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Urinary Concentrations of Phthalate Metabolites in Relation to Pregnancy Loss among Women Conceiving with Medically Assisted Reproduction
  • Published Date:
    Nov 2016
  • Source:
    Epidemiology. 27(6):879-888.
Filetype[PDF-372.12 KB]

  • Corporate Authors:
    for the Earth Study Team
  • Keywords:
  • Pubmed ID:
  • Pubmed Central ID:
  • Description:

    Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent.


    We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified eleven phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical loss and total pregnancy loss (<20 weeks’ gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis.


    Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks’ gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of ∑DEHP and three individual DEHP metabolites. For ∑DEHP, the RRs (CIs) were: 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three and four, compared to one, respectively (p-trend=0.04). RRs for total pregnancy loss were elevated in the highest quartiles of ΣDEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome.


    We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction.

  • Document Type:
  • Collection(s):
  • Funding:
    P30 ES000002/ES/NIEHS NIH HHS/United States
    K23 ES021471/ES/NIEHS NIH HHS/United States
    R01 ES009718/ES/NIEHS NIH HHS/United States
    CC999999/Intramural CDC HHS/United States
    T32 ES007069/ES/NIEHS NIH HHS/United States
    T32 DK007703/DK/NIDDK NIH HHS/United States
    R01 ES022955/ES/NIEHS NIH HHS/United States
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