<p>Organophosphate esters (OPEs) are widely used synthetic chemicals associated with increased plasma glucose in the general populations; however, evidence regarding their associations among pregnant women remains limited. In the Shanghai-Minhang Birth Cohort Study, urinary concentrations of eight OPE metabolites were measured at 12–16 weeks of gestation. Data on fasting plasma glucose (FPG) and 1 h-plasma glucose (1 h-PG) were obtained from medical records. Women were classified as having elevated glucose levels based on abnormal FPG, 1 h-PG, or a diagnosis of gestational diabetes mellitus (GDM). Multiple linear regression and Bayesian Kernel Machine Regression (BKMR) were employed to estimate associations between individual OPE metabolites or OPE mixtures and plasma glucose levels. Modified Poisson regression assessed the associations of OPE metabolites with the risk of elevated glucose levels. Compared with the lowest exposure group, the highest exposure to bis(1,3-dichloro-2-propyl) phosphate, dibutyl phosphate, and diphenyl phosphate was significantly associated with lower FPG levels. However, 1 h-PG levels tended to increase in the moderate exposure group, with ΣCl-OPEs showing a marginally significant association. Poisson regression results similarly indicated that pregnant women with moderate exposure had an increased risk of elevated glucose levels, though without statistical significance. The BKMR model produced similar findings, indicating that chlorinated-OPE primarily contributed to altered FPG and 1 h-PG, with bis(1,3-dichloro-2-propyl) phosphate and bis(1-chloro-2-propyl) phosphate being the major contributors, respectively. Additionally, associations between OPE exposure and decreased FPG levels were predominantly observed among pregnant women with daily fruit and vegetable intake. The present study observed different association patterns between OPE exposure and FPG or 1 h-PG levels, suggesting potential disruptive effects of OPEs on glucose homeostasis during pregnancy.</p>