Trimester-specific phthalate concentrations and glucose levels among women from a fertility clinic

Environ Health. 2018 Jun 14;17(1):55. doi: 10.1186/s12940-018-0399-5.


Background: Subfertile women are at increased risk of glucose intolerance in pregnancy. Based on epidemiologic studies, exposure to certain phthalates is associated with diabetes, elevated glucose, and increased insulin resistance.

Objectives: To evaluate the association between urinary phthalate metabolites and pregnancy glucose levels in women seeking medically assisted reproduction.

Methods: We evaluated 245 women participating in a prospective cohort study based at a large fertility clinic who delivered live births and had data on pregnancy urinary phthalate metabolite concentrations and blood glucose levels. Urinary phthalate metabolite concentrations were from single spot urine samples collected in 1st and 2nd trimesters. Blood glucose data was abstracted from medical records for non-fasting 50-g glucose challenge tests at 24-28 weeks gestation. Multivariable linear regression models were used to evaluate associations between 7 urinary phthalate metabolites in quartiles and mean glucose adjusted for potential confounders.

Results: Eighteen percent of women had glucose levels ≥ 140 mg/dL. Second trimester monoethyl phthalate (MEP) concentrations were positively associated with glucose levels, with adjusted mean (95%CI) glucose levels of 121 mg/dl (114, 128) vs. 109 mg/dL (103, 116) for women in highest and lowest quartiles, respectively. Women in the highest quartile of second trimester mono-isobutyl phthalate (MiBP) concentrations had a mean glucose level 14 mg/dL lower compared to women in the lowest quartile. No other urinary phthalate metabolites were associated with glucose levels.

Conclusions: MEP and MiBP-metabolites of diethyl phthalate and dibutyl phthalate, respectively-were associated with higher pregnancy glucose in subfertile women-a population at high risk of glucose intolerance in pregnancy.

Keywords: Blood glucose levels; Endocrine disruptors; Infertility; Phthalates; Pregnancy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors*
  • Blood Glucose / analysis*
  • Body Mass Index*
  • Boston
  • Environmental Pollutants / urine*
  • Female
  • Fertility Agents / therapeutic use*
  • Humans
  • Middle Aged
  • Phthalic Acids / urine*
  • Pregnancy
  • Pregnancy Trimester, First / blood
  • Pregnancy Trimester, First / urine
  • Pregnancy Trimester, Second / blood
  • Pregnancy Trimester, Second / urine
  • Prospective Studies
  • Young Adult


  • Blood Glucose
  • Environmental Pollutants
  • Fertility Agents
  • Phthalic Acids