Prevalence and predictors of phthalate exposure in pregnant women in Charleston, SC

Predictors of phthalate metabolites in urine and follicular fluid and correlations between urine and follicular fluid phthalate metabolite concentrations among women undergoing in vitro fertilization

BACKGROUND

Phthalate metabolites in follicular fluid (FF) may negatively affect normal folliculogenesis; however, the predictors of phthalate metabolite concentrations in urine and FF and relationships between urine and FF phthalate metabolite concentrations among women undergoing in vitro fertilization (IVF) are poorly understood.

OBJECTIVE

To investigate predictors of phthalate metabolites in urine and FF and correlations between urine and FF phthalate metabolite concentrations among women undergoing IVF.

METHOD

We recruited 305 women seeking infertility treatment at a reproductive center in Wuhan, China, from October to November 2016. Information regarding demographic characteristics, personal care product use and plastic material contact was obtained through direct interviews. Concentrations of 8 phthalate metabolites in urine and FF samples were measured using high-performance liquid chromatography and tandem mass spectrometry. Associations regarding metabolite concentrations in urine and FF samples were analysed by Spearman's correlation and linear regression. Generalized linear regression was used to examine potential predictors of phthalate metabolite concentrations in urine and FF.

RESULTS

Weak to moderate associations between urine and FF samples were found for monoethyl phthalate (MEP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) (correlation coefficient: MEP, 0.350; MEOHP, 0.377); no associations were observed for other metabolites. The predictive powers of urinary metabolite concentrations in determining FF metabolite concentrations were uniformly low, with R² ≤ 0.113. Body mass index (BMI) and educational level were inversely associated with the urinary concentrations of certain metabolites. Higher household income, intake of bottled drinks within 48 h, and use of shower gel and soap were frequently associated with higher urinary metabolite concentrations. BMI, higher household income and use of disposable plastic cups within 48 h were associated with higher metabolite concentrations in FF.

CONCLUSION

Phthalate metabolite concentrations in urine and FF vary according to sociodemographic characteristics and lifestyle factors. Phthalate metabolite concentrations in urine may not be appropriate for estimating ovary phthalate exposure.

Synthetic Chemicals and Cardiometabolic Health Across the Life Course Among Vulnerable Populations: a Review of the Literature from 2018 to 2019

PURPOSE OF REVIEW

Although vulnerable populations are disproportionately exposed to synthetic chemicals with endocrine disrupting properties, few recent reviews have summarized the impact of synthetic chemicals on cardiometabolic health among these groups.

RECENT FINDINGS

Of 37 eligible epidemiological studies among vulnerable populations published between January 2018 and April 2019 in which over half were prospective, the most investigated populations were pregnant women and children. Racial/ethnic minorities, individuals of low socioeconomic status (SES), and those occupationally exposed were studied the least. The most studied persistent organic pollutants (POPs) were per-/poly-fluoroalkyl substances (PFAS), and the most studied non-POPs were phenols. Across chemical classes, studies found certain POPs (e.g., PFAS) and non-POPs (i.e., phenols, phthalates, and parabens) to be associated with gestational diabetes and dysregulated glucose metabolism. Results for other cardiometabolic health outcomes were inconsistent but suggested certain chemicals may negatively affect cardiometabolic health. Synthetic chemicals likely adversely affect cardiometabolic health, but current findings were inconclusive. Few recent studies focused on racial/ethnic minorities, low SES, and occupationally exposed populations. To address poor cardiometabolic health and related disparities, more studies across vulnerable populations are warranted.

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications

Endocrine-disrupting chemicals (EDCs) are exogenous substances that are able to interfere with hormone action, likely contributing to the development of several endocrine and metabolic diseases. Among them, Bisphenol A (BPA) and phthalates contaminate food and water and have been largely studied as obesogenic agents. They might contribute to weight gain, insulin resistance and pancreatic β-cell dysfunction in pregnancy, potentially playing a role in the development of pregnancy complications, such as gestational diabetes mellitus (GDM), and adverse outcomes. Pregnancy and childhood are sensitive windows of susceptibility, and, although with not univocal results, preclinical and clinical studies have suggested that exposure to BPA and phthalates at these stages of life might have an impact on the development of metabolic diseases even many years later. The molecular mechanisms underlying this association are largely unknown, but adipocyte and pancreatic β-cell dysfunction are suspected to be involved. Remarkably, transgenerational damage has been observed, which might be explained by epigenetic changes. Further research is needed to address knowledge gaps and to provide preventive measure to limit health risks connected with exposure to EDCs.

