Women’s exposure to phthalates and use of personal care products

Women who used more personal care products, particularly those with fragrance had higher concentrations of several phthalates in their urine (In Journal of Exposure Science and Environmental Epidemiology, 2013)

Abstract: Several phthalates, particularly diethyl phthalate (DEP) and di-n-butyl phthalate, can be used in personal care products (PCPs) to fix fragrance and hold color. We investigated associations between women’s reported use of PCPs within the 24 hours prior to urine collection and concentrations of several urinary phthalate metabolites. Methods: Between 2002 and 2005, 337 women provided spot urine samples and answered questions regarding their use of thirteen PCPs at a follow-up visit 3-36 months after pregnancy.  We examined associations between urinary concentrations of several phthalate metabolites and use of PCPs using linear regression. Results: Use of individual PCPs ranged from 7% (nail polish) to 91% (deodorant). After adjusting for age, education, and urinary creatinine, women reporting use of perfume had 2.92 times higher (95% CI: 2.20-3.89) concentration of monoethyl phthalate (MEP, the primary metabolite of DEP) than other women. Other PCPs that were significantly associated with MEPconcentrations  included: hair spray, nail polish, and deodorant. MEP concentrations increased with the number of PCPs used.  Conclusion: PCP use was widespread in this group of recently pregnant women. Women’s use of PCPs, particularly of perfumes and fragranced products, was positively associated with urinary concentration of multiple phthalate metabolites.

Prenatal exposure to stressful life events is associated with masculinized anogenital distance (AGD) in female infants

Mother’s stress in pregnancy is related to how her girl’s genital development in infancy

Abstract: In animal models, prenatal stress programs reproductive development in the resulting offspring, however little is known about effects in humans. Anogenital distance (AGD) is a commonly used, sexually dimorphic biomarker of prenatal androgen exposure in many species. In rodents, prenatally stressed males have shorter AGD than controls (suggesting lower prenatal androgen exposure), whereas prenatally stressed females have
longer AGD than controls (suggesting greater prenatal androgen exposure). Our objective was to investigate the relationship between stressful life events in pregnancy and infant AGD. In a prospective cohort study, pregnant women and their partners reported exposure to stressful life events during pregnancy. Pregnancies in which the couple reported 4+ life eventswere considered highly stressed. After birth (average 16.5 months), trained examiners measured AGD in the infants (137 males, 136 females). After adjusting for age, body size and other covariates, females born to couples reporting high stress had significantly longer (i.e. more masculine) AGD than females born to couples reporting low stress (p = 0.015). Among males, high stress was weakly, but not significantly, associated with shorter AGD. Our results suggest prenatal stress may masculinize some aspects of female reproductive development in humans. More sensitive measures of prenatal stress and additional measures of reproductive development are needed to better understand these relationships and clarify mechanisms.(Published in Physiology and Behavior 2013)


Exposure to prenatal life events stress is associated with masculinized play behavior in girls

Mother’s stress in pregnancy linked to how her girl plays (Published in Neurotoxicology. January 2014)

Abstract: Previous research on humans and animal models suggests that exposure to prenatal stress not only affects fetal development, but can do so in different ways in males and females. Only one published study has prospectively examined the relationship between exposure to prenatal stress and gender-specific play behavior during childhood, finding masculinized play behavior in girls who experienced high prenatal life events stress, but no associations in boys.  Here we examine this question in a second prospective cohort from the Study for Future Families. Pregnant women completed questionnaires on stressful life events during pregnancy, and those who reported one or more events were considered  “high stress”. Families were recontacted several years later (mean age of index child: 4.9 years) , and mothers completed a questionnaire including the validated Preschool Activities  Inventory (PSAI), which measures sexually dimorphic play behavior. In sex-stratified analyses, after adjusting for child’s age, parental attitudes towards gender-atypical play, age and sex of siblings, and other relevant covariates, girls (n=72) exposed to high prenatal life events stress had higher scores on the PSAI masculine sub-scale (β=3.48, p=0.006) and showed a trend towards higher (more masculine) composite scores (β=2.63, p=0.08). By contrast, in males (n=74), prenatal stress showed a trend towards associated with higher PSAI feminine sub-scale scores (β=2.23, p=0.10), but no association with masculine or composite scores. These data confirm previous findings in humans and animal models suggesting that prenatal stress may have androgenic effects on female fetuses and anti-androgenic effects on male fetuses.

