.375), possibly reflecting BPF's use in certain epoxy coatings for food containers or beverage packaging. Conversely, coffee intake was negatively associated with high BPAF exposure (aOR\u0026thinsp;=\u0026thinsp;0.118, 95% CI: 0.016\u0026ndash;0.874), the reasons for which warrant further investigation but may relate to consumption habits or beverage components affecting metabolism.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLimited Associations with Non-Dietary Pathways\u003c/h3\u003e\n\u003cp\u003eIn contrast to dietary intake, non-dietary pathways showed minimal associations in our analysis. The frequency of using personal care products (shampoo, cosmetics, detergents) showed no consistent significant correlation with any bisphenol compound, except for weak negative correlations between nail polish/whitening cream use and BPS levels (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Similarly, inhalation-related factors, including mosquito repellent/air freshener use and indoor activity duration, showed no significant correlations with serum bisphenol concentrations (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This lack of association does not completely negate the relevance of dermal or inhalation routes but suggests that, within this cohort and based on our assessment methods, their contribution to internal exposure may be substantially lower than that of dietary intake. Potential explanations include limitations in self-reported frequency data, variability in dermal absorption efficiency, or relatively lower environmental air concentrations of these compounds compared to dietary loading.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between Frequency of Personal Care Product Use during Pregnancy and Bisphenol Levels\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal Care Product Use during Pregnancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBPAF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBPF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBPA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBPs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShampoo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHair dye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCold wave lotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipstick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNail polish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.060*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHair styling products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhitening cream\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.057*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetergents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisinfectants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: Bisphenol levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** P\u0026thinsp;\u0026lt;\u0026thinsp;0.01. The frequency of use for personal care products was categorized into four levels: For shampoo, the levels were \u0026ge;\u0026thinsp;once per 3 days, once every 2 days, once daily, and twice daily. For hair dye and cold wave lotion, the levels were almost never, once every six months, once every two months, and once monthly. For all other products, the levels were almost never, once per week, several times per week, and daily.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between Frequency of Inhalation-Related Exposures during Pregnancy and Bisphenols Levels\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation-Related Exposure during Pregnancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBPAF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBPF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBPA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBPs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of mosquito repellent use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of air freshener use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of continuous office work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMainly staying indoors on rest days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: Bisphenol levels were Z-score transformed. Spearman rank correlation analysis was used for pairwise comparison. * \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. The frequency of mosquito repellent and air freshener use was categorized as: almost never, once per week, several times per week, and daily.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eImplications for Risk Assessment and Public Health\u003c/h3\u003e\n\u003cp\u003eThe widespread co-exposure to BPA and its substitutes, particularly the high detection rates of BPS and BPAF, highlights a critical public health issue. Toxicological studies indicate that these analogs, such as BPS and BPAF, also exhibit endocrine-disrupting properties, with potencies comparable to BPA in some assays (M. Huang, Liu, Fu, Jiang, \u0026amp; Yang, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ullah et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Therefore, the health implications of this mixed exposure profile, especially for pregnant women and fetal development, require urgent attention.\u003c/p\u003e \u003cp\u003eOur study clearly identifies dietary intake\u0026mdash;specifically of pork, poultry, and eggs\u0026mdash;as the dominant and modifiable exposure pathway for BPA and total bisphenols. This provides a direct target for intervention. Prenatal health education should emphasize practical strategies to reduce exposure, such as encouraging consumption of fresh, minimally processed foods, reducing the use of plastic containers for storing or heating food (particularly fatty foods), and advocating for alternatives to canned goods where possible.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e \u003cp\u003eSeveral limitations should be considered. The cross-sectional design precludes causal inference between dietary habits and bisphenol levels. Self-reported data are subject to recall bias. Serum concentrations represent an integrated measure of exposure, metabolism, and excretion, which may attenuate associations with specific transient exposures. Finally, the single-region cohort may limit generalizability. Future longitudinal studies with repeated biomonitoring, coupled with detailed environmental and dietary sampling, are needed to confirm these pathways, elucidate temporal dynamics, and identify precise contamination sources in the food chain.