Tracey Woodruff

All Publications

• The combined impact of chemical and non-chemical stressors on adverse health outcomes: an overview of reviews from the epidemiological literature and experimental animal studies. Journal of exposure science & environmental epidemiology Trowbridge, J., Lasher, E., Gao, X., Chartres, N., Joglekar, R., Morello-Frosch, R., Fox, M. A., Payne-Sturges, D., Buckley, J. P., Woodruff, T. J. 2026

  Abstract

  Assessing environmental chemical health risks requires accounting for a range of factors that influence risk, including exposure to multiple chemicals, biological factors, and non-chemical stressors, such as socioeconomic status, access to health care, and discrimination. Exposure to non-chemical stressors can interact with or modify the effects of chemical exposures on adverse health outcomes, making them a critical component of cumulative risk assessment. However, incorporating this research into evidence-based decision-making, including cumulative risk assessment approaches, requires a comprehensive evaluation of the literature to understand the magnitude of non-chemical stressors' impact on the exposure-outcome relationship.To conduct an overview of reviews to identify, evaluate, and summarize the body of evidence on this topic in published systematic and scoping reviews.We pre-published our study protocol, conducted a systematic literature search, and we reviewed and extracted data from eligible studies, using the Navigation Guide Methodology for Systematic Review. We adapted and used the AMSTAR 2.0 tool to evaluate and rate the quality of environmental health studies.We identified 13 systematic and five scoping reviews that met our pre-defined eligibility criteria. All reviews evaluated human epidemiologic evidence, and one evaluated human and animal evidence. Three reviews were of moderate quality, four reviews were of low quality, and 11 reviews were critically low. We summarized the findings from reviews rated as low or moderate quality (n = 7). The most common exposure was air pollution. Studies described a broad range of outcomes and used varied definitions and conceptualizations of non-chemical stressors, including using race ethnicity as an indicator of social stress or socioeconomic status (SES) or using direct and indirect measures of SES, such as health insurance status and median household income. Two reviews with certainty assessments found an increased association with adverse health outcomes when environmental chemical and non-chemical stressors were considered together versus individually.Current risk assessment methods fail to account for the combined effect of chemical and non-chemical stressors. Consolidating systematic reviews on the influence of extrinsic non-chemical stressors can facilitate the development of risk assessment methods that account for their impact.

  View details for DOI 10.1038/s41370-026-00862-x

  View details for PubMedID 42380643

  View details for PubMedCentralID 5158104

• Plasma or Serum? A Pilot Evaluation of Matrix Selection for Integrated Metabolomics and Exposomics of Clinical Samples. Toxics Ji, X., Edwards, J., Wang, M., Irwin, J. C., Liu, B., Gutierrez, A. M., Li, L., Lager, J. C., Nezhat, C. R., Stevenson, D. K., Oskotsky, T. T., Sirota, M., Abrahamsson, D., Giudice, L. C., Woodruff, T. J., Robinson, J. F., Park, J. S. 2026; 14 (6)

  Abstract

  Serum and plasma are the most widely used matrices in metabolomics and human biomonitoring studies; however, the optimal matrix for integrated non-targeted analysis (NTA) workflows combining metabolomics and exposomics has not been systematically evaluated. This pilot study applied parallel NTA workflows to paired serum and plasma samples from five individuals to characterize matrix-dependent differences and provide an empirical basis for matrix selection in integrated studies. Three analytical methods were employed: one metabolomic method (Method 1) using Hydrophilic Interaction Liquid Chromatography (HILIC) and Reversed-Phase Liquid Chromatography (RPLC) columns and one exposomics (Method 2) method using an RPLC column, each analyzed in both electrospray ionization (ESI) positive and negative modes. Overall, serum and plasma showed broad similarity, with substantial overlap in detected features and strong linear correlations between paired samples (R2 = 0.70-0.87). However, PCA revealed systematic differences between the two matrices along PC1 and PC2, likely attributable to matrix effects arising from coagulation-related compositional changes in serum. For metabolomics, glycerophospholipids, sphingolipids, and acylcarnitines were consistently enriched in serum, attributable to platelet activation and phospholipase release during blood coagulation, consistent with prior reports. In contrast, oxidized fatty acid species were predominantly elevated in plasma, warranting caution in oxylipin-focused studies using serum. For exogenous chemical profiling, the two matrices performed comparably, with 32 out of 36 annotated features showing no significant matrix-dependent differences (p > 0.05), including PFAS, pharmaceuticals, and diverse xenobiotics. These findings support the interchangeability of serum and plasma for broad exposomics studies. Overall, while both matrices provided broadly comparable global coverage, plasma may represent a more appropriate matrix for integrated NTA workflows, as it better preserves in vivo metabolite composition and minimizes coagulation-induced confounding, though validation in larger cohorts is needed.