Publication available from Science Direct: http://www.sciencedirect.com/science/article/pii/S0161813X13001927

Invited Commentary in JAMA Peds: Environmental Phthalate Exposure and the Odds of Preterm Birth:

In this issue of JAMA Pediatrics, Ferguson et al make an important public health  contribution by demonstrating a sizable impact of phthalates, a class of commonly used chemicals, on a health outcome of major public health concern: the growing burden of preterm birth. Worldwide, 15 million babies are born preterm (<37weeks’ gestation),with rates increasing over 2 decades in almost all countries that have reliable data. While the regions with the highest preterm birth rates in 2010 were Southeastern Asia, South Asia, and sub-Saharan Africa, the United States is sixth among the 10 countries with the greatest number of preterm births. In fact, cases in the United States account for 42% of all preterm births in developed countries. (for more…download the PDF below)

Lifestyle behaviors associated with exposures to endocrine disrupting chemicals in a Mennonite population


Old Order Mennonites adhere to a simpler lifestyle. They eat mostly fresh unprocessed foods, farm without pesticides, and use personal care products sparingly, if at all, and no cosmetics. For transportation they predominantly use bicycles and a horse and buggy. These practices made us think that they would experience lower exposures to endocrine disrupting chemicals, including bisphenol A and several phthalates. Therefore, we studied a small group of pregnant women from this community and measured amounts of several of these chemicals. Over all levels were lower than those measured in the general public, and some were much lower. We conclude that this study, though small, reveals important messages about how to avoid or reduce our exposure to potentially harmful chemicals.

Men with shorter Anogenital Distance have lower sperm counts

In male rodents, anogenital distance (AGD) –the distance form the anus to the genitals–reflects the pups exposure to testosterone and other androgens during prenatal development and also predicts later reproductive
success. These results, from a study of young healthy men living in Rochester NY, suggest that this is also true in young healthy men and that the androgenic environment during early fetal life exerts a fundamental
influence on both AGD and adult sperm counts in humans, as demonstrated in rodents

EHP Paper of the Year, 2009

Citation: Tilson HA 2009. EHP Paper of the Year, 2009. Environ Health Perspect 117:A232-A232. http://dx.doi.org/10.1289/ehp.12903

The Paper of the Year Award was established in 2008 by Environmental Health Perspectives (EHP) as a means of reinforcing high-quality articles published in the journal, identifying emerging research themes, and tracking the impact of groundbreaking research (Tilson 2008). In this issue, we are pleased to announce that the EHP Paper of the Year for 2009 is “Decrease in Anogenital Distance among Male Infants with Prenatal Phthalate Exposure” by Shanna H. Swan, Katharina M. Main, Fan Liu, Sara L. Stewart, Robin L. Kruse, Antonia M. Calafat, Catherine S. Mao, J. Bruce Redmon, Christine L. Ternand, Shannon Sullivan, J. Lynn Teague, and the Study for Future Families Research Team (Swan et al. 2005). We chose this paper because of its high impact in both the research and legislative realms since its publication in 2005.

This paper (Swan et al. 2005) was the first to demonstrate an association between pregnant women’s exposure to phthalates and adverse effects on genital development in their male children. Rodent studies had previously identified a syndrome of adverse effects of phthalates on the male reproductive system (Foster 2006Sharpe 2005), and find-ings from Swan et al. (2005) supported the hypothesis that prenatal phthalate exposure at environmental levels can also adversely affect male reproductive development in humans. These findings are important because humans are commonly exposed to phthalates found in a wide variety of consumer products, including soft vinyl items, medical tubing and IV bags, and a variety of personal care products such as perfume, lotion, shampoo, cosmetics, nail polish, and hairspray.

Toxicologists routinely measure the external genitalia to assess reproductive toxicity in animal studies. One of these measures, anogenital distance (AGD)—a particularly sensitive indicator of masculinization—is shortened in male rodents following prenatal exposure to several phthalates (Foster 2006Sharpe 2005).Swan et al. (2005) translated the standard animal exam to humans in order to investigate potential effects of phthalates on reproductive development in male infants. Specifically, they estimated associations between the presence and quantity of nine phthalate metabolites in mothers’ prenatal urine samples and AGD and other measurements in their sons. Higher levels of four phthalate metabolites [monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), and monoisobutyl phthalate (MiBP)] were associated with a shorter AGD. Swan subsequently replicated and extended these findings (2008).

Swan et al. (2005) has had an impact on phthalate legislation such as the Consumer Product Safety Improvement Act of 2008, which dramatically reduced the amount of six phthalates (including DEHP and DBP) that are permissible in children’s toys. The findings of Swan et al. (2005) have also been discussed and documented in numerous congressional hearings, including the June 2008 House Subcommittee on Commerce, Trade, and Consumer Protection hearing (Committee on Energy and Commerce 2008). This research was also cited heavily in support of regulations passed in California, Vermont, and Washington and introduced in Maine, New York, New Jersey, Connecticut, Maryland, Massachusetts, Rhode Island, West Virginia, Minnesota, Illinois, Oregon, and Hawaii.