Early life exposure to phthalates in the Canadian Healthy Infant Longitudinal Development (CHILD) study: a multi-city birth cohort

BACKGROUND

Few studies have examined phthalate exposure during infancy and early life, critical windows of development. The Canadian Healthy Infant Longitudinal Development (CHILD) study, a population-based birth cohort, ascertained multiple exposures during early life.

OBJECTIVE

To characterize exposure to phthalates during infancy and early childhood.

METHODS

Environmental questionnaires were administered, and urine samples collected at 3, 12, and 36 months. In the first 1578 children, urine was analyzed for eight phthalate metabolites: mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-3-carboxypropyl phthalate (MCPP). Geometric mean (GM) concentrations were calculated by age, together with factors that may influence concentrations. Trends with age were examined using mixed models and differences within factors examined using ANOVA.

RESULTS

The highest urinary concentration was for the metabolite MBP at all ages (GM: 15-32 ng/mL). Concentrations of all phthalate metabolites significantly increased with age ranging from GM: 0.5-15.1 ng/mL at 3 months and 1.9-32.1 ng/mL at 36 months. Concentrations of all metabolites were higher in the lowest income categories except for MEHP at 3 months, among children with any breastfeeding at 12 months, and in urine collected on dates with warmer outdoor temperatures (>17 °C), except for MBzP at 3 months and MEHP at 3 and 12 months. No consistent differences were found by gender, study site, or maternal age.

CONCLUSIONS

Higher phthalate metabolite concentrations were observed among children in lower income families. Examination of factors associated with income could inform interventions aimed to reduce infant phthalate exposure.

Determinants and characterization of exposure to phthalates, DEHTP and DINCH among pregnant women in the PROTECT birth cohort in Puerto Rico

BACKGROUND

As a result of evidence suggesting phthalate toxicity, their use has decreased in recent years. However, new phthalates and non-phthalate replacements have emerged in their place, with unknown potential impacts on health.

METHODS

We measured 15 phthalate, two di(2-ethylhexyl)terephthalate (DEHTP), and two di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH) urinary metabolites, collected up to three times during pregnancy from 994 women in Northern Puerto Rico (2011-2017). We used tests of linear trend to assess changes in concentrations over time and linear mixed models to identify predictors of exposure (sociodemographic characteristics, drinking water sources, diet, product use).

RESULTS

Several phthalate metabolites decreased over the study period indicating decreased exposure, while the geometric mean of DEHTP metabolites (molecular sum) increased threefold between 2014 and 2017. Intraclass correlations revealed low to moderate reproducibility of these biomarkers across pregnancy. Several metabolites were associated with maternal age, income, education, pre-pregnancy BMI, drinking public water, use of cleaning and personal care products, and ice cream consumption. DINCH metabolite concentrations remained low throughout the study period.

CONCLUSION

Although exposure to some phthalates may be decreasing, exposure to replacements, such as DEHTP, is increasing. Additional studies are needed to further characterize sources of phthalate replacement chemicals and potential exposure-related health effects among vulnerable populations.

Association of self-reported personal care product use with blood glucose levels measured during pregnancy among women from a fertility clinic

BACKGROUND

Personal care products (PCPs), known sources of endocrine disrupting chemicals (EDCs) such as phthalates and parabens, are widely used among women of reproductive age. EDCs have been linked to pregnancy complications such as gestational diabetes (GDM), and PCP use could represent a modifiable source of exposure in this sensitive time window. Yet, to our knowledge, no study has directly evaluated the association between pregnancy use of PCP and late pregnancy glucose levels, established risk factors for complications such as GDM.

METHODS

A total of 233 women from the Environment and Reproductive Health (EARTH) Study had data available on 1st and/or 2nd trimester PCP use, assessed through self-reported use over the previous 24 h, and blood glucose levels after the glucose loading test (GLT), taken at late 2nd trimester. Associations between each individual PCP and total PCP with glucose levels were evaluated in multivariable adjusted linear regression models.

