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Daily exposure to chemicals used in the manufacture of plastic food containers and many cosmetics may be tied to nearly 56,600 preterm births in the United States in 2018, a new study shows. The resulting medical costs, the authors of the report say, were estimated to reach a minimum of $1.6 billion and as much as $8.1 billion over the lifetime of the children.

For decades, the chemicals, called phthalates, have been shown to interfere with the function of certain hormones, signaling compounds that circulate in the blood and guide much of the body’s processes. Exposure to these toxins, which is believed to occur as consumer products break down and are ingested, has been linked to obesity, cancer, and fertility issues, among many other health concerns.

Led by researchers at ��ɫtv Grossman School of Medicine, the new analysis of phthalate exposure in more than 5,000 American mothers has specifically linked it to increased risk of lower weight and gestational age (the period of time between conception and birth) among newborns. These risk factors, the authors say, are known to at least modestly heighten risk for infant death and interfere with academic performance and may potentially contribute to heart disease and diabetes.

“Our findings uncover the tremendous medical and financial burden of preterm births we believe are connected to phthalates, adding to the vast body of evidence that these chemicals present a serious danger to human health,” said study lead author “There is a clear opportunity here to lessen these risks by either using safer plastic materials or by reducing the use of plastic altogether whenever possible,” added Dr. Trasande, the Jim G. Hendrick, MD, Professor of Pediatrics in the at ��ɫtv Langone Health.

The study, , is believed to be the largest of its kind to date and includes information from a much more racially and ethnically diverse group of women than previous studies on the topic, says Dr. Trasande.

For the research, the team analyzed data from the Environmental Influences on Childhood Health Outcomes (ECHO) program, an initiative by the National Institutes of Health to better understand the effects of a wide range of environmental, social, and economic factors on children’s health. The information, which ranged from access to food and the impact of racism and income inequality on toxin exposures, allowed researchers to account for and separate out demographic factors besides phthalates that could influence preterm birth, says Dr. Trasande.

To assess prenatal phthalate exposure, the researchers measured levels of 20 different metabolites (the components into which the chemicals break down within the body) in urine samples collected at three points during each subject’s pregnancy. Then, the team looked for associations between these metabolite levels and preterm births. Next, they estimated the resulting monetary costs from intensive care unit stays and other related medical bills and lost worker productivity over a lifetime from lowered IQ points.

Besides examining overall exposure to the toxins, the authors also searched for distinctions between specific phthalates. In particular, they compared di-2-ethylhexyl phthalate (DEHP), a chemical long used to make plastic more flexible, with several newer replacements for DEHP, which has faced heightened scrutiny in recent years.

According to the findings, when grouping mothers based on the amount of DEHP metabolites in their urine, the 10 percent with the highest levels had a 50 percent increased risk of giving birth before week 37 of their pregnancy, compared with the 10 percent with the lowest levels. Meanwhile, the risk for preterm birth was doubled for women exposed to the highest quantities of three common DEHP alternatives, di-isodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP), compared with those who had little to no exposure.

“These results demonstrate the need to regulate phthalates as a class rather than trying to address them one at a time,” said Dr. Trasande, who is also a professor in the at ��ɫtv Langone. “Otherwise, investigators are likely going to find the same study results in another few years about the next group of chemicals used as replacements.”

According to Dr. Trasande, who is also the director of ��ɫtv Langone’s and the , the authors next plan to expand their analysis to exposures in other countries and to examine the health effects of preventing phthalate exposure in the first place. California, among a few other states, has banned some use of phthalates in consumer products, as have European Union member states.

Dr. Trasande cautions that further research is needed to better understand the specific mechanisms behind the link between phthalate exposure and preterm birth.

Funding for the study was provided by National Institutes of Health grants P2CES033423, U2COD023375, U24OD023382, U24OD023319, UH3OD023285, UH3OD023305, UH3OD023251, UH3OD023248, UH3OD023318, UH3OD023271, UH3OD023342, UH3OD023272, and UH3OD023290.

In addition to Dr. Trasande, another ��ɫtv investigator involved in the study is Mrudula Naidu, MPH. Other study authors include Morgan Nelson, MS, at RTI International in Research Triangle Park, North Carolina; Akram Alshawabkeh, PhD, at Northeastern University in Boston; Emily Barrett, PhD, at Rutgers University in Piscataway, New Jersey; Jessie Buckley, PhD, and Anne Starling, PhD, at Johns Hopkins University in Baltimore; and Dana Dabelea, MD, at the University of Colorado in Aurora. Study co-investigators include Anne Dunlop, MD, at Emory University in Atlanta; Julie Herbstman, PhD, at Columbia University in New York; John Meeker, ScD, at the University of Michigan in Ann Arbor; Craig Newschaffer, PhD, at Pennsylvania State University in Hershey; Amy Padula, PhD, at the University of California, San Francisco; Megan Romano, PhD, at Dartmouth College in Lebanon, New Hampshire; Douglas Ruden, PhD, at Wayne State University in Detroit; Sheela Sathyanarayana, MD, at the University of Washington in Seattle; and Susan Schantz, PhD, at the University of Illinois Urbana-Champaign. Ghassan Hamra, PhD, at Johns Hopkins University, served as study senior author.

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