Environmental phthalate exposure and preterm birth

JAMA Pediatr. 2014 Jan;168(1):61-67. doi: 10.1001/jamapediatrics.2013.3699.


Importance: Preterm birth is a leading cause of neonatal mortality, with a variety of contributing causes and risk factors. Environmental exposures represent a group of understudied, but potentially important, factors. Phthalate diesters are used extensively in a variety of consumer products worldwide. Consequently, exposure in pregnant women is highly prevalent.

Objective: To assess the relationship between phthalate exposure during pregnancy and preterm birth.

Design, setting, and participants: This nested case-control study was conducted at Brigham and Women's Hospital, Boston, Massachusetts. Women were recruited for a prospective observational cohort study from 2006-2008. Each provided demographic data, biological samples, and information about birth outcomes. From within this group, we selected 130 cases of preterm birth and 352 randomly assigned control participants, and we analyzed urine samples from up to 3 time points during pregnancy for levels of phthalate metabolites.

Exposure: Phthalate exposure during pregnancy.

Main outcomes and measures: We examined associations between average levels of phthalate exposure during pregnancy and preterm birth, defined as fewer than 37 weeks of completed gestation, as well as spontaneous preterm birth, defined as preterm preceded by spontaneous preterm labor or preterm premature rupture of the membranes (n = 57).

Results: Geometric means of the di-2-ethylhexyl phthalate (DEHP) metabolites mono-(2-ethyl)-hexyl phthalate (MEHP) and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), as well as mono-n-butyl phthalate (MBP), were significantly higher in cases compared with control participants. In adjusted models, MEHP, MECPP, and Σ DEHP metabolites were associated with significantly increased odds of preterm birth. When spontaneous preterm births were examined alone, MEHP, mono-(2-ethyl-5-oxohexyl) phthalate, MECPP, Σ DEHP, MBP, and mono-(3-carboxypropyl) phthalate metabolite levels were all associated with significantly elevated odds of prematurity.

Conclusions and relevance: Women exposed to phthalates during pregnancy have significantly increased odds of delivering preterm. Steps should be taken to decrease maternal exposure to phthalates during pregnancy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case-Control Studies
  • Environmental Exposure / adverse effects*
  • Female
  • Humans
  • Infant, Newborn
  • Massachusetts / epidemiology
  • Maternal Exposure*
  • Phthalic Acids / adverse effects*
  • Phthalic Acids / urine
  • Pregnancy
  • Premature Birth / chemically induced*
  • Premature Birth / urine
  • Prospective Studies
  • Risk Factors
  • Young Adult


  • Phthalic Acids
  • phthalic acid