Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 675 (doi:10.1542/peds.2008-1621)

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LETTER TO THE EDITOR

Baby Products and Phthalates: In Reply

Sheela Sathyanarayana, MD, MPH
Department of Pediatrics
University of Washington
Seattle, WA 98104-2499

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

Catherine Karr, MD, PhD
Departments of Occupational and Environmental Health Sciences and Pediatrics
University of Washington
Seattle, WA 98104

Paula Lozano, MD, MPH
Department of Pediatrics
University of Washington
Seattle, WA 98104

Shanna Swan, PhD
Department of Obstetrics and Gynecology
University of Rochester School of Medicine and Dentistry
Rochester, NY 14627

The purpose of our study was to examine the strength of association between infants' phthalate metabolite urinary concentrations and the mothers' reported use of baby care products. This was an epidemiologic investigation, not a product-testing or toxicokinetic study. Therefore, we did not analyze specific products for phthalate content or collect information on the amount of product applied and time of urine collection, as acknowledged in our discussion. However, absence of this information does not invalidate the epidemiologic association that we observed.

Our study supports dermal absorption as a route of exposure to diethyl phthalate (DEP). Dermal absorption of DEP and excretion of its major metabolite, monoethyl phthalate (MEP), occurs after whole-body application of creams in men.¹ A similar study in young infants would be unethical, given that children may be at higher risk of phthalate toxicity than adults.

As Dr Bailey states, the parent compound DEP accounts for a large proportion of phthalate use in fragrance. We stated that we did not know if the parent compounds of monomethyl phthalate and monoisobutyl phthalate were used during manufacturing. It is also possible that these compounds are present in containers and leach into the products.

The laboratory at the Centers for Disease Control and Prevention analyzed samples of the diapers and urine containers before the study started and found no detectable concentrations of the hydrolytic phthalate metabolites measured (unpublished data). Oxidative metabolites cannot be formed as a result of contamination. We agree that using field blanks would strengthen our findings, and we plan to use them in future studies.

Human epidemiologic studies have documented associations between MEP concentrations in the general population and human health outcomes, including sperm DNA damage in relation to MEP urinary concentrations in men,² perinatal breast milk MEP concentrations and changes in reproductive hormones in young breastfed infants,³ MEP urinary concentrations and decreased pulmonary function in men,⁴ and prenatal urine MEP concentrations and changes in anogenital distance in male infants.⁵ Additional research is needed to determine the potential long-term human health impact of DEP exposure.

On the basis of our findings, we maintain our recommendation that if parents are concerned, they may choose to limit the use of personal baby care products to decrease exposure to some phthalates.

REFERENCES

1. Janjua NR, Frederiksen H, Skakkebaek NE, Wulf HC, Andersson AM. Urinary excretion of phthalates and paraben after repeated whole-body topical application in humans. Int J Androl. 2008;31 (2):118 –130[CrossRef][Web of Science][Medline]
2. Hauser R, Meeker JD, Singh NP, et al. DNA damage in human sperm is related to urinary levels of phthalate monoester and oxidative metabolites. Hum Reprod. 2007;22 (3):688 –695[Abstract/Free Full Text]
3. Main KM, Mortensen GK, Kaleva MM, et al. Human breast milk contamination with phthalates and alterations of endogenous reproductive hormones in infants three months of age. Environ Health Perspect. 2006;114 (2):270 –276[Web of Science][Medline]
4. Hoppin JA, Ulmer R, London SJ. Phthalate exposure and pulmonary function. Environ Health Perspect. 2004;112 (5):571 –574[Web of Science][Medline]
5. Swan SH, Main KM, Liu F, et al. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect. 2005;113 (8):1056 –1061[Web of Science][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 Web of Science 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 Sathyanarayana, S. Articles by Swan, S. Search for Related Content PubMed Articles by Sathyanarayana, S. Articles by Swan, S. Related Collections Office Practice Social Bookmarking                         What's this?