Endocrine-disrupting chemicals and gestational weight gain: A systematic review and meta-analysis

Endocrine-disrupting chemicals (EDCs) are widespread environmental contaminants that interfere with hormonal regulation and metabolic homeostasis. Pregnancy is a critical window of susceptibility in which EDCs exposure may affect maternal metabolism and gestational weight gain (GWG), a key determinant of maternal and fetal health. This systematic review and meta-analysis synthesized epidemiological evidence on the association between maternal EDCs exposure and GWG and evaluated compound-specific patterns and sources of heterogeneity across studies.Following PRISMA guidelines, eligible observational studies published before June 2025 were identified and included if they assessed maternal exposure to EDCs and GWG outcomes. Random-effects meta-analyses were conducted for EDCs assessed in ≥ 3 independent cohorts, estimating pooled standardized mean differences (SMD). Heterogeneity, publication bias, and subgroup analyses by pre-pregnancy Body Mass Index (BMI) were examined.Twenty-one studies involving 74,077 pregnant women were included in the qualitative synthesis, and nine met criteria for quantitative analysis. Phthalate exposure was significantly and positively associated with GWG (SMD = 1.43, 95% CI = 0.38–2.47, p = 0.008), while PFAS exposure showed no consistent relationship (SMD = 0.08, 95% CI = -0.48-0.64, p = 0.78). Substantial heterogeneity was observed largely attributable to differences in study design, biospecimens, and exposure assessment. No significant modification by maternal BMI was detected.Our findings suggest that exposure to specific EDCs, particularly phthalates, may contribute to excessive GWG, supporting their role as metabolic disruptors during pregnancy. However, longitudinal and multi-matrix exposure assessments are needed to clarify causal pathways linking EDC exposure to maternal weight regulation and metabolic health.