  View details for DOI 10.3390/toxics14060494

  View details for PubMedID 42347393

• Gestational Exposure to 10 Classes of Priority Chemicals and Birth Outcomes in the ECHO Cohort. JAMA network open Buckley, J. P., Pacyga, D. C., Xun, X., Barr, D. B., Barrett, E. S., Bastain, T., Bennett, D. H., Braun, J. M., Breton, C. V., Carignan, C., Croen, L. A., Dunlop, A. L., Farzan, S. F., Ferrara, A., Gilliland, F. D., Herbstman, J. B., Karagas, M. R., Karr, C. J., Kuiper, J. R., Meeker, J. D., Miller, R. L., Morello-Frosch, R., O'Connor, T. G., Oh, J., Perera, F. P., Porucznik, C. A., Romano, M. E., Sathyanarayana, S., Schantz, S. L., Schmidt, R. J., Sherris, A. R., Trasande, L., Volk, H., Watkins, D. J., Zhao, Q., Zhu, Y., Li, Z., Pellizzari, E., Kannan, K., Woodruff, T. J. 2026; 9 (6): e2618883

  Abstract

  Gestational environmental chemical exposures are widespread. Some chemicals are known to adversely affect birth outcomes, but many remain understudied.To evaluate associations of gestational exposure to a priori identified chemicals in 10 classes with birth outcomes in a large, diverse US cohort.In the prospective Environmental influences on Child Health Outcomes Cohort study, 5318 mother-child pairs were enrolled from January 1, 2000, to December 31, 2021, with data on gestational urinary chemical concentrations, gestational age at birth, and birth weight. Statistical analysis was performed from January 2024 to February 2026.In single, midgestation (median, 25 weeks [IQR, 21-30 weeks]) urine samples, concentrations of 113 analytes (chemicals or their metabolites) from 10 chemical classes were simultaneously measured: fungicides and herbicides (n = 11), insecticides (n = 20), halogenated phenols (n = 5), organophosphate esters (n = 10), benzophenones (n = 6), bisphenols (n = 14), parabens (n = 6), antimicrobials (n = 2), phthalates or alternative plasticizers (n = 32), and polycyclic aromatic hydrocarbons (PAHs) (n = 7).Linear mixed-effects regression models with a random effect for site were used to estimate covariate-adjusted differences in gestational age at birth (days) and birth weight-for-gestational age (BW-GA) z scores per IQR increase in urinary analyte concentrations. In secondary analyses, odds ratios (ORs) for preterm birth and small for gestational age (SGA) were estimated.In the sample of 5318 mother-child pairs, most infants (2667 female [50%]; median gestational age at birth, 39.0 weeks [IQR, 38.0-40.0 weeks]) were born to college-educated (67% [3218 of 4785]), parous (56% [2815 of 5007]) mothers (median age at delivery, 30.7 years [IQR, 26.1-34.3 years]). A total of 43 of 113 analytes (38%) were detected in 50% or more of samples. Multiple phthalates or alternative plasticizers were associated with younger gestational age at birth or lower BW-GA z scores; for example, summed diisononyl phthalate metabolites were associated with a 0.6-day (95% CI, -1.0 to -0.1 days) younger gestational age (preterm birth OR, 1.16 [95% CI, 1.01-1.34]), and summed phthalate or alternative plasticizers were associated with a 0.06 (95% CI, -0.11 to -0.02) lower BW-GA z score (SGA OR, 1.09 [95% CI, 0.93-1.27]). Two halogenated phenols, benzophenone 8, bisphenol F, and several PAHs were associated with lower BW-GA z scores; for example, 1- and 9-hydroxphenanthrene were associated with a 0.04 (95% CI, -0.08 to -0.01) lower BW-GA z score (SGA OR, 1.13 [95% CI, 1.01-1.27]).This large cohort study of diverse US pregnancies found widespread exposure to 10 classes of environmental chemicals, many of which were associated with differences in gestational age at birth or lower BW-GA z scores. These findings indicate that reducing gestational exposure to chemicals, particularly phthalates or alternative plasticizers and PAHs, could promote healthy deliveries and better child outcomes.

  View details for DOI 10.1001/jamanetworkopen.2026.18883

  View details for PubMedID 42307947

• Policy Change and Defining the Xenome Are Essential to Address the Environmental Chemical Contribution to Chronic Diseases. Environmental science & technology Abrahamsson, D., Woodruff, T. J. 2026

  View details for DOI 10.1021/acs.est.6c02956

  View details for PubMedID 42101963

• Utilizing Non -Targeted Plasma Profiling to Identify Environmental Contributors and Disease Signatures of Endometriosis Li, L., Ji, X., Gutierrez, A., Edwards, J., Wang, M., Irwin, J., Liu, B., Vo, K., Casillas, A., Stubblefield, S., Dhandapani, V., Chen, J., Gomez, M., Opoku-Anane, J., Lager, J., Nezhat, C., Oskotsky, T., Abrahamsson, D., Sirota, M., Giudice, L., Park, J., Woodruff, T., Robinson, J. SPRINGER HEIDELBERG. 2026

  View details for Web of Science ID 001737538602244

• Climate Change and Reproductive Health. Endocrine reviews Fernandez, A. C., Pelnekar, S., Robinson, J. F., Shaw, G. M., Padula, A. M., Woodruff, T. J., Giudice, L. C. 2025

