Premature births linked to ‘hormone-disrupting’ chemicals could cost US billions

Daily exposure to chemicals used in the manufacturing of plastic food containers and many cosmetic products may be linked to nearly 56,600 premature births in the United States in 2018, a new study suggests. The resulting medical costs, according to the report’s authors, were estimated at a minimum of $1.6 billion and as much as $8.1 billion over the children’s lifetime.

For decades, chemicals called phthalates have been shown to interfere with the functioning of certain hormones or signaling compounds that circulate in the blood and guide many of the body’s processes. Exposure to these toxins, which likely occurs when consumer products break down and are ingested, has been linked to problems with obesity, cancer, and fertility, among many other health problems.

Led by researchers at the NYU Grossman School of Medicine, the new analysis of phthalate exposure in more than 5,000 U.S. mothers specifically linked it to an increased risk of weight loss and gestational age (the period between conception and birth) in newborns.

According to the authors, these risk factors at least slightly increase the risk of childhood death, interfere with academic performance, and can potentially contribute to heart disease and diabetes. According to their results, approximately 10% of all premature births in 2018 could be linked to these chemicals.

“Our findings reveal the enormous medical and financial burden of premature births that we believe are linked to phthalates, adding to the large body of evidence that these chemicals pose a serious danger to human health,” said the lead author. of the study, Leonardo Trasande, MD, MPP.

“There is a clear opportunity here to reduce these risks, either by using safer plastic materials or by completely reducing plastic use wherever possible,” added Trasande, Jim G. Hendrick, MD, professor. in the Department of Pediatrics at NYU Langone Health. .

The study, published in the journal Lancet Planetary Healthis considered 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, Trasande says.

For the research, the team analyzed data from the Environmental Influences on Childhood Health Outcomes (ECHO) program, a National Institutes of Health initiative 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 to exposure to toxins, allowed researchers to consider and distinguish demographic factors other than phthalates that could influence premature birth, says Trasande.

To assess prenatal exposure to phthalates, researchers measured the levels of 20 different metabolites (the components that the chemicals break down into in the body) in urine samples collected at three time points during each subject’s pregnancy. Next, the team looked for associations between these metabolite levels and premature births. Then, they estimated the monetary costs resulting from intensive care unit stays and other associated medical bills, as well as workers’ loss of productivity over their lifetime due to declining IQ points.

In addition to looking at overall exposure to toxins, the authors also looked 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 substitutes for DEHP, which has come under increased scrutiny these last years.

According to the results, when grouping mothers by the amount of DEHP metabolites in their urine, the 10% with the highest levels had a 50% increased risk of giving birth before the 37th week of their pregnancy, compared to to the 10% with the lowest levels. . Meanwhile, the risk of preterm birth was doubled for women exposed to the highest amounts of three common alternatives to DEHP, diisodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP), compared to these. which was little or not exposed.

“These results demonstrate the need to regulate phthalates as a class rather than trying to address them one by one,” said Trasande, a professor in NYU Langone’s Department of Population Health. “Otherwise, investigators will likely find the same study results in a few years on the next group of chemicals used as replacements.”

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

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