# Maternal-Foetal Effects of Exposure to Bisphenol A: Outcomes and Long-Term Consequences
## 3 Endocrine Disruptors Exposures in Foetal Development  
Foetal development is due to the interaction between maternal, placental and foetal factors, and small alterations in this complex maternal-foetal balance can cause various pathologies in both mother and foetus.  
Maternal nutrition is directly related to foetal development and has been shown to be a major factor in this relationship many years ago. The quantity and quality of this  
\begin{table}
\begin{tabular}{c c} \hline \hline  & \"fetal exposure\" \\  & \"fetal exposure\" AND \"immune system\" \\ \"Bisphenol A\" & \"fetal exposure\" AND \"obesity\" OR \"metabolic \\ OR & \"disorder\" OR \"diabetes\" \\ \"BPA\" & \"fetal exposure\" AND \"fetal growth restriction\" \\  & \"fetal exposure\" AND \"urogenital\" \\  & \"pregnancy\" OR \"gestational\" AND \\  & \"preeclampsia\" \\  & \"pre-term birth\" \\ \hline \hline \end{tabular}
\end{table}
Table 1: Terms used for the PubMed and Scopus online databases.  
Figure 1: Flow diagram of the literature review process.  
nutrition are now fundamental parameters for a healthy pregnancy and are already part of the daily routine of medical surveillance. On the other hand, maternal diseases (such as diabetes and hypertension) and/or the mother's bad lifestyle habits (smoking, alcohol and drugs) and/or the use of therapeutic medication (hypertensive, endocrine) can lead to alterations in foetal development and growth [12,13].  
Several exogenous chemicals are found in the environment and in daily products and have the ability to disrupt the normal functioning of the endocrine system. For this reason, they are called endocrine-disrupting chemicals (EDCs). Thus, EDCs are exogenous chemicals or mixtures of chemicals that can interfere with any aspect of endogenous hormonal signalling, affecting not only the synthesis, release and transport of hormones but also their cellular metabolism, binding and elimination [14,15]. In other words, these compounds can mimic endogenous hormones and thus act on the endocrine system as agonists or antagonists of specific hormone receptors, interfering with the production, release, metabolism, elimination and/or mechanisms of action of hormones.  
EDCs are a highly heterogeneous group of compounds, ranging from synthetic chemicals to certain naturally occurring constituents of some plants. In addition, EDCs are ubiquitous in the environment, which means that humans are constantly exposed to them through a variety of routes, including ingestion, dermal absorption, inhalation and maternal-foetal transfer. As mentioned above, human exposure to these compounds at very different concentrations can lead to adverse health effects, including effects on the reproductive system, inflammation, the respiratory system, the endocrine system, the metabolism and the cardiovascular system. These exposures are of particular relevance during pregnancy, as the biological changes characteristic of pregnancy may increase susceptibility to such exposures [3,16].  
In this sense, pregnancy is a unique period characterised by hormone-mediated events that act in a highly coordinated manner. These hormones induce physiological changes to prepare the woman for the development of the foetus, lactation and childbirth. These physiological changes include metabolic, renal, digestive, immunological, endocrine and cardiovascular adaptations. Footplacental vascular function is often altered, increasing the risk of pregnancy-related complications and predisposing the foetus to adverse health outcomes later in life. Nevertheless, most EDCs remain poorly studied and, therefore, require further investigation concerning their exposure to toxicological effects linked to health, especially in pregnant women. Among EDCs, BPA has been associated with several adverse effects in human physiological systems, with increased concern for the susceptible populations, such as pregnant women and developing foetuses.