Phthalates are multifunctional chemicals that are often used in personal care products, medications, and plastics, resulting in daily exposure in adults as well as children. Certain phthalates are endocrine disrupting compounds (EDCs) with known anti-androgenic properties.1

A prospective cohort study of 407 women-child pairs from New York City revealed that increasing maternal urinary butyl benzyl phthalate (BBzP) metabolites during pregnancy were associated with a 50% increased likelihood of early-onset (presenting ≤24 months of age) eczema in children.2 In another study from New York City, maternal urinary phthalate metabolite concentrations were associated with poorer orientation and quality of alertness in girls.3

A study assessed the association of prenatal phthalate exposure with behavior and executive functioning at 4-9 years of age. Increased loge concentrations of low molecular weight (LMW) phthalate metabolites were found to be associated with poorer scores on the aggression, conduct problems, attention problems, and depression clinical scales; and externalizing problems and behavioral symptom index composite scales.4

Several studies suggest a potential link between gestational/childhood phthalate exposure and neurodevelopment.1 Prenatal phthalate exposure at environmental levels has also been shown to adversely affect male reproductive development in humans.5 A potential change in the thyroid hormones of pregnant women during early pregnancy after di-n-butyl phthalate (DnBP) exposure has also been noted.6

Exposure to phthalates also increases the risk of recurrent pregnancy loss.7 A study assessed a group of 256 women at Massachusetts General Hospital Fertility Center from 2004 to 2014 undergoing medically assisted reproduction. Women with the highest concentrations of di-(2-ethylhexyl) phthalate (DEHP) were 60% more likely to lose a pregnancy before 20 weeks than those with the lowest concentrations. Another study followed 350 pregnant women who delivered their babies at Brigham and Women’s Hospital in Boston from 2006 to 2008. Women with the highest urinary concentrations of monoethyl phthalate (MEP) had two-fold higher risk of excessive weight gain during pregnancy as compared to those with the lowest concentrations. Those with the greatest mid-pregnancy MEP concentrations had a seven-fold increased likelihood of impaired glucose tolerance in mid-pregnancy than women with the lowest concentrations.8 Higher exposure to some phthalates and phenols has also been linked with lower BP during pregnancy.9

Considering the harmful effects of phthalates, a strategy needs to be developed to reduce phthalate exposure among reproductive-aged women. People should switch to unscented personal care products that are “fragrance-free” or “phthalate-free.”8

References

1. Braun JM, Sathyanarayana S, Hauser R. Phthalate Exposure and Children’s Health. Curr Opin Pediatr. 2013 Apr; 25(2): 247–254.
2. Just AC, Whyatt RM, Perzanowski MS, et al. Prenatal exposure to butylbenzyl phthalate and early eczema in an urban cohort. Environ Health Perspect. 2012 Oct;120(10):1475-80.
3. Engel SM, Zhu C, Berkowitz GS, et al. Prenatal phthalate exposure and performance on the Neonatal Behavioral Assessment Scale in a multiethnic birth cohort. Neurotoxicology. 2009 Jul;30(4):522-8.
4. Engel SM, Miodovnik A, Canfield RL, et al. Prenatal phthalate exposure is associated with childhood behavior and executive functioning. Environ Health Perspect. 2010 Apr;118(4):565-71.
5. Swan SH, Main KM, Liu F, et al. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect. 2005 Aug;113(8):1056-61.
6. Huang P-C, Tsai C-H, Liang W-Y , et al. Early Phthalates Exposure in Pregnant Women Is Associated with Alteration of Thyroid Hormones. PLoS One. 2016; 11(7): e0159398.
7. Liao KW, Kuo PL, Huang HB, et al. Increased risk of phthalates exposure for recurrent pregnancy loss in reproductive-aged women. Environ Pollut. 2018 Oct;241:969-977.
8. Available from: https://www.hsph.harvard.edu/news/features/phthalates-exposure-pregnancy-loss-gestational-diabetes/9. Warembourg C, Basagaña X, Seminati C, et al. Exposure to phthalate metabolites, phenols and organophosphate pesticide metabolites and blood pressure during pregnancy. Int J Hyg Environ Health. 2018 Dec 27.