Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1292 (doi:10.1542/peds.2008-0401)

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LETTER TO THE EDITOR

Baby Care Products

Daniel C. Postellon, MD
Department of Pediatric Endocrinology
Helen DeVos Children's Hospital
Grand Rapids, MI 49503

To the Editor.—

The study by Sathyanarayana et al¹ contained major methodologic errors. It is difficult to accept their conclusion that infant care products were the source of the urinary phthalates in their study, because they did not show that these products contained phthalates. Even after mentioning that phthalates are found in plastic products and are released through "leaching into liquids," they failed to mention if any of the diapers used in the study, or any of the collection containers, contained phthalates. Instead of merely asserting that there was "minimal concern about contamination," it would have been worthwhile to incubate the diapers with urine and infant care products at body temperature for a few hours to determine if this process altered the measured levels of phthalates. Until this is done, I have serious concerns that all of the phthalate measurements in this study are invalid.

I also have concerns about the use of anogenital distance as a measure of "human male reproductive function." There have been only 5 published studies^2–6 in human male infants in which this distance was actually measured, and none of them addressed reproduction. I would agree with the author of one of these studies that "[w]hether AGD [anogenital distance] measures in humans relate to clinically important outcomes, however, remains to be determined, as does its utility as a measure of androgen action in epidemiological studies."²

REFERENCES

1. Sathyanarayana S, Karr CJ, Lozano P, et. al. Baby care products: possible sources of infant phthalate exposure. Pediatrics. 2008;121 (2). Available at: www.pediatrics.org/cgi/content/full/121/2/e260
2. Romano-Riquer SP, Hernández-Avila M, Gladen BC, Cupul-Uicab LA, Longnecker MP. Reliability and determinants of anogenital distance and penis dimensions in male newborns from Chiapas, Mexico. Paediatr Perinat Epidemiol. 2007;21 (3):219 –228[CrossRef][Web of Science][Medline]
3. Longnecker MP, Gladen BC, Cupul-Uicab LA, et al. In utero exposure to the antiandrogen 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) in relation to anogenital distance in male newborns from Chiapas, México. Am J Epidemiol. 2007;165 (9):1015 –1022[Abstract/Free Full Text]
4. Marsee K, Woodruff TJ, Axelrad DA, Calafat AM, Swan SH. Estimated daily phthalate exposures in a population of mothers of male infants exhibiting reduced anogenital distance [published correction appears in Environ Health Perspect. 2007;115(2):A73]. Environ Health Perspect. 2006;114 (6):805 –809[Web of Science][Medline]
5. Swan SH, Main KM, Liu F, et al. Decrease in anogenital distance among male infants with prenatal phthalate exposure [published correction appears in Environ Health Perspect. 2005;113(9):A583]. Environ Health Perspect. 2005;113 (9):1056 –1061[Web of Science][Medline]
6. Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E, Longnecker MP, Hernandez-Avila M. Anogenital distance in human male and female newborns: a descriptive, cross-sectional study. Environ Health. 2004;3 (1):8[CrossRef][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Postellon, D. C. Search for Related Content PubMed PubMed Citation Articles by Postellon, D. C. Related Collections Therapeutics & Toxicology Social Bookmarking                         What's this?