RESULTS

Both positive and negative differences in glucose levels were observed when comparing users vs. non-users of several PCPs including 2nd trimester use of deodorant (adjusted mean difference: 12.2 mg/dL, 95% CI: -0.6, 24.9); bar soap (6.9 mg/dL, 95% CI: -0.9, 14.7 mg/dL); and liquid soap (-13.3, 95% CI: -26.8, 0.1 mg/dL), and 1st trimester use of sunscreen (-14.6 mg/dL, 95% CI: -27.8, -1.5 mg/dL). Total number of PCPs used in the 2nd trimester was also associated with higher glucose levels, with the largest difference of 20 mg/dL when comparing individuals who used eight vs none PCPs (95% CI: 3-37).

CONCLUSIONS

In a pregnancy cohort of women seeking care at a fertility clinic, we found the use of several PCPs to be positively or negatively associated with glucose levels in the late second trimester, which may reflect increased risk of GDM and subsequent perinatal outcomes. These results strengthen the role of product use as a potentially modifiable source of EDCs that may impact glucose levels.

Monitoring of urinary phthalate metabolites among pregnant women in Isfahan, Iran: the PERSIAN birth cohort

Recently, increasing evidences have shown that the exposure to phthalates can adversely affect health status of pregnant women and their newborns. However, only a limited number of studies have investigated the concentrations of these compounds in the body fluids of pregnant women. In the present study, we aimed to evaluate the concentrations of phthalate metabolites in urinary samples of pregnant women in correlation with the population characteristics and different lifestyle factors. The study was conducted in 2018-2019 and urinary samples were taken from 121 pregnant women during their first pregnancy trimester who lived in Isfahan, Iran. The concentrations of monobutyl phthalate (MBP), mono-benzyl phthalate (MBzP), mono-2-ethylhexyl phthalate (MEHP), and mono (2-ethyl-5hydroxyhexyl) phthalate (MEHHP) metabolites in urinary samples were determined by gas chromatography mass spectrometry (GC/MS). The socio-demographic profile of the participants (maternal education, age, family income, pre-pregnancy BMI), their lifestyle information (smoking habit, food pattern, and physical activity), cleaning products use data (cosmetic and household cleaning products) were collected by the use of PERSIAN birth cohort questionnaire. MBzP, MBP, MEHP, and MEHHP were detected in 100% of participated pregnant women with the mean concentration of 342.5 ± 193.8, 308.5 ± 229.4, 126.5 ± 118.3, and 866.5 ± 307.6 μg/g creatinine, respectively. Significant correlations were observed between the mean concentration of urinary phthalate metabolites with the following variables: using plastic packaging (for bread, lemon juice, pickle, leftover, and water), lower physical activity, passive smoking exposure during pregnancy (p value<0.05). Furthermore, the pre-pregnancy BMI (r = 0.27, r = 0.3, r = 0.26, and r = 0.26), use of the household cleaning products (r = 0.2, r = 0.22, r = 0.3, and r = 0.26), utilize of the cosmetic products (r = 0.46, r = 0.48, r = 0.49, and r = 0.54), and passive smoking status (r = 0.5, r = 0.44, r = 0.44, and r = 0.26) directly correlated with the urinary concentrations of MBP, MBzP, MEHP, and MEHHP, respectively. No significant association was seen between the concentration of urinary phthalate metabolites with the maternal education level and family income. According to our findings, higher amounts of phthalate metabolites were detected in urinary samples of pregnant women who were passive smokers, or had higher pre-pregnancy BMI and lower physical activity, as well as those women who used higher amounts of cosmetic and household cleaning products, or used plastic packaging for food and non-food products.

Benzyl butyl phthalate (BBP) triggers the malignancy of acute myeloid leukemia cells via upregulation of PDK4

Acute Myeloid Leukemia (AML) is a cancer of hematopoietic stem cells with a rapid progression. Recent studies indicated that endocrine disruptor chemicals (EDCs) are potential risk factors for AML progression. Our present data showed that an industrial endocrine disrupting chemical, Benzyl butyl phthalate (BBP), can promote the proliferation of AML cells and decrease their sensitivity to daunorubicin (DNR) and cytarabine (Ara-C) treatments. Further, BBP can increase the glucose consumption, lactate generation, and ATP levels of AML cells. Among the measured glycolysis-related genes, BBP can increase the expression of pyruvate dehydrogenase lipoamide kinase isozyme 4 (PDK4), a mitochondrial protein that regulates the tricarboxylic acid cycle (TCA) cycle. The inhibitor of PDK4 or its specific siRNA can attenuate BBP-induced cell proliferation and ATP generation, which suggested the essential roles of PDK4 in BBP-induced glycolysis and proliferation. Further, BBP can increase the mRNA stability of PDK4, while had no effect on its transcription and protein stability. miR-15b-5p can bind with the 3'UTR of PDK4 to decrease its mRNA stability, while BBP can decrease the expression of miR-15b-5p in AML cells. Collectively, our data showed that BBP can trigger the malignancy of AML cells via regulation of miR-15b-5p/PDK4 signals.

