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Phthalate exposure ups risk of pregnancy loss in Chinese women

Tristan Manalac
10 Aug 2017
Rights groups are also concerned about surrogate mothers being exploited due to the unregulated environments.

Higher urinary concentrations of monoethyl phthalate (MEP), high molecular weight phthalate (HMWP) metabolites, and other phthalate metabolites, increase the risk of pregnancy loss in pregnant Chinese women, a new study has found.

“Our findings suggested that Chinese women who were exposed to phthalates during early pregnancy had an increased risk of clinical pregnancy loss, especially embryonic loss,” researchers said.

Concentrations of phthalate metabolites were measured from urine samples of 3,111 pregnant women. Those with ectopic pregnancies, stillbirths, therapeutic abortions or multiple gestations were excluded from the study.

Aside from MEP and HMWP metabolites, urinary levels of monomethyl phthalate, monobutyl phthalate (MBP), monobenzyl phthalate, mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and low molecular weight phthalate (LMWP) metabolites were also measured.

Logistic regression analysis showed that a higher risk of clinical pregnancy loss was significantly associated with higher levels of MEP (odds ratio [OR], 1.62; 95 percent CI, 0.98 to 2.69), MBP (OR, 1.59; 1.00 to 2.56), MEOHP (OR, 1.70; 1.05 to 2.74), MEHHP (OR, 2.26; 1.35 to 3.78), LMWP (OR, 1.60; 1.00 to 2.60) and HMWP (OR, 1.74; 1.08 to 2.80) after adjusting for education, parity, maternal age and gestational weeks. [Sci Rep 2017;7:6800]

Similarly, the risk of embryonic loss was associated with higher concentrations of MEP (OR, 1.65; 0.84 to 3.23), MEOHP (OR, 2.16; 1.13 to 4.11), MEHHP (OR, 2.19; 1.12 to 4.28) and HMWP (OR, 2.19; 1.15 to 4.17). In contrast, the risk of foetal loss was associated only with higher MEHHP levels (OR, 2.41; 1.10 to 5.30).

The current literature has been conflicted about the extent of the relationship between exposures to different types of phthalates with pregnancy loss, researchers said. [Environ Health Perspect 2012; 120:458-463; Epidemiology 2016; 27:879-888]

“We hypothesized that the discrepancy between the present study and the previous studies was attributed partially to the differences in maternal characteristics, study design, sample size and miscarriage type and partially to co-linearity among phthalate metabolites,” they continued.

The current study showed that embryonic loss was sensitive to phthalate exposure possibly because phthalates interfere with oestradiol and progesterone production in the ovaries, the investigators explained.

“Their adverse effects on endocrine functioning is likely to change the circulating levels of hormones responsible for maintaining pregnancy.”

The study has some important limitations. One is the unusually low proportion of pregnancy loss in the study sample which may be explained by the higher socioeconomic status of the participants in general. Use of a single-spot urine sample for measuring phthalate concentration is another weakness.

Regardless, the study has shown that exposure to phthalates during pregnancy, measured through urinary phthalate levels, is a risk factor for pregnancy loss in Chinese women. Future studies are needed to verify these findings.

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Most Read Articles
6 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Shilpa Kolhe, MBBS, MD, MRCOG; Shilpa Deb, MBBS, DGO, MRCOG, 01 Aug 2012

Dysmenorrhoea is a medical condition characterized by severe uterine pain during menstruation manifesting as cyclical lower abdominal or pelvic pain, which may also radiate to the back and thighs. The term dysmenorrhoea is derived from the Greek words ‘dys’ meaning difficult, painful or abnormal, ‘meno’ meaning month, and ‘rrhea’ meaning flow. It is commonly divided into primary dysmenorrhoea, where there is no coexistent pathology, and secondary dysmenorrhoea where there is an identifiable pathological condition known to contribute to painful menstruation. Symptoms of primary dysmenorrhoea begin a few hours before the start of menstruation and are often relieved during the first few days of bleeding. The initial onset of primary dysmenorrhoea is usually shortly after menarche (6–12 months), when ovulatory cycles are established. Secondary dysmenorrhoea can also occur at any time after menarche but is most commonly observed in women in their third and fourth decade of life in association with an existing condition.

02 Dec 2014
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