New study indicates that a substance used to give plastics flexibility was linked to the deaths of 74,000 newborns in 2018.
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.
A baby is considered premature when it is born before the 37th week of gestation. About 1 in 10 babies in the United States will be born prematurely in 2024, according to the 2025 March of Dimes Report .
"Babies who survive may have respiratory problems, feeding difficulties, cerebral palsy , developmental delays , vision problems , and hearing problems ," according to the U.S. Centers for Disease Control and Prevention .
The two chemicals in the study – di-2-ethylhexyl phthalate, or DEHP, and its relative, diisononyl phthalate, or DiNP – belong to a family of synthetic chemicals called phthalates.
Phthalates are known to interfere with the body's hormone production mechanism, known as the endocrine system, and are "associated with developmental, reproductive, brain, immune, and other problems," according to the National Institute of Environmental Health Sciences. Even minor hormonal disruptions can cause "significant biological and developmental effects," the institute states.
“This is a dangerous class of chemicals,” warns Leonardo Trasande, lead author of the new study and Jim G. Hendrick, MD, Professor of Pediatrics at NYU Langone Grossman School of Medicine in New York.
“In the context of all the efforts we are making to get more babies born in the United States, we must also ensure that babies are born healthy,” says Trasande, who is also a professor of population health and director of the Division of Environmental Pediatrics and the Center for Environmental Hazard Research at NYU Langone Health.
"This data further reinforces efforts to negotiate a treaty on plastics that limits the concerning chemicals commonly used in plastics," he adds.
The American Chemistry Council's High Phthalates Panel informed CNN via email that the U.S. Environmental Protection Agency conducted a comprehensive risk assessment of DiNP uses under the Toxic Substances Control Act and concluded that it does not pose "an unreasonable risk of harm to human health, consumers, the general public, or the environment."
The council, which represents the U.S. chemical, plastics, and chlorine industries, did not comment on di-2-ethylhexyl phthalate, or DEHP.
“Ubiquitous” chemical substances
Phthalates are often called "ubiquitous" chemicals because they are used in a vast number of consumer products. These chemicals provide flexibility to children's toys, art supplies, food storage containers, vinyl flooring, shower curtains, garden hoses, medical devices, and much more.
Phthalates also help lubricate substances and carry fragrances in personal care products , including deodorants, nail polishes, perfumes, gels, hair sprays or shampoos, soaps, and body lotions.
"These are additives that are also used in cling film-type plastic packaging, commonly used in food packaging," warns Leonardo Trasande.
Research has linked phthalates to reproductive problems , such as genital malformations and undescended testicles in male infants, and lower sperm counts and testosterone levels in adult men. Studies have also linked phthalates to childhood obesity , asthma , cardiovascular problems , and cancer.
A 2021 study , co-authored by Leonardo Trasande, found that phthalates may contribute to 91,000 to 107,000 premature deaths per year among people aged 55 to 64 in the United States alone. People with the highest phthalate levels had a higher risk of death from any cause, but especially from heart disease.
How might these chemicals contribute to premature births and infant deaths? While much more research is needed, scientists have some ideas.
“One pathway is disruption of placental function, which is known to be affected by phthalates and other endocrine-disrupting chemicals,” says Jane Muncke, director-general and scientific director of the Food Packaging Forum, a Zurich-based non-profit foundation dedicated to scientific communication and research on plastics and other chemicals used in the industry.
“Ironically, premature babies will be exposed to even more plastics, since neonatal wards rely on plastic tubing,” adds Jane Muncke, who was not involved in the most recent study. “This is also a powerful and pressing reminder that innovation in safer materials, especially for use in healthcare, is urgent and should be a high priority for policymakers and businesses.”
The placenta, which attaches to the uterine wall, provides oxygen, nutrients, and immune support to the developing fetus. Placental insufficiency, in which the organ does not develop or function correctly, is one of the main causes of spontaneous premature birth, experts say.
“Inflammation is not very good for placental adhesion and can facilitate the rupture of membranes,” explains Leonardo Trasande. “The rupture of membranes, the lack of adhesion to the uterine wall, and the loss of essential nutrients for the fetus can trigger uterine contractions. There is no single mechanism.”
An entire class of chemical substances
The new study, published on March 30 in the journal eClinicalMedicine , analyzed the effects of DEHP and DiNP in 200 countries and territories in 2018. The data were drawn from large national surveys in Canada, Europe, and the United States, as well as estimates from previous research in regions of the world that do not collect their own data.
Africa, the Middle East, and South Asia bore the brunt of the health burden related to premature birth. Some of these areas have rapidly growing plastics industries and high levels of global plastic waste, according to the study.
The investigation was not designed to establish that DEHP and DiNP directly or individually cause premature birth, nor did it analyze other types of phthalates, the authors emphasize.
That makes sense, agrees Donghai Liang, associate professor of environmental health at Emory University's Rollins School of Public Health in Atlanta.
“DEHP, in particular, has been one of the most widely studied phthalates in relation to preterm birth, so there is a stronger epidemiological basis for modeling its contribution,” says Liang, who was not involved in the research, in an email to CNN. “DiNP was included because it is a common substitute for DEHP and is becoming increasingly relevant as industries phase out older phthalates.”
“That being said, I wouldn’t interpret this as meaning that only these two phthalates are important,” he emphasizes. “The broader concern actually relates to phthalates as a class, and focusing on one or two at a time may underestimate the overall risk.”
Manufacturers frequently seek substitutes for chemicals that science has linked to health hazards and that are being regulated by federal and state governments. For example, in 2008, the United States banned DEHP in concentrations greater than 0.1% in children's toys and baby care products, and two states— California and North Carolina —are working to ban DEHP in intravenous fluid bags.
“We are playing a dangerous game of 'Whac-A-Mole' with hazardous chemicals,” summarizes Leonardo Trasande.
“We have a situation where concerns arise about a chemical product, and the industry simply replaces it with a chemical analogue that may have the same effects, if not worse.”
How to avoid phthalates
The good news is that phthalates have a short half-life and leave the body within a few days, experts said. Therefore, careful planning to avoid plastics can have a significant impact.
“For pregnant mothers and families looking to minimize exposure, there are some reasonable and practical measures that can help,” says Donghai Liang. “These include choosing personal hygiene products labeled ‘phthalate-free.’ Check ingredient lists for terms such as diethyl phthalate (DEP), dibutyl phthalate (DBP), and benzylbutyl phthalate (BBzP).”
However, product labels don't always list chemicals consistently. For example, in personal care products, phthalates are often included under broader terms like "fragrance" or "parfum," warns Donghai Liang.
“Phthalates are important additives for keeping fragrances smelling good,” says Leonardo Trasande. “Another important tip: since heat promotes the release of chemicals like phthalates from plastic, avoid putting plastic in the microwave or dishwasher.”
Use proper ventilation to improve indoor air quality and vacuum regularly, as phthalates can accumulate in household dust, adds Donghai Liang.
“That being said, it’s important to point out that these exposures are widespread and often difficult to avoid entirely,” he states. “Effective protection cannot depend solely on individual behavior. The most effective solutions lie upstream, including stricter regulations, safer product formulations, better labeling, and improved environmental management and regulatory oversight.”
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