Dietary Predictors of Phthalate and Bisphenol Exposures in Pregnant Women

Endocrine disrupting chemicals (EDCs) can disrupt fetal developmental processes during pregnancy, leading to long-term adverse outcomes in humans. A major source of exposure to EDCs, such as phthalates and bisphenols, is the food supply, primarily due to contamination from processing and packaging. Therefore, this review aimed to 1) review food-monitoring sources of phthalates and bisphenols, and 2) evaluate methodologies and provide future directions needed to establish EDC-limiting dietary recommendations in pregnancy. Using PubMed, 10 peer-reviewed studies were found on dietary predictors of EDC exposure in pregnancy, and all were selected for review. Use of plastic containers in pregnancy was associated with higher urinary phthalate metabolites, whereas canned food consumption was associated with higher urinary bisphenol A (BPA) concentrations. Foods and dietary patterns associated with healthier food choices (e.g., organic/grown/raised/caught foods, folic acid supplements, vegetarianism) were generally associated with lower urinary phthalate metabolite and BPA concentrations. Despite the many food-monitoring studies reporting high BPA and phthalate concentrations in various foods, the designs of most studies described here were not sufficiently robust to consistently detect associations of specific foods/food groups with phthalates and BPA. Given the limitations of currently available research, future studies should incorporate more valid questionnaires to accurately assess dietary EDC exposure, strive for concurrent diet and exposure assessment, and assess whether geographical and cultural differences modify associations of diet with gestational EDC exposures. Such progress will be critical for developing dietary recommendations that ensure the safety and health of pregnant women.

Racial disparity in maternal phthalates exposure; Association with racial disparity in fetal growth and birth outcomes

Experimental and observational data implicate phthalates as developmental toxicants. However, few data are available to assess the maternal risks of gestational exposure by race and infant sex. To begin to address this data gap, we characterized associations between maternal urinary phthalate metabolites and birth outcomes among African American and white mothers from a southeastern U.S. population. We enrolled pregnant African American (n = 152) and white (n = 158) women with singleton live births between 18 and 22 weeks gestation. We measured phthalate metabolites (mono-n-butyl phthalate (MBP), monoisobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), monoethyl phthalate (MEP), monomethyl phthalate (MMP), and the sums of DEHP (ΣDEHP) and DBP (ΣDBP) metabolites) in up to two gestational urine specimens from mothers, and evaluated confounder-adjusted associations per natural log unit greater concentration with birth weight for gestational age z-score, small for gestational age (SGA; <10th %tile), preterm birth (PTB; <37 weeks gestation), and low birth weight (LBW; <2500 g). We also tested for interactions by maternal race and infant sex. We found that lower z-scores were associated with greater MiBP (β = -0.28; 95% CI: -0.54, -0.02) and MMP (β = -0.30; 95% CI: -0.52, -0.09) concentrations, while MEP interacted with race (p = 0.04), indicating an association among whites (β = -0.14; 95% CI: -0.28, 0.001) but not among African Americans (β = 0.05; 95% CI = -0.09, 0.19). Greater MiBP (OR = 2.82; 95% CI: 1.21, 6.56) and MEOHP (OR = 2.80; 95% CI: 1.05, 7.42) were associated with an overall higher SGA risk, greater MEHP was associated with higher SGA risk (p = 0.10) in whites (OR = 3.26 95% CI: 0.64, 16.56) but not in African Americans (OR = 0.71 95% CI: 0.07, 7.17), and the associations for MiBP (p = 0.02) and ΣDBP (p = 0.02) varied by infant sex. We detected interactions for PTB in which African Americans were at higher risk than whites for greater MiBP (p = 0.08) and MEP (p = 0.02) although lower risk for greater MEHP (p = 0.09). Greater MEP was associated with an overall higher LBW risk (OR = 1.33; 95% CI: 0.95, 1.86), and males were at higher risk than females with greater MBP (p = 0.002), MiBP (p = 0.02), MBzP (p = 0.01), MEP (p = 0.002), MMP (p = 0.09), and ΣDBP (p = 0.01) concentrations. Overall, our results suggest that gestational phthalate exposure is associated with adverse maternal birth outcomes, and that the effects vary by maternal race and infant sex.

