Phthalate exposure linked to higher odds for preterm birth, low birth weight
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Key takeaways:
- Higher concentrations of maternal urinary phthalates are linked to younger gestational age and lower birth weight and length.
- Phthalates contributed to an estimated 56,595 preterm births in the U.S. in 2018.
Exposure to phthalates may have contributed to 56,595 preterm births, resulting in an additional $3.84 billion in health care costs in the U.S. during 2018, according to study data.
“Phthalates are used in personal care products, cosmetics and food packaging,” Leonardo Trasande, MD, MPP, director of the Center for the Investigation of Environmental Hazards at NYU Grossman School of Medicine, told Healio. “A large number of studies had already previously identified a particular phthalate widely used in food packaging called di(2-ethylhexyl) phthalate (DEHP) to disrupt hormones and contribute to inflammation that can disrupt the function of the placenta in maintaining a healthy pregnancy. What we did here was to assess exposures to DEHP as well as chemicals that are increasingly replacing DEHP that may have had the same health effects in relation to gestational lengths and birth outcomes.”
Trasande and colleagues conducted a prospective analysis of 5,006 mother-child dyads who had data available as part of the Environmental influences on Child Health Outcomes (ECHO) cohort study. Phthalate metabolites were measured through maternal urine samples. Phthalates were included in the analysis if they were detected in more than 50% of samples and if at least 1,000 women had a detectable sample. Gestational age at birth, birth weight, birth length, birth weight for gestational z score were assessed as continuous outcomes. Preterm birth, small for gestational age, large for gestational age and low birth weight were analyzed as binary outcomes.
The study was published in The Lancet Planetary Health.
The study included 20 phthalate metabolites. The highest phthalate concentrations measured were mono-ethyl phthalate and phthalic acid.
Increasing concentrations of phthalates were generally associated with younger gestational age, lower birth length and lower birth weight. Phthalate acid, diisononyl phthalate (DiNP), diisodecyl phthalate (DiDP) and di-n-octyl phthalate (DnOP) were associated with greater declines in all three continuous outcomes than low molecular weight phthalates, high molecular weight phthalates and DEHP. No phthalates were associated with birth weight for gestational age z score.
Higher levels of phthalate acid, DiNP, DiDP and DnOP were most strongly associated with increased odds for preterm birth and low birth weight. No associations were observed between any phthalates and small for gestational age or large for gestational age.
Researchers used National Health and Nutrition Examination Survey data along with findings from the study to estimate adverse birth outcomes attributable to phthalates and their associated costs in the U.S. during 2018. Researchers estimated that phthalate exposure contributed to 56,595 preterm birth cases in 2018 with associated costs of $3.84 billion.
Trasande said better regulation of DEHP and chemicals replacing DEHP are needed. In the meantime, he said there are several steps people can take to reduce their exposure to phthalates.
“We need to renegotiate our relationship with plastic,” Trasande said. “In particular, we need to reduce our consumption and production of plastic. These are chemical waste that are in our bodies from food packaging. It’s similar to the great Pacific garbage patch, it’s just that these are invisible, not visible fragments. What we’re seeing here is the need for families to use stainless steel and glass instead of plastic, particularly when the plastic use is nonessential.”
For more information:
Leonardo Trasande, MD, MPP, can be reached at leonardo.trasande@nyulangone.org.
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