Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1292-1293 (doi:10.1542/10.1542/peds.2008-0748)
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LETTER TO THE EDITOR

Baby Care Products: In Reply

Sheela Sathyanarayana, MD, MPH
Department of Pediatrics
University of Washington
Seattle, WA 98115-8160

Antonia M. Calafat, PhD
Centers for Disease Control and Prevention
Atlanta, GA 30333

Catherine J. Karr, MD, PhD
Departments of Occupational and Environmental Health Sciences and Pediatrics
University of Washington
Seattle, WA 98115-8160

Paula Lozano, MD, MPH
Department of Pediatrics
University of Washington
Seattle, WA 98115-8160

Elizabeth Brown, PhD
Department of Biostatistics
University of Washington
Seattle, WA 98115-8160

Shanna H. Swan, PhD
Department of Obstetrics and Gynecology
University of Rochester School of Medicine and Dentistry
Rochester, NY 14642

In our study,1 we controlled for other potential sources of phthalate exposure by prescreening the urine-collection materials for phthalates. All infants in the study used the same type of diaper, and all diapers tested were wet with urine only. The laboratory at the Centers for Disease Control and Prevention analyzed samples of the diapers and urine containers before the study was initiated and found no detectable concentrations of any of the hydrolytic phthalate metabolites measured in this study (A.M.C., unpublished data). Oxidative metabolites of phthalates cannot be formed as a result of contamination. Even if the diapers or urine containers did contain some concentration of phthalates, this contribution would likely be distributed equally between the infants and only bias results toward the null.2 We acknowledge that multiple routes for exposure to phthalates exist, including ingestion of food and dust and inhalation of indoor air.3 However, this fact does not diminish the strength of our findings that reported infant care product use is significantly associated with increased concentrations of infant urinary concentrations of several phthalate metabolites.

We did not examine any health outcomes in this study, and we did not make any conclusions regarding health outcomes for these infants. Anogenital distance is associated with genital abnormalities at birth in animals and is directly impacted by hormonal exposures in utero.4 Longitudinal studies examining prenatal exposures to endocrine disruptors and health outcomes will allow us to determine if this is also the case for humans.

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. Koepsell TD, Weiss NS. Epidemiologic Methods: Studying the Occurrence of Illness. New York, NY: Oxford University Press; 2003
  3. Wormuth M, Scheringer M, Vollenweider M, Hungerbühler K. What are the sources of exposure to eight frequently used phthalic acid esters in Europeans? Risk Anal. 2006;26 (3):803 –824[CrossRef][Web of Science][Medline]
  4. Gray LE, Ostby J, Furr J, et al. Effects of environmental antiandrogens on reproductive development in experimental animals. Hum Reprod Update. 2001;7 (3):248 –264[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article
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