Preconception and first trimester exposure to pesticides and associations with stillbirth

Associations of pesticide exposures during preconception with stillbirth have not been well explored. We linked Arizona pesticide use records with birth certificates from 2006 to 2020 and estimated associations of living within 500 m of any pyrethroid, organophosphate (OP), or carbamate pesticide applications during a 90-day preconception window or the first trimester, with stillbirth. We considered a binary measure of exposure (any exposure), as well as log-pounds and log-acres applied within 500 m, in a negative control exposure framework with log-binomial regression. We included 1 237 750 births, 2290 stillbirths, and 27 pesticides. During preconception, any exposure to pesticides was associated with stillbirth, including cyfluthrin (risk ratio [RR] = 1.97; 95% CI, 1.17-3.32); zeta-cypermethrin (RR = 1.81; 95% CI, 1.20-2.74); OPs as a class (RR = 1.60; 95% CI, 1.16-2.19); malathion (RR = 2.02; 95% CI, 1.26-3.24); carbaryl (RR = 6.39; 95% CI, 2.07-19.74); and propamocarb hydrochloride (RR = 7.72; 95% CI, 1.10-54.20). During the first trimester, fenpropathrin (RR = 4.36; 95% CI, 1.09-17.50); permethrin (RR = 1.57; 95% CI, 1.02-2.42); OPs as a class (RR = 1.50; 95% CI, 1.11-2.01); acephate (RR = 2.31; 95% CI, 1.22-4.40); and formetanate hydrochloride (RR = 7.22; 95% CI, 1.03-50.58) were associated with stillbirth. Interpretations were consistent when using continuous measures of pounds or acres of exposure. Pesticide exposures during preconception and first trimester may be associated with stillbirth. This article is part of a Special Collection on Environmental Epidemiology.