Two chemicals used to make plastic more flexible are linked to nearly 2 million premature births and the deaths of 74,000 newborns worldwide in 2018, according to a new study, reports BritPanorama.
A baby is considered premature when born before the 37th week of pregnancy. About 1 in 10 infants in the US was born prematurely in 2024, according to the 2025 March of Dimes Report Card.
“Babies who survive may have breathing problems, feeding difficulties, cerebral palsy, developmental delay, vision problems, and hearing problems,” according to the US Centers for Disease Control and Prevention.
The chemicals in the study — Di-2-ethylhexylphthalate (DEHP) and diisononyl phthalate (DiNP) — belong to a family of synthetic chemicals known as phthalates.
Phthalates are known to interfere with the body’s mechanism for hormone production, commonly referred to as the endocrine system. They are also linked to developmental, reproductive, brain, immune, and other problems, according to the National Institute of Environmental Health Sciences. Even small hormonal disruptions can lead to significant developmental and biological effects, the institute states.
“This is a dangerous class of chemicals,” said Dr. Leonardo Trasande, senior author of the new study and the Jim G. Hendrick, M.D., Professor of Pediatrics at NYU Langone’s Grossman School of Medicine in New York City.
“In the context of all the efforts that we’re taking to have more babies born in the United States, we should also make sure that babies are born healthy,” Trasande emphasized, highlighting the need for thorough consideration of newborn health alongside birth rates.
“These data further support efforts to negotiate a plastic treaty that limits chemicals of concern commonly used in plastics,” he added.
The American Chemistry Council’s High Phthalates Panel stated that the US Environmental Protection Agency conducted a comprehensive risk evaluation of uses of DiNP under the Toxic Substances Control Act and concluded that it does not pose “unreasonable risk of injury to human health for consumers, the general population, or the environment.”
The council, representing the US chemical, plastics, and chlorine industries, did not comment specifically on DEHP.
‘Everywhere’ chemicals
Phthalates are often referred to as “everywhere” chemicals due to their presence in numerous consumer products. These chemicals provide flexibility in children’s toys, art supplies, food storage containers, vinyl flooring, shower curtains, garden hoses, and medical devices, among others.
Phthalates also help lubricate substances and carry fragrances in personal care products, including deodorants, nail polishes, perfumes, hair gels, sprays, shampoos, soaps, and body lotions.
“These are additives that are also used in the cling-type plastic wrapping commonly employed in food packaging,” Trasande noted.
Research has linked phthalates with reproductive issues such as genital malformations and undescended testes in baby boys, lower sperm counts, and testosterone levels in adult males. Studies have also connected phthalates to childhood obesity, asthma, cardiovascular issues, and cancer.
A 2021 study co-authored by Trasande found that phthalates may contribute to 91,000 to 107,000 premature deaths annually among individuals aged 55 to 64 in the United States. Those with the highest phthalate levels had an increased risk of death from all causes, especially heart disease.
How might these chemicals contribute to preterm births and infant deaths? More research is needed, but scientists have begun to formulate some hypotheses.
“One pathway is the disruption of placental function, which has been documented to be affected by phthalates and other endocrine-disrupting chemicals,” said Jane Muncke, managing director and chief scientific officer at the Food Packaging Forum, a nonprofit foundation based in Zurich, Switzerland, focusing on science communication and research on plastics and chemicals in industry.
“Ironically, babies born preterm will be exposed to even more plastics, as neonatal wards rely on plastic tubing,” Muncke, who was not involved in the latest study, added. “This serves as an urgent reminder that innovation into safer materials, especially for healthcare use, should be a high priority for policymakers and entrepreneurs.”
The placenta provides oxygen, nutrients, and immune support to the developing fetus. Placental insufficiency, where the organ fails to develop or function correctly, is a leading cause of spontaneous preterm birth, experts say.
“Inflammation isn’t very beneficial for placental adhesion and may facilitate ruptured membranes,” Trasande explained. “Ruptured membranes, a lack of adhesion to the uterine wall, and a loss of key nutrients to the fetus may trigger uterine contractions. There’s no single pathway.”
An entire class of chemicals
The new study, published Tuesday in the journal eClinicalMedicine, examined the effects of DEHP and DiNP across 200 countries and territories in 2018. Data was sourced from large national surveys in Canada, Europe, and the United States, along with estimates from earlier investigations in regions without their own data collection.
Africa, the Middle East, and South Asia bore the brunt of the premature health burden; some of these areas have rapidly growing plastics industries and high levels of global plastic waste, according to the study.
The investigation did not aim to establish that DEHP and DiNP directly cause preterm birth or analyse other types of phthalates, according to the authors.
Dr. Donghai Liang, an associate professor of environmental health at Emory University’s Rollins School of Public Health in Atlanta, acknowledged this limitation.
“Specifically, DEHP has been one of the most widely studied phthalates in relation to preterm birth, so there is a stronger epidemiologic basis for modeling its contribution,” Liang stated in an email. “DiNP was included because it is a common replacement for DEHP and is increasingly relevant as industries transition from older phthalates.”
“That said, I would not interpret this as suggesting that only these two phthalates matter,” he clarified. “The overarching concern should be phthalates as a class; focusing on one or two at a time might underestimate the overall risk.”
Manufacturers often seek replacements for chemicals linked to health harms and regulated by federal and state governments. For instance, in 2008, the US banned DEHP in concentrations greater than 0.1% in children’s toys and child-care articles, while California and North Carolina are working to ban DEHP in IV solution bags.
“We are playing a dangerous game of Whac-A-Mole with hazardous chemicals,” Trasande cautioned. “We have a situation where concerns arise about one chemical, and industry simply replaces it with a chemical analog that may have similar, if not worse, effects.”
How to avoid phthalates
The good news is that phthalates have a short half-life and leave the body within a few days. Therefore, proactive measures to avoid plastics can significantly impact exposure.
“For mothers and expecting families looking to minimize exposure, there are reasonable and practical steps that can help,” Liang suggested. “These include choosing personal care products labeled ‘phthalate-free’ and checking ingredient lists for terms like diethyl phthalate (DEP), dibutyl phthalate (DBP), and benzyl butyl phthalate (BBzP).”
However, product labels do not consistently list chemicals. For personal care products, phthalates are frequently included under broader terms like “fragrance” or “parfum,” Liang noted.
“Phthalates are significant additives that help fragrances remain potent,” Trasande added. “Another critical tip is to avoid microwaving or machine dishwashing plastic, as heat encourages chemicals like phthalates to leach from plastic.”
Using proper ventilation to enhance indoor air quality and regular vacuuming is also advisable since phthalates can accumulate in household dust, Liang advised.
“It is essential to emphasize that these exposures are widespread and often challenging to entirely avoid,” he pointed out. “Meaningful protection cannot depend solely on individual behaviour; the most effective solutions lie upstream, including stronger regulations, safer product formulations, better labeling, and improved environmental management and regulatory oversight.”