  Abstract

  Climate change is a major threat to the world's population and is due to global warming from human activities that increase atmospheric greenhouse gas levels -burning fossil fuels, industry emissions, vehicular exhaust, and aerosol chlorofluorocarbons - that trap heat in the earth's atmosphere and adversely impact air quality. Resulting higher global temperatures, extreme weather events, and rising sea levels lead to greater frequency of wildfires and floods, which, in turn, result in population displacements and threaten air and water quality, food and water security, economic and public health infrastructures, and societal safety. Climate change has direct and indirect impacts on human health and well-being across the globe with disproportionate impact on vulnerable populations including women, pregnant persons, the developing fetus, children, older adults, indigenous peoples, persons with disabilities, pre-existing and/or chronic medical conditions, and low income and communities of color. As consequences of climate change, global mortality and non-communicable diseases are mounting due to lack of progress to reverse current trends. Climate change effects on reproductive processes and outcomes have received less attention globally, despite huge consequences for human development, fertility, and pregnancy outcomes. This review provides evidence for direct and indirect effects of climate change on human health with a focus on reproductive processes and outcomes based on experimental models and epidemiologic data, and strategies to mitigate harms. The goal is to increase awareness about climate effects on reproductive health among clinicians, researchers, the public, and policymakers, and to engage all stakeholders to change the current trajectory of harm.

  View details for DOI 10.1210/endrev/bnaf026

  View details for PubMedID 40755394

• Water Fluoridation and Birth Outcomes in California. Environmental health perspectives Goin, D. E., Padula, A. M., Woodruff, T. J., Sherris, A., Charbonneau, K., Morello-Frosch, R. 2024; 132 (5): 57004

  Abstract

  There is a lack of research on the relationship between water fluoridation and pregnancy outcomes.We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California.We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to 0.7 ppm (the current level recommended by the US Department of Health and Human Services) and 0.5 ppm (below the current recommendation) on birth weight, birth-weight-for-gestational age z-scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers.Fluoride levels ranged from 0 to 2.5 ppm, with a median of 0.51 ppm. There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to 0.7 ppm [-2.2g; 95% confidence interval (CI): -4.4, 0.0] and to 0.5 ppm (-5.8g; 95% CI: -10.0, -1.6). There were small negative associations with birth-weight-for-gestational-age z-scores for both hypothetical interventions (0.7 ppm: -0.004; 95% CI: -0.007, 0.000 and 0.5 ppm: -0.006; 95% CI: -0.013, 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to 0.7 ppm [risk difference (RD)=-0.001; 95% CI: -0.002, 0.000 and 0.5 ppm (-0.001; 95% CI: -0.003, 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention.We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age z-scores in California. https://doi.org/10.1289/EHP13732.

  View details for DOI 10.1289/EHP13732

  View details for PubMedID 38752991

  View details for PubMedCentralID PMC11098007

• Drinking water contaminants in California and hypertensive disorders in pregnancy. Environmental epidemiology (Philadelphia, Pa.) Padula, A. M., Ma, C., Huang, H., Morello-Frosch, R., Woodruff, T. J., Carmichael, S. L. 2021; 5 (2): e149

  Abstract

  Environmental pollutants have been associated with hypertensive disorders in pregnancy including gestational hypertension, preeclampsia, and eclampsia, though few have focused on drinking water contamination. Water pollution can be an important source of exposures that may contribute to adverse pregnancy outcomes.Methods: We linked water quality data on 13 contaminants and two violations from the California Communities Environmental Health Screening Tool to birth records from vital statistics and hospital discharge records (2007-2012) to examine the relationship between drinking water contamination and hypertensive disorders in pregnancy. We examined contaminants in single- and multipollutant models. Additionally, we examined if the relationship between water contamination and hypertensive disorders in pregnancy differed by neighborhood poverty, individual socioeconomic status, and race/ethnicity.Results: Arsenic, nitrate, trihalomethane, hexavalent chromium, and uranium were detected in a majority of water systems. Increased risk of hypertensive disorders in pregnancy was modestly associated with exposure to cadmium, lead, trihalomethane, and hexavalent chromium in drinking water after adjusting for covariates in single pollutant models with odds ratios ranging from 1.01 to 1.08. In multipollutant models, cadmium was consistent, lead and trihalomethane were stronger, and additional contaminants were associated with hypertensive disorders in pregnancy including trichloroethylene, 1,2-Dibromo-3-chloropropane, nitrate, and tetrachloroethylene. Other contaminants either showed null results or modest inverse associations. The relationship between water contaminants and hypertensive disorders in pregnancy did not differ by neighborhood poverty.Conclusions: We found increased risk of hypertensive disorders in pregnancy associated with exposure to several contaminants in drinking water in California. Results for cadmium, lead, trihalomethane, and hexavalent chromium were robust in multipollutant models.

  View details for DOI 10.1097/EE9.0000000000000149

  View details for PubMedID 33870020