{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:11:31Z","timestamp":1777867891896,"version":"3.51.4"},"reference-count":160,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Endocrine-disrupting chemicals (EDCs) are a diverse group of environmental pollutants capable of interfering with hormonal and immune system regulation. In recent years, increasing concern has been raised about the effects of chemicals, including bisphenols, phthalates, per- and polyfluoroalkyl substances (PFAS), insecticides, and parabens, on maternal and fetal health, primarily due to their widespread exposure in human populations. Pregnancy represents a critical window characterized by tightly regulated hormonal and immunological adaptations. Emerging evidence suggests that EDC exposure during this period may alter maternal microbiota, disrupt immune responses, and interfere with endocrine signaling. These changes may increase susceptibility to bacterial and viral infections, including bacterial vaginosis, urinary tract infections, and intrauterine infections, all of which are associated with adverse pregnancy outcomes. This review summarizes the current evidence on the sources and mechanisms of exposure to endocrine disruptors during pregnancy and examines the potential biological pathways linking endocrine disruption to the development of infections. Particular emphasis is placed on the interactions between immune regulation, hormonal signaling, and changes in the microbiome, which may contribute to increased susceptibility to infections. A deeper understanding of these complex mechanisms is critical to improve risk assessment, develop effective public health strategies, and ultimately protect maternal and fetal health in an environment of increasing chemical exposure. A literature search was conducted using PubMed\/MEDLINE, Scopus, and Web of Science, including studies published up to January 2026.<\/jats:p>","DOI":"10.3390\/microorganisms14051012","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:47:28Z","timestamp":1777546048000},"page":"1012","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Endocrine Disruptor Exposure During Pregnancy on Bacterial Complications and Viral Infections: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Sofoklis","family":"Stavros","sequence":"first","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, University General Hospital \u201cATTIKON\u201d, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-3688","authenticated-orcid":false,"given":"Angeliki","family":"Gerede","sequence":"additional","affiliation":[{"name":"Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3036-7212","authenticated-orcid":false,"given":"Nektaria","family":"Zagorianakou","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Health Sciences, University of Ioannina, 4th Kilometer National Highway Str. Ioannina-Athens, 45500 Ioannina, Greece"},{"name":"Scientific Laboratory for Innovative Technologies in Internal Medicine, Preventive Medicine and Overall Care, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3333-2620","authenticated-orcid":false,"given":"Efthalia","family":"Moustakli","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Health Sciences, University of Ioannina, 4th Kilometer National Highway Str. Ioannina-Athens, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-1521","authenticated-orcid":false,"given":"Anastasios","family":"Potiris","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, University General Hospital \u201cATTIKON\u201d, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismini","family":"Anagnostaki","sequence":"additional","affiliation":[{"name":"Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5656-2270","authenticated-orcid":false,"given":"Alexios","family":"Kozonis","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, University General Hospital \u201cATTIKON\u201d, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Tzeli","sequence":"additional","affiliation":[{"name":"Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aikaterini Lydia","family":"Vogiatzoglou","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, University General Hospital \u201cATTIKON\u201d, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavlos","family":"Machairoudias","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-818X","authenticated-orcid":false,"given":"Konstantinos","family":"Zacharis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, General Hospital of Lamia, 35100 Lamia, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9553-6803","authenticated-orcid":false,"given":"Athanasios","family":"Zikopoulos","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine and Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8686-594X","authenticated-orcid":false,"given":"Dimitrios","family":"Loutradis","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Fertility Institute S.A, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-3040","authenticated-orcid":false,"given":"Ekaterini","family":"Domali","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","unstructured":"Feingold, K.R., Ahmed, S.F., Anawalt, B., Blackman, M.R., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., Dungan, K., and Hamilton, E. (2025, September 05). Endocrine disruptor chemicals, Endotext, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK569327\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2564389","DOI":"10.1155\/ije\/2564389","article-title":"Interference mechanisms of endocrine system and other systems of endocrine-disrupting chemicals in cosmetics\u2014In vitro studies","volume":"2024","author":"Zhang","year":"2024","journal-title":"Int. J. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1582-4934.2012.01649.x","article-title":"Molecular mechanism(s) of endocrine-disrupting chemicals and their potent oestrogenicity in diverse cells and tissues that express oestrogen receptors","volume":"17","author":"Lee","year":"2013","journal-title":"J. Cell. Mol. