Association between Endocrine Disruptors and Surgical Congenital Malformations: Systematic Review and Meta-Analysis
Abstract
BACKGROUND
Prenatal exposure to endocrine disruptors (EDs) represents a growing public health concern due to its potential association with congenital malformations requiring pediatric surgical intervention. The ubiquity of these chemicals in modern environments and their ability to interfere with normal hormonal development during critical fetal windows raises significant concerns for pediatric surgeons. This systematic review was registered prospectively in PROSPERO (CRD420251158778).
METHODS
We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Web of Science, and gray literature from 2010-2025 for observational studies evaluating prenatal exposure to phthalates, bisphenols, perfluorinated compounds (PFAS), and organochlorines, with outcomes of surgical congenital malformations. Quality was assessed using the Newcastle-Ottawa Scale and GRADE methodology. Random-effects meta-analysis was performed using R software.
RESULTS
Of 4,121 studies identified, 66 met inclusion criteria (total population: 35,732). According to the Newcastle-Ottawa Scale, 42 studies (64%) had high quality (≥7 points), 18 (27%) moderate quality (5-6 points), and 6 (9%) low quality (<5 points). Significant associations were found between ED exposure and hypospadias (pooled OR: 2.21, 95% CI: 1.15-3.27; I2=65.4%, p=0.003), cryptorchidism (OR: 1.85, 95% CI: 1.02-3.36; I2=58.2%, p=0.041), and congenital heart disease (OR: 1.39, 95% CI: 1.09-1.76;…
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