# Maternal-Foetal Effects of Exposure to Bisphenol A: Outcomes and Long-Term Consequences
## 5 Maternal-Foetal Effects of BPA
### Foetal Reproductive Function  
Current scientific evidence suggests that prenatal exposure to BPA is associated with alterations in reproductive function. Data obtained from animal models show that foetal exposure to BPA increases the risk of developing hypospadias, cryptorchidism and histological changes in the foetal testicle. These effects seem to be related to the central and peripheral alteration of hormonal homeostasis, leading to the inhibition of the proper development of the male genital tract [52]. Regarding the female reproductive system, in vivo and experimental studies have reported that BPA affects its normal function as well as the endocrine glands and hormone receptors [53]. As a sensitive biomarker of the foetal hormonal environment and an extensively used measurement of reproductive toxicity in animals, the anogenital distance (AGD) has also been analysed in epidemiological studies [54; 55]. Three different studies aimed to investigate the connection between BPA exposure during pregnancy and progeny's AGD [54; 55; 56]. BPA levels were measured in first-trimester urine samples from pregnant women who gave birth to girls, and after birth, the offspring's AGD was assessed. Greater exposure to BPA was found to be associated with a shorter AGD, suggesting that BPA may alter the hormonal environment of the female foetus [54]. On the other hand, [PERSON] et al. and [PERSON] et al. found a similar association, but only in boys. In the study conducted by [PERSON] and co-workers, BPA levels were also quantified in maternal urine, and the shortened AGD was measured in both boys and girls at birth, 6 and 12 months, with a significant association at this last timepoint for boys only [56]. Differently, [PERSON] et al. quantified BPA levels in cord blood and measured the AGD distance of healthy newborns up to three days of age. The results showed that a shorter AGD distance (from the anus to the base of the scrotum) was found in male newborns with increased BPA levels [55]. Overall, these studies show a positive association between BPA exposure and AGD distance, and there seems to be a gender-specific effect. Although the study by [PERSON] et al. also demonstrated this association, it was only carried out on girls and had no basis for comparison with male AGD distance. Possibly, this effect is more prominent in boys, but further investigations are needed to better understand BPA effects. Besides alterations at birth, maternal exposure to BPA may affect the reproductive system during growth, from adolescence to adulthood. In this regard, [PERSON] and co-workers investigated the effects of in utero and peripubertal BPA exposure on female sexual maturation and hormone concentrations; however, no associations were found [57]. Regarding the male reproductive function, a higher in utero exposure to BPA was related to increased luteinising hormone (LH) levels and a compensated reduced Leydic cell function in adulthood [58], while [PERSON] et al. found a connection with sperm concentration and motility [59]. Even though these two studies show alterations in different parameters of male reproduction, we can assume that prenatal exposure to BPA can, in fact, affect the male reproductive function in adulthood. It is important to bear in mind that people are simultaneously exposed to several EDCs in addition to BPA, and for example, it has already been shown that phthalates also promote changes in AGD distance, sexual hormone levels, sexual maturation. Thus, the results, summarized in Table 4, from these studies must be interpreted with caution since this may be a result of a mixed exposure. In this sense, using data from the Environment and Reproductive Health (EARTH) Study, [PERSON] et al. and [PERSON] et al. quantified urinary BPA concentration before conception in both women and men and analysed the risk of preterm birth.