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.nfs.2023.03.004","article-title":"Endocrine-active and endocrine-disrupting compounds in food\u2014Occurrence, formation and relevance","volume":"31","author":"Stiefel","year":"2023","journal-title":"NFS J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1210\/er.2009-0002","article-title":"Endocrine-disrupting chemicals: An Endocrine Society scientific statement","volume":"30","author":"Bourguignon","year":"2009","journal-title":"Endocr. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pan, J., Liu, P., Yu, X., Zhang, Z., and Liu, J. (2024). The adverse role of endocrine disrupting chemicals in the reproductive system. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1324993"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"\u00c2ngelo-Dias, M., Martins, C.G., Mata, M., Barata, M., Chung, A., Sarzedas, S., Fernandes, \u00c9., Appleton, C., Lima, J., and Borrego, L.M. (2025). Immunological reference intervals in pregnancy: Longitudinal analysis of adaptive lymphocyte subsets. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1634176"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fox, R., Akinboro, S., K\u0119dzia, A., and Niechcia\u0142, E. (2025). The effects of maternal endocrinopathies and exposure to endocrine disruptors during pregnancy on the fetus and newborn. Biomedicines, 13.","DOI":"10.3390\/biomedicines13081965"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Predieri, B., Iughetti, L., Bernasconi, S., and Street, M.E. (2022). Endocrine disrupting chemicals\u2019 effects in children: What we know and what we need to learn?. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231911899"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.envint.2019.01.078","article-title":"Immunomodulatory effects of synthetic endocrine disrupting chemicals on the development and functions of human immune cells","volume":"125","author":"Nowak","year":"2019","journal-title":"Environ. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jri.2012.10.015","article-title":"From mice to women: The conundrum of immunity to infection during pregnancy","volume":"97","author":"Krishnan","year":"2013","journal-title":"J. Reprod. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.ogc.2016.07.004","article-title":"Immune regulation in pregnancy: A matter of perspective?","volume":"43","author":"Bonney","year":"2016","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11244","DOI":"10.1038\/s41598-025-95996-7","article-title":"Modulation of immune gene expression profile in Labeo catla with chronic toxicity to emerging endocrine disruptors through a multiorgan approach","volume":"15","author":"Das","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"G\u00e1lvez-Ontiveros, Y., P\u00e1ez, S., Monteagudo, C., and Rivas, A. (2020). Endocrine disruptors in food: Impact on gut microbiota and metabolic diseases. Nutrients, 12.","DOI":"10.3390\/nu12041158"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e0342922","DOI":"10.1128\/spectrum.03429-22","article-title":"The vaginal microbiota of pregnant women varies with gestational age, maternal age, and parity","volume":"11","author":"Romero","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Shen, L.-P., Cai, B.-J., Guan, J.-X., Peng, T., and Jin, L. (2025). Comprehensive analysis of vaginal microbiota, metabolites, and inflammatory factors in preterm and term pregnancies. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1689494"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kumar, M., Saadaoui, M., and Al Khodor, S. (2022). Infections and pregnancy: Effects on maternal and child health. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.873253"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Vlad, T., Eftenoiu, A.-E., Voinescu, A., Musuroi, S.I., Musuroi, C., Moatar, A.E., Vlad, D.C., Trandafir, A., Vlad, C.S., and Cobec, I.M. (2025). Antimicrobial resistance in maternal infections during pregnancy. Biomedicines, 13.","DOI":"10.3390\/biomedicines13040777"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s44298-026-00174-9","article-title":"Mechanistic insights into the impact of prenatal viral infections on maternal and offspring immunity","volume":"4","author":"Salem","year":"2026","journal-title":"npj Viruses"},{"key":"ref_20","first-page":"e83890","article-title":"Endocrine disruptors and their impact on quality of life: A literature review","volume":"17","year":"2025","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e18140","DOI":"10.1016\/j.heliyon.2023.e18140","article-title":"Origin, dietary exposure, and toxicity of endocrine-disrupting food chemical contaminants: A Comprehensive review","volume":"9","author":"Sharifi","year":"2023","journal-title":"Heliyon"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Schjenken, J.E., Green, E.S., Overduin, T.S., Mah, C.Y., Russell, D.L., and Robertson, S.A. (2021). Endocrine Disruptor Compounds\u2014A Cause of Impaired Immune Tolerance Driving Inflammatory Disorders of Pregnancy?. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.607539"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Potiris, A., Daponte, N., Moustakli, E., Zikopoulos, A., Kokkosi, E., Arkouli, N., Anagnostaki, I., Vogiatzoglou, A.L., Tzeli, M., and Sarella, A. (2025). Prenatal dietary exposure to endocrine disruptors and its lasting impact on offspring health. Toxics, 13.","DOI":"10.3390\/toxics13100864"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Di Pietro, G., Forcucci, F., and Chiarelli, F. (2023). Endocrine disruptor chemicals and children\u2019s health. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032671"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Puche-Juarez, M., Toledano, J.M., Moreno-Fernandez, J., G\u00e1lvez-Ontiveros, Y., Rivas, A., Diaz-Castro, J., and Ochoa, J.J. (2023). The role of endocrine disrupting chemicals in gestation and pregnancy outcomes. Nutrients, 15.","DOI":"10.3390\/nu15214657"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Amir, S., Shah, S.T.A., Mamoulakis, C., Docea, A.O., Kalantzi, O.I., Zachariou, A., Calina, D., Carvalho, F., Sofikitis, N., and Makrigiannakis, A. (2021). Endocrine disruptors acting on estrogen and androgen pathways cause reproductive disorders through multiple mechanisms: A review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041464"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101885","DOI":"10.1016\/j.toxrep.2024.101885","article-title":"Endocrine-disrupting chemicals (EDCs) and epigenetic regulation in embryonic development: Mechanisms, impacts, and emerging trends","volume":"14","author":"Akanbi","year":"2025","journal-title":"Toxicol. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"112031","DOI":"10.1016\/j.mce.2023.112031","article-title":"Exposure to endocrine disrupting chemicals impacts immunological and metabolic status of women during pregnancy","volume":"577","author":"Merrill","year":"2023","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"112046","DOI":"10.1016\/j.mce.2023.112046","article-title":"Prenatal exposures to endocrine disrupting chemicals: The role of multi-omics in understanding toxicity","volume":"578","author":"Rabotnick","year":"2023","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1586\/17474108.2013.811939","article-title":"Bisphenol A and human reproductive health","volume":"8","author":"Cantonwine","year":"2013","journal-title":"Expert Rev. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Costa, H.E., Medeiros, I., Mariana, M., and Cairrao, E. (2025). Maternal\u2013foetal effects of exposure to bisphenol A: Outcomes and long-term consequences. Appl. Sci., 15.","DOI":"10.3390\/app15020697"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wang, Y., and Qian, H. (2021). Phthalates and their impacts on human health. Healthcare, 9.","DOI":"10.3390\/healthcare9050603"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"116380","DOI":"10.1016\/j.envpol.2020.116380","article-title":"Multisystemic alterations in humans induced by bisphenol A and phthalates: Experimental, epidemiological and clinical studies reveal the need to change health policies","volume":"271","year":"2021","journal-title":"Environ. Pollut."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yang, Y., Wang, J., Tang, S., Qui, J., Luo, Y., Yang, C., Lai, X., and Cao, H. (2025). Per- and polyfluoroalkyl substances (PFAS) in consumer products: An overview of the occurrence, migration, and exposure assessment. Molecules, 30.","DOI":"10.3390\/molecules30050994"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Bautista, J.M., Bernal-Mercado, A.T., Mart\u00ednez-Cruz, O., Burgos-Hern\u00e1ndez, A., L\u00f3pez-Zavala, A.A., Ruiz-Cruz, S., Ornelas-Paz, J.J., Borboa-Flores, J., Ramos-Enr\u00edquez, J.R., and Del-Toro-S\u00e1nchez, C.L. (2025). Environmental and health impacts of pesticides and nanotechnology as an alternative in agriculture. Agronomy, 15.","DOI":"10.20944\/preprints202507.0439.v1"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1289\/ehp.1205485","article-title":"Toxicological function of adipose tissue: Focus on persistent organic pollutants","volume":"121","author":"Emond","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"L\u00fc, L., Liu, Y., Yang, Y., He, J., Luo, L., Chen, S., and Xing, H. (2024). Bisphenol A exposure interferes with reproductive hormones and decreases sperm counts: A systematic review and meta-analysis of epidemiological studies. Toxics, 12.","DOI":"10.3390\/toxics12040294"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"104580","DOI":"10.1016\/j.envint.2019.02.003","article-title":"Phthalate exposure and female reproductive and developmental outcomes: A systematic review of the human epidemiological evidence","volume":"130","author":"Radke","year":"2019","journal-title":"Environ. Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/MED.0000000000000712","article-title":"The role of endocrine-disrupting phthalates and bisphenols in cardiometabolic disease: The evidence is mounting","volume":"29","author":"Lucas","year":"2022","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rappazzo, K.M., Coffman, E., and Hines, E.P. (2017). Exposure to perfluorinated alkyl substances and health outcomes in children: A systematic review of the epidemiologic literature. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14070691"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s40572-024-00441-y","article-title":"Public health risks of PFAS-related immunotoxicity are real","volume":"11","author":"Bline","year":"2024","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.scitotenv.2016.09.009","article-title":"Exposure to pesticides and the associated human health effects","volume":"575","author":"Kim","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"118222","DOI":"10.1016\/j.envres.2024.118222","article-title":"Prenatal current-use pesticide exposure and children\u2019s neurodevelopment at one year of age in the Infants\u2019 Environmental Health (ISA) birth cohort, Costa Rica","volume":"249","author":"Mora","year":"2024","journal-title":"Environ. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.ijheh.2016.05.001","article-title":"Environmental pollutants and child health\u2014A review of recent concerns","volume":"219","author":"Vrijheid","year":"2016","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"A107","DOI":"10.1289\/ehp.1306695","article-title":"State of the science of endocrine disruptors","volume":"121","author":"Birnbaum","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"107576","DOI":"10.1016\/j.envint.2022.107576","article-title":"Lifestyle interventions to reduce endocrine-disrupting phthalate and phenol exposures among reproductive age men and women: A review and future steps","volume":"170","author":"Martin","year":"2022","journal-title":"Environ. Int."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kumar, M., Sarma, D.K., Shubham, S., Kumawat, M., Verma, V., Prakash, A., and Tiwari, R. (2020). Environmental endocrine-disrupting chemical exposure: Role in non-communicable diseases. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.553850"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Plunk, E.C., and Richards, S.M. (2020). Endocrine-disrupting air pollutants and their effects on the hypothalamus\u2013pituitary\u2013gonadal axis. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21239191"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.toxlet.2024.05.016","article-title":"Human skin absorption of three phthalates","volume":"398","author":"Hopf","year":"2024","journal-title":"Toxicol. Lett."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s40572-015-0064-x","article-title":"Cumulative chemical exposures during pregnancy and early development","volume":"2","author":"Mitro","year":"2015","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1093\/humrep\/der437","article-title":"Occupational exposure to chemicals and fetal growth: The Generation R study","volume":"27","author":"Snijder","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kotta-Loizou, I., Pritsa, A., Antasouras, G., Vasilopoulos, S.N., Voulgaridou, G., Papadopoulou, S.K., Coutts, R.H.A., Lechouritis, E., and Giaginis, C. (2024). Fetus exposure to drugs and chemicals: A holistic overview on the assessment of their transport and metabolism across the human placental barrier. Diseases, 12.","DOI":"10.3390\/diseases12060114"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Vornic, I., Buciu, V., Fur\u0103u, C.G., Gaje, P.N., Ceausu, R.A., Dumitru, C.S., Barb, A.C., Novacescu, D., Cumpanas, A.A., and Latcu, S.C. (2024). Oxidative stress and placental pathogenesis: A contemporary overview of potential biomarkers and emerging therapeutics. Int. J. Mol. Sci., 25.","DOI":"10.20944\/preprints202410.0912.v1"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2217\/epi-2016-0112","article-title":"Effects of prenatal exposure to endocrine disruptors and toxic metals on the fetal epigenome","volume":"9","author":"Bommarito","year":"2017","journal-title":"Epigenomics"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Mamsen, L.S., Kristensen, S.G., Pors, S.E., B\u00f8tkj\u00e6r, J.A., Ernst, E., Macklon, K.T., Gook, D., Kumar, A., Kalra, B., and Andersen, C.Y. (2021). Consequences of \u03b2-thalassemia or sickle cell disease for ovarian follicle number and morphology in girls who had ovarian tissue cryopreserved. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.593718"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1039\/D5VA00145E","article-title":"Impact of bisphenol A exposure on fetal brain development and neurological health\u2014A review","volume":"5","author":"Feng","year":"2026","journal-title":"Environ. Sci. Adv."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"101568","DOI":"10.1016\/j.beem.2021.101568","article-title":"Perinatal exposure to endocrine disrupting chemicals and neurodevelopment: How articles of daily use influence the development of our children","volume":"35","author":"Fischer","year":"2021","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"7567708","DOI":"10.1155\/2022\/7567708","article-title":"Understanding the immune system in fetal protection and maternal infections during pregnancy","volume":"2022","author":"Hussain","year":"2022","journal-title":"J. Immunol. Res."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Abu-Raya, B., Michalski, C., Sadarangani, M., and Lavoie, P.M. (2020). Maternal immunological adaptation during normal pregnancy. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.575197"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: A unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Zhang, X., and Wei, H. (2021). Role of decidual natural killer cells in human pregnancy and related pregnancy complications. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.728291"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1002\/bdr2.1419","article-title":"Uterine natural killer cells: To protect and to nurture","volume":"110","author":"Sojka","year":"2018","journal-title":"Birth Defects Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"10362","DOI":"10.1111\/jcmm.17022","article-title":"Regulation of the innate immune cells during pregnancy: An immune checkpoint perspective","volume":"25","author":"Li","year":"2021","journal-title":"J. Cell. Mol. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e70037","DOI":"10.1111\/cpr.70037","article-title":"Dual role of natural killer cells in early pregnancy: Immunopathological implications and therapeutic potential in recurrent spontaneous abortion and recurrent implantation failure","volume":"58","author":"Guan","year":"2025","journal-title":"Cell Prolif."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"967629","DOI":"10.1155\/2012\/967629","article-title":"The Th1:Th2 dichotomy of pregnancy and preterm labour","volume":"2012","author":"Sykes","year":"2012","journal-title":"Mediat. Inflamm."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Huang, N., Chi, H., and Qiao, J. (2020). Role of regulatory T cells in regulating fetal\u2013maternal immune tolerance in healthy pregnancies and reproductive diseases. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01023"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s12026-012-8303-9","article-title":"The influence of pregnancy on systemic immunity","volume":"54","author":"Pazos","year":"2012","journal-title":"Immunol. Res."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Harding, A.T., and Heaton, N.S. (2022). The impact of estrogens and their receptors on immunity and inflammation during infection. Cancers, 14.","DOI":"10.3390\/cancers14040909"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.yhbeh.2012.02.023","article-title":"Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis","volume":"62","author":"Robinson","year":"2012","journal-title":"Horm. Behav."