The extent and predictors of phthalate exposure among couples undergoing in vitro fertilization treatment

Phthalates are chemicals used as plasticizers and solvents in many consumer products but are suspected of disrupting the endocrine system and are known for their reproductive/developmental health risks. This study examined the extent and predictors of phthalate exposure among 599 couples undergoing in vitro fertilization. A questionnaire was administered to obtain sociodemographic, health, and lifestyle data, and two spot urine samples were collected from the couples to analyze eight phthalate metabolites, cotinine (COT) as a smoking index, and creatinine to adjust for urine dilution. Seven phthalate metabolites were detected in > 94% of the urine samples, and monobenzyl phthalate (MBzP) was found in 24% of the women and 26% of their male partners. Median phthalate levels were highest for monoethyl phthalate (MEP), at 333.26 μg/l in women and 290 μg/l in male partners, and lowest for MBzP, at 1.17 μg/l in women and 1.14 μg/l in male partners. Correlation coefficients of ≥ 0.4 between the women and their male partners for the eight urinary phthalate metabolites may indicate a shared source of exposure. A multivariate regression model was used to assess the association between predictors and each urinary phthalate metabolite. Several potential predictors for the variations in specific urinary phthalate metabolites were identified, including the body mass index, age, socioeconomic status, and regional distribution for both women and their male partners but with slightly different patterns. Women with a history of breastfeeding, using bottled water for cooking and storing food in plastic bags had lower MEP (8.7%), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) (9.2%), and both mono-iso-butyl phthalate and MECPP (8.2 and 8.1%). A history of contraceptive use was associated with an increase in MECPP (8.7%), mono-(2-ethyl-5-hydroxyhexyl) phthalate (11.4%), mono-(2-ethyl-5-oxohexyl) phthalate (7.6%), and the molar sum of bis (2-ethylhexyl) phthalate metabolites (8.9%). Urinary COT levels were associated with an increase of 10-16% in all urinary metabolites in women but of only 10.5% in mono-(2-ethylhexyl) phthalate in male partners. More than 95% of the couples reported the use of cosmetics, perfumes, and personal-care products, but we were not able to find associations with urinary phthalate metabolites, perhaps due to their short half-lives. MEP levels associated with the use of household cleaning products were 11.2% higher in male partners. Our levels were generally higher than those reported elsewhere, perhaps due to different lifestyles, cultural practices, dietary habits, use of personal-care products, and governmental legislation.

Exposure to di-(2-ethylhexyl) phthalate transgenerationally alters anxiety-like behavior and amygdala gene expression in adult male and female mice

Phthalates are industrial plasticizers and stabilizers commonly found in polyvinyl chloride plastic and consumer products, including food packaging, cosmetics, medical devices, and children's toys. Di-(2-ethylhexyl) phthalate (DEHP), one of the most commonly used phthalates, exhibits endocrine-disrupting characteristics and direct exposure leads to reproductive deficits and abnormalities in anxiety-related behaviors. Importantly, increasing evidence indicates that the impacts of DEHP exposure on reproduction and social behavior persist across multiple generations. In this study, we tested the hypothesis that transgenerational DEHP exposure alters anxiety-like behavior and neural gene expression in both male and female mice. Pregnant CD-1 mice were orally dosed daily with either tocopherol-stripped corn oil or DEHP (20 or 200 μg/kg/day; 500 or 750 mg/kg/day) from gestational day 10.5 until birth to produce the F1 generation. Females from each generation were bred with untreated, unrelated CD-1 males to produce subsequent generations. Behavior and gene expression assays were performed with adult, intact F3 males and females. Transgenerational DEHP exposure increased time spent in the open arm in the elevated plus maze for adult females (750 mg/kg/day lineage), but not males. In adult females, we observed a down-regulation of mRNA expression of estrogen receptor 1 in the 200 μg/kg/day and 500 mg/kg/day treatment lineages, mineralocorticoid receptor in the 200 μg/kg/day lineage, and dopamine receptor 2 in the 20 μg/kg/day and 750 mg/kg/day lineages. In adult males, we found an up-regulation of estrogen receptor 2 in the 20 and 200 μg/kg/day lineages, and dopamine receptor 1 in the 20 μg/kg/day and 750 mg/kg/day lineages. No hippocampal gene expression modifications were observed in response to treatment. These results implicate dose-specific transgenerational effects on behavior and neural gene expression in adult male and female mice.

