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Maternal phthalate exposure, gestational length, and preterm birth risk: a prospective cohort study nested within a
Karen P Best1,2, Lisa N Yelland3,4, Liu Ge3
1SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia. karen.best@sahmri.com.
Insights
Maternal phthalate exposure, common in plastics, was studied for its link to preterm birth. This research found no clear association between phthalate levels and shortened pregnancy duration in Australian women.
Area of Science:
- Environmental Health
- Reproductive Toxicology
- Perinatal Epidemiology
Background:
- Preterm birth remains a significant cause of infant mortality, with unknown etiologies in many cases.
- Environmental exposures, including endocrine-disrupting chemicals like phthalates, are suspected contributors to preterm birth.
- Phthalates, widely used plasticizers, lead to ubiquitous human exposure, yet their impact on gestational length is inconsistently reported.
Purpose of the Study:
- To investigate the relationship between maternal urinary phthalate metabolite concentrations and gestational length.
- To assess the association between phthalate exposure and the risk of preterm birth in an Australian cohort.
Main Methods:
- A prospective cohort study involving 605 pregnant women in South Australia.
- Quantification of 13 urinary phthalate metabolites using liquid chromatography-tandem mass spectrometry between 22-26 weeks' gestation.
- Linear regression models analyzed associations between phthalate levels and gestational length, controlling for maternal factors.
Main Results:
- Phthalate metabolites were detected in over 99% of samples, with mono-ethyl phthalate (MEP), mono-isobutyl phthalate (MiBP), and mono-butyl phthalate (MBP) being most prevalent.
- No significant association was observed between maternal phthalate metabolite concentrations and gestational length in adjusted or unadjusted analyses.
- No significant link was found between phthalate exposure and an increased risk of preterm birth.
Conclusions:
- Widespread maternal phthalate exposure in this Australian cohort did not show a clear association with shortened gestation.
- Further monitoring of emerging plasticizer exposures is necessary.
- Findings contribute to understanding environmental impacts on maternal and infant health and inform public health policy.
Background:
Preterm birth (< 37 weeks gestation) is a leading cause of infant morbidity and mortality, yet the underlying causes remain unknown in many cases. Environmental exposures, including endocrine-disrupting chemicals such as phthalates, have been implicated in preterm birth risk. Phthalates are commonly used as plasticisers in consumer products, resulting in widespread human exposure. While some studies suggest an association between maternal phthalate exposure and reduced gestational length, findings remain inconsistent. This study aimed to investigate the relationship between urinary phthalate metabolite concentrations and gestational length in an Australian pregnancy cohort.
Methods:
This prospective cohort study was nested within the Omega-3 to Reduce the Incidence of Prematurity (ORIP) trial. A total of 605 women with singleton pregnancies from South Australia provided urine samples between 22- and 26-weeks' gestation for phthalate metabolite analysis. Thirteen phthalate metabolites were quantified using liquid chromatography-tandem mass spectrometry. Gestational age at birth was determined from medical records. Linear regression models assessed associations between phthalate concentrations and gestational length, adjusting for maternal characteristics including age, BMI, socioeconomic status, education, smoking, and alcohol consumption.
Results:
Phthalate metabolites were detected in > 99% of urine samples, with the highest concentrations observed for mono-ethyl phthalate (MEP), mono-isobutyl phthalate (MiBP), and mono-butyl phthalate (MBP). There was no evidence of an association between phthalate exposure and gestational length in either unadjusted or adjusted analyses. No significant association was found between phthalate exposure and preterm birth risk.
Conclusions:
Despite widespread phthalate exposure, no clear link was identified between maternal phthalate levels and shortened gestation in this Australian cohort. However, continued surveillance is needed to monitor emerging plasticiser exposures and inform public health policies on maternal and infant health.
Trial Registration Number:
Australian New Zealand Clinical Trials Registry number, ACTRN12613001142729. Date of registration: 27/09/2013.
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