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Cort\u00e9s, M., Olate, P., Rodriguez, R., Diaz, R., Mart\u00ednez, A., Hern\u00e1ndez, G., Sepulveda, N., Paz, E.A., and Qui\u00f1ones, J. (2025). Human microbiome as an immunoregulatory axis: Mechanisms, dysbiosis, and therapeutic modulation. Microorganisms, 13.","DOI":"10.3390\/microorganisms13092147"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2206505","DOI":"10.1080\/19490976.2023.2206505","article-title":"Maternal microbe-specific modulation of the offspring microbiome and development during pregnancy and lactation","volume":"15","author":"Tian","year":"2023","journal-title":"Gut Microbes"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Jovandaric, M.Z., Babic, S., Milincic, M., Medjo, B., Raus, M., Krstic, M., and Tiric, D. (2026). Microbiome, epigenetics, and nutritional factors in shaping perinatal pregnancy outcomes. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27041622"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"S211","DOI":"10.33549\/physiolres.934513","article-title":"Endocrine disruptors and gut microbiome interactions","volume":"69","author":"Hampl","year":"2020","journal-title":"Physiol. Res."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Fabozzi, G., Rebuzzini, P., Cimadomo, D., Allori, M., Franzago, M., Stuppia, L., Garagna, S., Ubaldi, F.M., Zuccotti, M., and Rienzi, L. (2022). Endocrine-disrupting chemicals, gut microbiota, and human (in)fertility\u2014It is time to consider the triad. Cells, 11.","DOI":"10.3390\/cells11213335"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Safarchi, A., Al-Qadami, G., Tran, C.D., and Conlon, M. (2025). Understanding dysbiosis and resilience in the human gut microbiome: Biomarkers, interventions, and challenges. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1559521"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Sajdel-Sulkowska, E.M. (2023). The impact of maternal gut microbiota during pregnancy on fetal gut\u2013brain axis development and life-long health outcomes. Microorganisms, 11.","DOI":"10.20944\/preprints202307.0759.v1"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Miko, E., Csaszar, A., Bodis, J., and Kovacs, K. (2022). The maternal\u2013fetal gut microbiota axis: Physiological changes, dietary influence, and modulation possibilities. Life, 12.","DOI":"10.3390\/life12030424"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/s41575-023-00864-2","article-title":"The maternal gut microbiome in pregnancy: Implications for the developing immune system","volume":"21","author":"Koren","year":"2024","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s12967-023-04230-3","article-title":"Maternal microbiota and gestational diabetes: Impact on infant health","volume":"21","author":"Singh","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Gorczyca, K., Obuchowska, A., Kimber-Trojnar, \u017b., Wierzchowska-Opoka, M., and Leszczy\u0144ska-Gorzelak, B. (2022). Changes in the gut microbiome and pathologies in pregnancy. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19169961"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.2147\/ITT.S569016","article-title":"The role of intestinal microbiota and immune system interactions in autoimmune diseases","volume":"14","author":"Yurtseven","year":"2025","journal-title":"ImmunoTargets Ther."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/s41522-025-00839-y","article-title":"Microbial regulators of physiological and reproductive health in women of reproductive age: Their local, proximal and distal regulatory roles","volume":"11","author":"Cheng","year":"2025","journal-title":"npj Biofilms Microbiomes"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12934-020-01464-4","article-title":"Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health","volume":"19","author":"Chee","year":"2020","journal-title":"Microb. Cell Fact."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Yang, P., Lu, T., Liang, X., Huang, T., Wu, L., He, Z., Xiao, X., and Fan, S. (2024). The influence of placenta microbiota of normal term pregnant women on immune regulation during pregnancy. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06353-x"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Aguilera, M., G\u00e1lvez-Ontiveros, Y., and Rivas, A. (2020). Endobolome, a new concept for determining the influence of microbiota disrupting chemicals (MDC) in relation to specific endocrine pathogenesis. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.578007"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"114880","DOI":"10.1016\/j.envpol.2020.114880","article-title":"Bisphenol A exposure induces gut microbiota dysbiosis and consequent activation of gut\u2013liver axis leading to hepatic steatosis in CD-1 mice","volume":"265","author":"Feng","year":"2020","journal-title":"Environ. Pollut."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e00093-17","DOI":"10.1128\/mSystems.00093-17","article-title":"Perinatal bisphenol A exposure induces chronic inflammation in rabbit offspring via modulation of gut bacteria and their metabolites","volume":"2","author":"Reddivari","year":"2017","journal-title":"mSystems"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"163991","DOI":"10.1016\/j.scitotenv.2023.163991","article-title":"Dietary exposure to endocrine disruptors in gut microbiota: A systematic review","volume":"886","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Campbell, C., Kandalgaonkar, M.R., Golonka, R.M., Yeoh, B.S., Vijay-Kumar, M., and Saha, P. (2023). Crosstalk between gut microbiota and host immunity: Impact on inflammation and immunotherapy. Biomedicines, 11.","DOI":"10.3390\/biomedicines11020294"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Giannella, L., Grelloni, C., Quintili, D., Fiorelli, A., Montironi, R., Alia, S., Delli Carpini, G., Di Giuseppe, J., Vignini, A., and Ciavattini, A. (2023). Microbiome changes in pregnancy disorders. Antioxidants, 12.","DOI":"10.3390\/antiox12020463"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Hiratsuka, D., Matsuo, M., and Hirota, Y. (2026). The reproductive tract microbiome and female fertility: Dysbiosis, disease links, and emerging therapeutic strategies. Fertil. Steril., in press.","DOI":"10.1016\/j.fertnstert.2026.01.010"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.envpol.2016.08.039","article-title":"Bisphenol A alters gut microbiome: Comparative metagenomics analysis","volume":"218","author":"Lai","year":"2016","journal-title":"Environ. Pollut."