Chemicals called phthalates, found in plastics and cosmetics, may be linked to a raised risk of babies being born early, suggests a new study.
Researchers found that women who delivered babies before 37 weeks gestation had higher levels of phthalates in their urine, compared to women who delivered their children at full term, which is 39 weeks.
“Preterm birth is a real public health problem,” said John Meeker, who led the study. “We’re not really sure how to go about preventing it, but this may shed light on environmental factors that people may want to be educated in.”
Meeker, from the University of Michigan School of Public Health in Ann Arbor, added, “We knew that exposure to phthalates was virtually ubiquitous here in the U.S. and possibly worldwide and preterm births increased for unknown reasons over the past several decades.”
Phthalates are included in products for a variety of reasons, include to make plastic flexible.
Past studies also have found evidence that would suggest the chemicals may be tied to earlier births.
For example, previous research has linked the chemicals to shorter pregnancies and lower birth weights.
“There are many possible routes of exposure depending on the chemical of interest and the scenario,” Meeker said. Most commonly, the chemical enters the body through food and beverages. It may also be absorbed through the skin.
For the new study, the researchers used data from a study conducted at Brigham and Women’s Hospital in Boston between 2006 and 2008.
During the study, pregnant women were asked to fill out surveys and provide urine samples throughout their pregnancies. The researchers compared 130 mothers who delivered their babies before 37 weeks to 352 women who delivered their babies at term.
While each woman provided numerous urine samples during their pregnancies, the researchers analyzed three to measure the amount of phthalates in their bodies.
They looked for breakdown products of a phthalate chemical known as DEHP.
Overall, the two byproducts MEHP and MECPP were more abundant in women who delivered their children early, compared to women who delivered after 37 weeks. That was also true for MBP, a byproduct of Dibutyk phthalate.
According to the U.S. Environmental Protection Agency, those chemicals are used to make products - such as plastic pipes, shower curtains and food packaging - soft and flexible.
Each of the phthalates examined was linked to a risk increase of anywhere from 16 percent to 65 percent increase in risk for preterm birth.
About one of every eight infants is born prematurely in the U.S., according to the Centers for Disease Control and Prevention.
Shanna Swan, who wrote an editorial accompanying the new study in JAMA Pediatrics, said that difference may not mean much to an individual woman, but it adds up across a large population.
Swan is a professor Department of Preventive Medicine at the Icahn School of Medicine at Mount Sinai in New York.
“There are a lot of indications or warnings that signal that women avoid phthalates when they can,” she said. “I say ‘when they can’ because it’s difficult.”
“Most of the exposures are silent and we are not aware of them,” she added. “We don’t know how to avoid them.”
Previous studies have suggested that people who use fresh and organic produce - such as certain religious groups - have lower phthalate levels,” Swan said.
She added, however, that not many studies have examined the relationship between phthalates and preterm births.
Some studies, according to the researchers, have found no negative side effects from phthalate levels, but those only used levels from one urine sample. Phthalate levels can change during pregnancy.
Meeker said the new study can’t prove higher phthalate levels caused women to deliver early or if they should stay away from the chemicals.
“Our study wasn’t really geared to look at that,” he said. “Women may want to limit exposure if they can, but there are so many different points of exposure which makes it difficult.”
SOURCE: JAMA Pediatrics, online November 18, 2013
Environmental Phthalate Exposure and Preterm Birth
Kelly K. Ferguson, MPH; Thomas F. McElrath, MD, PhD; John D. Meeker, ScD
Main Outcomes and Measures We examined associations between average levels of phthalate exposure during pregnancy and preterm birth, defined as fewer than 37 weeks of completed gestation, as well as spontaneous preterm birth, defined as preterm preceded by spontaneous preterm labor or preterm premature rupture of the membranes (n = 57).
Results Geometric means of the di-2-ethylhexyl phthalate (DEHP) metabolites mono-(2-ethyl)-hexyl phthalate (MEHP) and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), as well as mono-n-butyl phthalate (MBP), were significantly higher in cases compared with control participants. In adjusted models, MEHP, MECPP, and Σ DEHP metabolites were associated with significantly increased odds of preterm birth. When spontaneous preterm births were examined alone, MEHP, mono-(2-ethyl-5-oxohexyl) phthalate, MECPP, Σ DEHP, MBP, and mono-(3-carboxypropyl) phthalate metabolite levels were all associated with significantly elevated odds of prematurity.
Conclusions and Relevance Women exposed to phthalates during pregnancy have significantly increased odds of delivering preterm. Steps should be taken to decrease maternal exposure to phthalates during pregnancy.
JAMA Pediatr. Published online November 18, 2013. doi:10.1001/jamapediatrics.2013.3699