# Maternal-Foetal Effects of Exposure to Bisphenol A: Outcomes and Long-Term Consequences
## 5 Maternal-Foetal Effects of BPA
### Foetal Reproductive Function
Besides pre-term birth, other parameters, such as foetal growth, size and weight, have also been investigated. In 2021, [PERSON] and colleagues published a study analysing pre-natal exposure to BPA and its alternatives, BPS and BPF. For this, first-morning urine samples were collected from 1197 pregnant women (third trimester) for bisphenol's quantification and compared with foetal growth measurements. Regarding BPA exposure, there was a significant association with decreased birth length, mainly in girls [71]. Resorting to a Dutch population-based prospective cohort, prenatal exposure to BPA was analysed for intrauterine growth effects. For that, urine samples were collected from a total of 219 pregnant women, of whom 99, 40 and 80 had one, two and three measurements of urinary BPA, respectively. Additionally, foetal parameters were measured using ultrasound in the second and third trimesters. The results showed an association between BPA levels and decreased foetal growth, with a reduction in foetal weight and head circumference, significant in the cases of three urinary BPA measurements. As pointed out by the authors, these results highlight the importance of repeated urinary measurements throughout time for more accurate outcomes [72]. Resorting to the same cohort, in a population sample of 1379 mother-child pairs, BPA, BPF and BPS were quantified in all trimesters of pregnancy (one spot urine sample in each trimester) and correlated with foetal growth measures and birth parameters. No associations were found between bisphenol's and foetal size parameters, with only a positive association between BPS and increased foetal head circumference and weight [73]. Spot urine samples collected at three timepoints during pregnancy from 855 women were analysed for bisphenol's levels, and simultaneously foetal' biometry was examined (at 20-, 30- and 36-weeks' gestation) for foetal growth estimation. Overall, bisphenol's were associated with small sex-specific shifts in foetal growth [74]. Additionally, the study conducted by [PERSON] et al. also found a positive sex-specific association between prenatal exposure to BPA and foetal head circumference; however, no associations were found for BPF and BPS exposures. In this case, 322 pregnant women were recruited during late pregnancy (between 36 and 42 weeks) to provide first-morning urine samples for bisphenol's quantification. Foetal birth parameters, including bipartietal diameter, head circumference, femur length and abdominal circumference, were measured to examine foetal growth [75]. In a longitudinal birth cohort, including 788 mother-child pairs in the third trimester, BPA exposure was negatively associated with intrauterine linear growth. BPA was quantified in maternal urine (in the second and third trimesters), and foetal femur length was measured with ultrasound [76]. When analysing foetal growth restriction, two different studies aimed to investigate the connection with maternal BPA exposure [62; 77]. [PERSON] et al. found a positive association between maternal and foetal exposure to BPA and asymmetric foetal growth caused by placenta insufficiency. This study used data from a prospective cohort on the foetal-maternal exposure to endocrine disruptors during the COVID-19 pandemic, specifically information on foetal growth parameters, maternal urine and cord blood samples. Then, quantification of several endocrine disruptors was performed and compared between footuses with and without asymmetric foetal growth restriction (asymmetric growth parameters assessed through the head circumference/abdominal circumference ratio) [62]. From an experimental perspective, [PERSON] and coworkers also analysed how exposure to BPA affected the foetal growth restriction. For that, human placentae from pregnancies diagnosed with and without foetal growth restriction were collected for BPA, oestrogen and breast cancer resistance protein (BCRP) quantification.