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/toxsci\/kfaa065","article-title":"The impact of environmental chemicals on the gut microbiome","volume":"176","author":"Chiu","year":"2020","journal-title":"Toxicol. Sci."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"166889","DOI":"10.1016\/j.scitotenv.2023.166889","article-title":"An insight into the critical role of gut microbiota in triggering the phthalate-induced toxicity and its mitigation using probiotics","volume":"904","author":"Goyal","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envpol.2016.11.045","article-title":"Effects of environmental pollutants on gut microbiota","volume":"222","author":"Jin","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.reprotox.2016.10.001","article-title":"Metabolism disrupting chemicals and metabolic disorders","volume":"68","author":"Heindel","year":"2017","journal-title":"Reprod. Toxicol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/j.fertnstert.2015.09.037","article-title":"Maternal microbiome and pregnancy outcomes","volume":"104","author":"Fox","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e00179-25","DOI":"10.1128\/iai.00179-25","article-title":"Microbial dysbiosis and associated disease mechanisms in maternal and child health","volume":"93","author":"Ahmed","year":"2025","journal-title":"Infect. Immun."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"100141","DOI":"10.1016\/j.medmic.2025.100141","article-title":"Microbiota during pregnancy, childbirth, and postpartum, and its relationship with health and disease states","volume":"25","author":"Gregorio","year":"2025","journal-title":"Med. Microecol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e71484","DOI":"10.1002\/hsr2.71484","article-title":"The role of the vaginal microbiome in preterm premature rupture of membranes: A comprehensive review of mechanisms and clinical implications","volume":"8","author":"Alikamali","year":"2025","journal-title":"Health Sci. Rep."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Xie, Z., Chen, Z., and Ma, G. (2025). Dynamic changes in the pregnancy microbiome and their role in preterm birth. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1683610"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Maciel-Fiuza, M.F., Muller, G.C., Campos, D.M.S., do Socorro Silva Costa, P., Peruzzo, J., Bonamigo, R.R., Veit, T., and Vianna, F.S.L. (2023). Role of gut microbiota in infectious and inflammatory diseases. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1098386"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1055\/s-0043-1778017","article-title":"Exploring immunome and microbiome interplay in reproductive health: Current knowledge, challenges, and novel diagnostic tools","volume":"41","author":"Lingasamy","year":"2023","journal-title":"Semin. Reprod. Med."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Amir, M., Brown, J.A., Rager, S.L., Sanidad, K.Z., Ananthanarayanan, A., and Zeng, M.Y. (2020). Maternal microbiome and infections in pregnancy. Microorganisms, 8.","DOI":"10.3390\/microorganisms8121996"},{"key":"ref_105","unstructured":"Habak, P.J., Carlson, K., and Griggs, J. (2026, March 24). Urinary tract infection in pregnancy, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537047\/."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Baimakhanova, B., Sadanov, A., Trenozhnikova, L., Balgimbaeva, A., Baimakhanova, G., Orasymbet, S., Tleubekova, D., Amangeldi, A., Turlybaeva, Z., and Nurgaliyeva, Z. (2025). Understanding the burden and management of urinary tract infections in women. Diseases, 13.","DOI":"10.3390\/diseases13020059"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Moustakli, E., Grigoriadis, T., Potiris, A., Drakaki, E., Zikopoulos, A., Anagnostaki, I., Zachariou, A., Domali, E., Drakakis, P., and Stavros, S. (2025). The impact of endocrine disruptors on the female genital tract microbiome: A narrative review. Life, 15.","DOI":"10.3390\/life15081177"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Molinari, F., Franco, G.A., Tranchida, N., Di Paola, R., and Cordaro, M. (2024). Molecular mechanism of action of endocrine-disrupting chemicals on the respiratory system. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252312540"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Kumar, M., Yan, Y., Jiang, L., Sze, C.H., Kodithuwakku, S.P., Yeung, W.S.B., and Lee, K.F. (2025). Microbiome\u2013maternal tract interactions in women with recurrent implantation failure. Microorganisms, 13.","DOI":"10.3390\/microorganisms13040844"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Zhou, Y., Zhou, Z., Zheng, L., Gong, Z., Li, Y., Jin, Y., Huang, Y., and Chi, M. (2023). Urinary tract infections caused by uropathogenic Escherichia coli: Mechanisms of infection and treatment options. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241310537"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Colella, M., Topi, S., Palmirotta, R., D\u2019Agostino, D., Charitos, I.A., Lovero, R., and Santacroce, L. (2023). An overview of the microbiota of the human urinary tract in health and disease: Current issues and perspectives. Life, 13.","DOI":"10.3390\/life13071486"},{"key":"ref_112","first-page":"347","article-title":"Bacterial vaginosis\u2014Vaginal polymicrobial biofilms and dysbiosis","volume":"120","author":"Swidsinski","year":"2023","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00281-020-00817-w","article-title":"The pregnancy microbiome and preterm birth","volume":"42","author":"Bayar","year":"2020","journal-title":"Semin. Immunopathol."},{"key":"ref_114","first-page":"e67040","article-title":"Navigating the microbial landscape: Understanding dysbiosis in human genital tracts and its impact on fertility","volume":"16","author":"Ughade","year":"2024","journal-title":"Cureus"},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"Amabebe, E., and Anumba, D.O.C. (2018). The vaginal microenvironment: The physiologic role of Lactobacilli. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00181"},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Wei, T., Zhao, C., and Zhang, L. (2026). The role of the vaginal microbiome in gynecological diseases: Mechanistic insights and emerging interventions. Biology, 15.","DOI":"10.3390\/biology15050432"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"24165","DOI":"10.1038\/s41598-021-03655-4","article-title":"Placental acute inflammation infiltrates and pregnancy outcomes: A retrospective cohort study","volume":"11","author":"Orsaria","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ajog.2015.08.040","article-title":"Acute chorioamnionitis and funisitis: Definition, pathologic features, and clinical significance","volume":"213","author":"Kim","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Vidal, M.S., Lintao, R.C.V., Severino, M.E.L., Tantengco, O.A.G., and Menon, R. (2022). Spontaneous preterm birth: Involvement of multiple feto-maternal tissues and organ systems, differing mechanisms, and pathways. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1015622"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"103301","DOI":"10.1016\/j.arcmed.2025.103301","article-title":"Inflammation in pregnancy: Key drivers, signaling pathways and associated complications","volume":"57","author":"Avila","year":"2026","journal-title":"Arch. Med. Res."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1039\/D3LC00998J","article-title":"Endocrine-disrupting compounds and their impact on human placental function: Evidence from placenta organ-on-chip studies","volume":"24","author":"Vidal","year":"2024","journal-title":"Lab Chip"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Figarska, A., and Witkowska-Pi\u0142aszewicz, O. (2022). Immunological response during pregnancy in humans and mares. Agriculture, 12.","DOI":"10.3390\/agriculture12030431"},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Cornish, E.F., Filipovic, I., \u00c5senius, F., Williams, D.J., and McDonnell, T. (2020). Innate immune responses to acute viral infection during pregnancy. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.572567"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"113382","DOI":"10.1016\/j.ecoenv.2022.113382","article-title":"The associations between endocrine disrupting chemicals and markers of inflammation and immune responses: A systematic review and meta-analysis","volume":"234","author":"Liu","year":"2022","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.kjms.2012.05.008","article-title":"Immunomodulatory effects of environmental endocrine disrupting chemicals","volume":"28","author":"Kuo","year":"2012","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Al Beloushi, M., Saleh, H., Ahmed, B., and Konje, J.C. (2024). Congenital and perinatal viral infections: Consequences for the mother and fetus. Viruses, 16.","DOI":"10.3390\/v16111698"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"166198","DOI":"10.1016\/j.bbadis.2021.166198","article-title":"Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus","volume":"1867","author":"Auriti","year":"2021","journal-title":"Biochim. Biophys. Acta Mol. Basis Dis."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Moutsopoulou, R.A., Markou, A., Lianou, A., Leontari, K., Iliodromiti, Z., Boutsikou, T., Kafalidis, G., Paliatsiou, S., Volaki, P., and Iacovidou, N. (2025). Congenital cytomegalovirus infection: From silent threat to vaccine horizon. Vaccines, 13.","DOI":"10.3390\/vaccines13090929"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1002\/bdra.23601","article-title":"Cytomegalovirus infection in pregnancy","volume":"109","author":"Davis","year":"2017","journal-title":"Birth Defects Res."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Oseghale, O., Vlahos, R., O\u2019Leary, J.J., Brooks, R.D., Brooks, D.A., Liong, S., and Selemidis, S. (2022). Influenza virus infection during pregnancy as a trigger of acute and chronic complications. Viruses, 14.","DOI":"10.3390\/v14122729"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/GCO.0000000000000440","article-title":"Zika virus: A public health perspective","volume":"30","author":"Chakhtoura","year":"2018","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Vanegas, O., and Martinez-Perez, O. (2023). SARS-CoV-2 infection and preeclampsia\u2014How an infection can help us to know more about an obstetric condition. Viruses, 15.","DOI":"10.20944\/preprints202305.0077.v1"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1002\/mco2.714","article-title":"The interaction of innate immune and adaptive immune system","volume":"5","author":"Wang","year":"2024","journal-title":"MedComm"},{"key":"ref_134","unstructured":"Golden, T., Robles-Matos, N., Dagpo, T., and Bansal, A. (2020). Immunomodulatory role of EDCs in disrupting metabolic health. Endocrine Disruption and Human Health, Elsevier."},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Popescu, M., Feldman, T.B., and Chitnis, T. (2021). Interplay between endocrine disruptors and immunity: Implications for diseases of autoreactive etiology. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.626107"},{"key":"ref_136","doi-asserted-by":"crossref","unstructured":"Adegoke, E.O., Rahman, M.S., Park, Y.-J., Kim, Y.J., and Pang, M.G. (2021). Endocrine-disrupting chemicals and infectious diseases: From endocrine disruption to immunosuppression. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22083939"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"2343362","DOI":"10.1080\/1547691X.2024.2343362","article-title":"Per- and polyfluoroalkyl substances alter innate immune function: Evidence and data gaps","volume":"21","author":"Phelps","year":"2024","journal-title":"J. Immunotoxicol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"108789","DOI":"10.1016\/j.cbpc.2020.108789","article-title":"Adverse effects of pesticides on the functions of immune system","volume":"235","author":"Lee","year":"2020","journal-title":"Comp. Biochem. Physiol. Part C Toxicol. Pharmacol."