Distribution and Dietary Predictors of Urinary Phthalate Metabolites among Pregnant Women in Shanghai, China

The exposure of pregnant women to phthalates is a major concern due to their adverse effect on developmental outcomes. Diet is an important pathway for exposure to phthalate compounds. Nevertheless, studies on dietary exposure of pregnant women to phthalates in China are limited. We aimed to assess the distribution and dietary predictors of phthalate exposure among pregnant women in China. We measured the levels of 10 urinary phthalate metabolites using high-performance liquid chromatography coupled with tandem mass spectrometry in 210 pregnant women as part of the 2015 China National Chronic Disease and Nutrition Survey in Shanghai. We assessed the urinary specific gravity-adjusted phthalate metabolite levels along with potential demographic and dietary predictors. Multivariable linear regression analysis was used to examine the relationship between each potential demographic variable and dietary predictor and urinary phthalate metabolites. Seven urinary phthalate metabolites were detected in >95% of pregnant women. The geometric mean (GM) of urinary phthalate biomarker values were highest for monobutyl phthalate (GM: 25.29 ng/mL) and monoisobutyl phthalate (GM:11.18 ng/mL). Multivariate regression analysis indicated that a lower educational level was associated with elevated urinary phthalate metabolite levels. Edible seaweed consumption had a positive correlation with urinary monoethyl phthalate and monoisobutyl phthalate levels, and the total molar sum of Di-(2-ethylhexyl) phthalate metabolites. These findings offer important data on the dietary exposure to phthalates in pregnant Chinese women and suggest interventions to improve food safety.

A Review of Biomonitoring of Phthalate Exposures

Phthalates (diesters of phthalic acid) are widely used as plasticizers and additives in many consumer products. Laboratory animal studies have reported the endocrine-disrupting and reproductive effects of phthalates, and human exposure to this class of chemicals is a concern. Several phthalates have been recognized as substances of high concern. Human exposure to phthalates occurs mainly via dietary sources, dermal absorption, and air inhalation. Phthalates are excreted as conjugated monoesters in urine, and some phthalates, such as di-2-ethylhexyl phthalate (DEHP), undergo secondary metabolism, including oxidative transformation, prior to urinary excretion. The occurrence of phthalates and their metabolites in urine, serum, breast milk, and semen has been widely reported. Urine has been the preferred matrix in human biomonitoring studies, and concentrations on the order of several tens to hundreds of nanograms per milliliter have been reported for several phthalate metabolites. Metabolites of diethyl phthalate (DEP), dibutyl- (DBP) and diisobutyl- (DiBP) phthalates, and DEHP were the most abundant compounds measured in urine. Temporal trends in phthalate exposures varied among countries. In the United States (US), DEHP exposure has declined since 2005, whereas DiNP exposure has increased. In China, DEHP exposure has increased since 2000. For many phthalates, exposures in children are higher than those in adults. Human epidemiological studies have shown a significant association between phthalate exposures and adverse reproductive outcomes in women and men, type II diabetes and insulin resistance, overweight/obesity, allergy, and asthma. This review compiles biomonitoring studies of phthalates and exposure doses to assess health risks from phthalate exposures in populations across the globe.

Spatial distribution and mass loading of phthalate esters in wastewater treatment plants in China: An assessment of human exposure

The occurrence and fate of nine phthalate esters (PAEs), including dimethyl phthalate (DMP), diethyl phthalate (DEP), di‑n‑butyl phthalate (DBP), di-isobutyl phthalate (DIBP), benzyl butyl phthalate (BzBP), di (2‑ethylhexyl) phthalate (DEHP), di‑n‑hexyl phthalate (DNHP), dicyclohexyl phthalate (DCHP), and di‑n‑octyl phthalate (DNOP), in sludges collected from 46 wastewater treatment plants (WWTPs) from 22 Chinese provinces were investigated. The nine PAEs were detected in almost all the sludge samples. DEHP was the most abundant congener in all sludge samples, followed by DBP and DIBP. The DEHP concentrations in sludge were in the range of 0.326-67.8 (mean: 14.7) μg/g dry weight (dw), which were at the lower bound or middle of the concentration range of DEHP in sludge globally (0.0200-3514 μg/g dw). Spatial distribution and mass loading of PAEs in WWTPs were investigated. The concentrations of Σ₉PAEs in sludges from different provinces were in the order as follows: Jilin (40.2 μg/g dw) > Liaoning (38.9 μg/g dw) > Beijing (30.7 μg/g dw), while the mass loading of ∑₉PAEs in sludges were Guangdong (10.1 tons/yr) > Liaoning (9.97 tons/yr) > Shandong (5.59 tons/yr). Our study showed that the geographical distribution of PAEs in sludges was similar to that in indoor dusts found in earlier study, suggesting the existence of a common source for these chemicals in both matrices. Based on the concentrations measured, human exposure to PAEs through sludge application in soil was evaluated and the exposure dose is minor.