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis cohort study demonstrates that pregnant women in the study region are widely exposed to a mixture of BPA and its major substitutes (BPS, BPF, BPAF). Dietary intake is the dominant exposure pathway, with pork, poultry, and eggs identified as significant dietary sources associated with elevated internal levels of BPA and total bisphenols. Exposure profiles differ across analogs, implying distinct environmental sources. These findings underscore the importance of targeted dietary interventions to reduce bisphenol exposure in this vulnerable population and highlight the necessity for ongoing surveillance and health risk assessment that accounts for mixed exposures to bisphenol analogs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e The authors declare that they have strictly followed all the valid national rules and ethical principles for vertebrate research approved by the Ethics Committee of Anhui Medical University (No. 20180081) and the Ethics Committee of Wuhu Maternity and Child Health Care Hospital (No. 20220003)..\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e Zhao-hui Huang, An-hui Zhang contributed to conceptualization, writing\u0026mdash;review and editing, funding acquisition and project administration. Min Zhu, Qian Zhai, Lian-jie Dou contributed to investigation, methodology, data curation. Jin-yu Mei contributed to conceptualization, supervision, resources, project administration, writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003eAll data supporting the findings of the present study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eThe authors acknowledge all the participants and staff involved in the study. Funding for this work was provided by grants from the \u0026quot;Maternal and Infant Nutrition and Health Research Project\u0026quot; of the Maternal and Child Health Center of the Chinese Center for Disease Control and Prevention (2022FYH019)\u003cu\u003e.\u003c/u\u003e\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBraun JM, Kalkbrenner AE, Just AC, Yolton K, Calafat AM, Sj\u0026ouml;din A, Lanphear BP (2014) Gestational exposure to endocrine-disrupting chemicals and reciprocal social, repetitive, and stereotypic behaviors in 4- and 5-year-old children: the HOME study. 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Environ Pollut 312:120092. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envpol.2022.120092\u003c/span\u003e\u003cspan address=\"10.1016/j.envpol.2022.120092\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-environmental-contamination-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aect","sideBox":"Learn more about [Archives of Environmental Contamination and Toxicology](https://www.springer.com/journal/244)","snPcode":"244","submissionUrl":"https://submission.nature.com/new-submission/244/3","title":"Archives of Environmental Contamination and Toxicology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bisphenols, Pregnant Women, Exposure Assessment, Exposure Pathways","lastPublishedDoi":"10.21203/rs.3.rs-8837774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8837774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBisphenol A (BPA) and its substitutes are widely detected in human populations, raising concerns about their health impacts, particularly for vulnerable groups such as pregnant women. This study aimed to characterize the internal exposure levels of BPA, bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF) among 1,258 pregnant women from the Wuhu Birth Cohort in China and to identify their primary exposure pathways. Serum concentrations were determined using ultra-high-performance liquid chromatography\u0026ndash;tandem mass spectrometry (UHPLC\u0026ndash;MS/MS). Mixed exposure to bisphenols was prevalent, with detection rates of 100% for BPS, 98.9% for BPAF, 84.0% for BPF, and 85.1% for BPA. BPA showed the highest median concentration (238.8 ng/g). Correlation and regression analyses consistently identified dietary intake as the dominant exposure route. Consumption of pork (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;2.806, 95% CI: 2.031\u0026ndash;3.877) and poultry (aOR\u0026thinsp;=\u0026thinsp;1.755, 95% CI: 1.064\u0026ndash;2.895) was significantly associated with elevated BPA exposure risk. Egg intake was related to higher BPS exposure (aOR\u0026thinsp;=\u0026thinsp;1.517, 95% CI: 1.058\u0026ndash;2.174), while wheat product consumption was linked to higher BPF exposure (aOR\u0026thinsp;=\u0026thinsp;1.524, 95% CI: 1.123\u0026ndash;2.070). Dermal contact and inhalation pathways did not show consistent associations with serum bisphenol levels. The results demonstrate widespread co-exposure to BPA and its substitutes in Chinese pregnant women, with diet as a key modifiable exposure pathway. These findings support the need for targeted dietary interventions and underscore the importance of updating health risk assessments to account for mixed bisphenol exposures.\u003c/p\u003e","manuscriptTitle":"Dominant Pathways of Bisphenol Compound Exposure among Pregnant Women: A Cohort-Based Assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:45:02","doi":"10.21203/rs.3.rs-8837774/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-04-19T14:14:27+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-11T21:21:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T10:53:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Environmental Contamination and Toxicology","date":"2026-02-10T02:26:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-environmental-contamination-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aect","sideBox":"Learn more about [Archives of Environmental Contamination and Toxicology](https://www.springer.com/journal/244)","snPcode":"244","submissionUrl":"https://submission.nature.com/new-submission/244/3","title":"Archives of Environmental Contamination and Toxicology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a66003e2-d336-45ae-9d1d-cb4be075615f","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T09:45:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:45:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8837774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8837774","identity":"rs-8837774","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}