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Passoni, F.C., Iulini, M., Galbiati, V., Marinovich, M., and Corsini, E. (2025). Disrupting defenses: Effects of bisphenol A and its analogs on human antibody production in vitro. Life, 15.","DOI":"10.3390\/life15081203"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"5422","DOI":"10.1038\/s41598-019-41134-z","article-title":"Early pregnancy exposure to endocrine disrupting chemical mixtures are associated with inflammatory changes in maternal and neonatal circulation","volume":"9","author":"Kelley","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1128\/CMR.00062-12","article-title":"The \u2018silent\u2019 global burden of congenital cytomegalovirus","volume":"26","author":"Manicklal","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.ajog.2012.06.068","article-title":"Effects of influenza on pregnant women and infants","volume":"207","author":"Rasmussen","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_143","first-page":"20","article-title":"Zika virus infection, basic and clinical aspects: A review article","volume":"48","author":"Noorbakhsh","year":"2019","journal-title":"Iran. J. Public Health"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"108805","DOI":"10.1016\/j.envint.2024.108805","article-title":"Diverse mechanisms by which chemical pollutant exposure alters gut microbiota metabolism and inflammation","volume":"190","author":"Teffera","year":"2024","journal-title":"Environ. Int."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"m3320","DOI":"10.1136\/bmj.m3320","article-title":"Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis","volume":"370","author":"Allotey","year":"2020","journal-title":"BMJ"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"111904","DOI":"10.1016\/j.envres.2021.111904","article-title":"Emerging concepts and opportunities for endocrine disruptor screening of the non-EATS modalities","volume":"204","author":"Martyniuk","year":"2022","journal-title":"Environ. Res."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/aji.12355","article-title":"Viral infections during pregnancy","volume":"73","author":"Silasi","year":"2015","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Potiris, A., Antsaklis, P., Christopoulos, P., Kathopoulis, N., Moustakli, E., Anagnostaki, I., Drakaki, E., Arkouli, N., Vogiatzoglou, A.L., and Zikopoulos, A. (2026). The impact of endocrine-disrupting chemicals on embryonic recurrent implantation failure: A narrative review. J. Xenobiotics, 16.","DOI":"10.3390\/jox16010030"},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Guarnotta, V., Amodei, R., Frasca, F., Aversa, A., and Giordano, C. (2022). Impact of chemical endocrine disruptors and hormone modulators on the endocrine system. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23105710"},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Weng, J., Couture, C., and Girard, S. (2023). Innate and adaptive immune systems in physiological and pathological pregnancy. Biology, 12.","DOI":"10.3390\/biology12030402"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.55730\/1300-0144.6124","article-title":"The influence of endocrine disruptors on the gut microbiota","volume":"55","year":"2025","journal-title":"Turk. J. Med. Sci."},{"key":"ref_152","doi-asserted-by":"crossref","unstructured":"Yan, Y., Guo, F., Liu, K., Ding, R., and Wang, Y. (2023). The effect of endocrine-disrupting chemicals on placental development. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1059854"},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Lubrano, C., Parisi, F., and Cetin, I. (2024). Impact of maternal environment and inflammation on fetal neurodevelopment. Antioxidants, 13.","DOI":"10.3390\/antiox13040453"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"14910","DOI":"10.3389\/bjbs.2025.14910","article-title":"The placenta as an immunological environment","volume":"82","author":"Menzies","year":"2025","journal-title":"Br. J. Biomed. Sci."},{"key":"ref_155","doi-asserted-by":"crossref","unstructured":"Rolfo, A., Nuzzo, A.M., De Amicis, R., Moretti, L., Bertoli, S., and Leone, A. (2020). Fetal-maternal exposure to endocrine disruptors: Correlation with diet intake and pregnancy outcomes. Nutrients, 12.","DOI":"10.3390\/nu12061744"},{"key":"ref_156","unstructured":"Feingold, K.R., Adler, R.A., Ahmed, S.F., Blackman, M.R., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., Dungan, K., and Hamilton, E. (2026, March 24). Immune system effects on the endocrine system, Endotext, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK279139\/."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.cytogfr.2024.07.007","article-title":"Inflammatory mechanisms of preterm labor and emerging anti-inflammatory interventions","volume":"78","author":"Habelrih","year":"2024","journal-title":"Cytokine Growth Factor Rev."},{"key":"ref_158","doi-asserted-by":"crossref","unstructured":"Elgueta, D., Murgas, P., Riquelme, E., Yang, G., and Cancino, G.I. (2022). Consequences of viral infection and cytokine production during pregnancy on brain development in offspring. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.816619"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/s41390-024-03145-z","article-title":"Viral infections in pregnancy and impact on offspring neurodevelopment: Mechanisms and lessons learned","volume":"96","author":"Yates","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1038\/s41574-023-00872-x","article-title":"The regulation of endocrine-disrupting chemicals to minimize their impact on health","volume":"19","author":"Maffini","year":"2023","journal-title":"Nat. Rev. Endocrinol."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/5\/1012\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:08:32Z","timestamp":1777547312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/5\/1012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":160,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["microorganisms14051012"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14051012","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}