Exposure to phthalates in couples undergoing in vitro fertilization treatment and its association with oxidative stress and DNA damage

This prospective study of 599 couples seeking fertility treatment and who were recruited between 2015 and 2017 was conducted to (a) explore the associations between phthalate exposure and in vitro fertilization (IVF) outcomes; and (b) examine the implication of oxidative stress as a mediator of these. We measured eight phthalate metabolites in two spot urine samples; oxidative stress biomarkers such as malondialdehyde, 8-hydroxy-2-deoxyguanosine, hydrogen peroxide, catalase (CAT), and total antioxidant capacity in follicular fluid and seminal plasma. We also examined DNA damage in sperm and granulosa cells. Couples were exposed to a broad range of phthalate compounds and seven metabolites were detected in over 94% of the urine samples, whereas monobenzyl phthalate was found in only 24% of women and 26% of men. Our results showed high levels of seven urinary phthalate metabolites (except monobenzyl phthalate) and a notable increase in many oxidative stress markers in both follicular fluid and seminal plasma. However, their associations with exposure were rather limited. Multivariate binomial regression modeling showed higher levels of follicular CAT levels reduced the probability of fertilization rate (≤ 50%) [Adjusted relative risk (RR_adj) = 0.52, p = 0.005] and unsuccessful live birth (RR_adj = 0.592, p = 0.023). We observed a 46% decrease in the probability of clinical pregnancy in association with an elevated percentage of DNA in the tail (RR_adj = 0.536, p = 0.04). There was a 32% and 22% increase in the probability of clinical pregnancy and unsuccessful live birth associated with higher levels of mono-(2-ethylhexyl) phthalate (RR_adj = 1.32, p = 0.049) and monoethyl phthalate (RR_adj = 1.22, p = 0.032) in women, respectively. In contrast, the probability of clinical pregnancy reduced by 20% with higher levels of mono-(2-ethyl-5-carboxypentyl) phthalate (RR_adj = 0.797, p = 0.037) and 19.6% with mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (RR_adj = 0.804, p = 0.041) in men. Other oxidative stress biomarkers or urinary phthalate metabolites showed suggestive relationships with certain IVF outcomes. Lastly, our results demonstrated that elevated levels of CAT in follicular fluid might have a positive impact on fertilization rate ≥ 50% and successful live birth. CAT seems to play a potential role in mediating the relationship between the risk of poor fertilization rate and MEOHP and mono-isobutyl phthalate. Additional data are required to understand the clinical implications of oxidative stress and its contribution to the reproductive toxicity of phthalate exposure.

Phthalate exposure during pregnancy and long-term weight gain in women

BACKGROUND

Phthalates are known endocrine disruptors and peroxisome proliferator-activated receptor (PPAR) activators, potentially capable of promoting an obesogenic effect. Pregnant women are especially vulnerable to phthalate exposure due to physiological and metabolic changes during pregnancy, including those related to the metabolism of xenobiotics. Phthalate exposure during pregnancy has been associated with early gestational weight gain, however, its effect on long-term weight gain remains unclear. The aim of the present study was to evaluate the association between phthalate exposure during pregnancy and long-term changes in weight among women.

METHODS

Urinary phthalate concentrations, socioeconomic, anthropometry and information on diet and socioeconomic status were collected during pregnancy from 178 women from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort. Maternal body weight and diet information was also collected up to 5 times in the first year postpartum and twice during follow-up visits 5.2-10.7 years later. A path analysis was performed to assess associations between urinary phthalate metabolite levels during pregnancy and change in weight (kg) per year after delivery, including age, education, living with/without partner, parity, daily energy intake and breastfeeding duration.

RESULTS

The mean age at pregnancy was 27.3 ± 5.9 years and mean body mass index during the first postpartum year was 27.07 ± 4.22 kg/m². On average, women gained 3.48 kg (0.52 ± 0.84 kg/year). A unit increase in log-transformed mono-3-carboxypropyl phthalate (MCPP) was associated with 0.33 kg (95% CI: 0.09, 0.56) higher weight gain per year, and mono-benzyl phthalate (MBzP) with 0.21 kg (95% CI: -0.38, -0.03) lower weight gain per year.

CONCLUSION

Exposure to certain phthalates during pregnancy may be associated with long-term weight change in women. More studies on the effects of phthalate exposure during pregnancy on women's long-term health are required.

Predictors of urinary antibiotics in children of Shanghai and health risk assessment

BACKGROUND

An extensive exposure to antibiotics has been confirmed in children, but the predictors and potential health risk remain unclear.

OBJECTIVE

To investigate the predictors of antibiotics in urine and potential health risk in children of Shanghai.

METHODS

We selected 284 school children aged 8-11 years from a central area of Shanghai, China, in 2017. Ultra-performance liquid chromatography coupled with high-resolution mass spectrometry was used to measure 20 antibiotics, including four human antibiotics (HAs), six veterinary antibiotics (VAs), 10 human/veterinary antibiotics (H/VAs), and three metabolites in first morning urine. Logistic regression model was used to examine the associations of 17 variables related to demographic and socioeconomic factors, recent antibiotic use, drinking water intake, food consumption, and anthropometric measurements with the detection frequency of HAs, VAs, or H/VAs in urine. After daily intake was estimated, health risk was assessed for VAs and H/VAs by using hazard quotient (HQ) and hazard index (HI) based on microbiological or toxicological effects.

RESULTS

The detection frequencies of 20 antibiotics and three metabolites ranged from 0 to 27.8% with an overall detection frequency being 56.0%. The detection frequency of HAs increased with age and screen time at weekend. Sex, age, family income and screen time were positively associated with the detection frequencies of VAs and H/VAs. Children reporting antibiotic use in the past three months had a higher detection frequency of HAs. Children with a higher consumption frequency of dairy products had a higher detection frequency of VAs + H/VAs, but a lower detection frequency of HAs. An increased overall detection frequency of all antibiotics was seen in children with higher consumption frequencies of aquatic products, livestock and poultry meat, or milk and dairy products. HQ >1 was only found for ciprofloxacin (5.6%) and ofloxacin (0.4%) based on microbiological effect. HI >1 was found in 6.0% of children for microbiological effect and none was found for toxicological effect.

CONCLUSIONS

Predictors for antibiotics in urine for children included sex, age, family income, screen time, clinical use, and animal-derived food consumption. There was potential health risk for children with exposure to antibiotics.

Urinary Phthalate Metabolites in Common Bottlenose Dolphins (Tursiops truncatus) From Sarasota Bay, FL, USA

Phthalates are chemical additives to common consumer goods including cleaning products, cosmetics, personal care products, and plastic. Because they are not chemically bound to these products and are widely used, the potential for environmental contamination is significant. Phthalates and their metabolites have been associated with endocrine disruption and reproductive impairment, among other adverse health effects, in laboratory animals and human epidemiologic studies. Common bottlenose dolphins (Tursiops truncatus) are vulnerable to environmental pollutants due to their apex position in the food chain, long life spans, and habitat overlap with developed coastal areas. The objective of this study was to quantify phthalate metabolite concentrations in urine collected from bottlenose dolphins in Sarasota Bay, Florida, during May 2016 (n = 7) and May 2017 (n = 10). Screening of nine phthalate monoester metabolites in bottlenose dolphin urine was performed by liquid chromatography tandem mass spectrometry using methods adapted from those used for analyzing human samples. At least one phthalate metabolite was detected in 71% of the dolphins sampled across both years, with the highest concentrations detected for monoethyl phthalate (MEP; GM = 5.4 ng/ml; 95%CI: 1.3-22.0 ng/ml) and mono-(2-ethylhexyl) phthalate (MEHP; GM = 1.9 ng/ml; 95%CI: 1.1-3.2 ng/ml). These data demonstrate exposure to two of the most commonly used phthalates in commercial manufacturing, diethyl phthalate (DEP) and di-2-ethylhexyl phthalate (DEHP). This study establishes methods for urinary detection of phthalate metabolites in marine mammals and provides baseline data to address a significant and growing, yet poorly understood, health threat to marine wildlife.