Phthalate DEHP Exposure Linked to Preterm Births Worldwide

Author: NYU Langone Health / NYU Grossman School of Medicine
Published: 31 Mar 2026 - Updated: 24 Aug 2026
Publication Details: Peer-Reviewed | Simulation, Modelling

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research, published in the peer-reviewed journal eClinicalMedicine, draws on population survey data from over 200 countries to estimate the global toll of phthalate chemical exposure on preterm birth. Led by scientists at NYU Langone Health, it offers the first worldwide estimate linking DEHP - a plasticizer found in everyday products like cosmetics and food packaging - to nearly 2 million early births in a single year, along with 74,000 newborn deaths and over 1.2 million years lived with disability. For parents, caregivers, medical professionals, disability advocates, and policymakers, the findings provide hard numbers behind a concern that has long existed at the margins of public health debate - and make a compelling case for class-wide regulation of plastic chemicals rather than piecemeal substitution.*

At a Glance

• 1 - The study was published in the peer reviewed journal eClinicalMedicine and led by NYU Langone Health. It drew on national survey data spanning 200 countries and territories.
• 2 - DEHP is not chemically bonded to the plastic it softens, so it can migrate out and enter the body through food, air, and dust. Researchers say it breaks down into microscopic particles that people ingest, inhale, and absorb through skin.
• 3 - The authors stress the analysis was not designed to prove DEHP alone causes preterm birth, and it excluded other phthalate types. They modeled a range of values, noting the true impact could be up to four times smaller than the headline estimate.
• 4 - Senior author Leonardo Trasande compared regulating phthalates one at a time to a game of Whac-A-Mole with hazardous chemicals. He argues that swapping in poorly understood replacements calls instead for class wide oversight of plastic additives.

Topic Definition

Phthalates

Phthalates are a class of synthetic chemical compounds widely used as plasticizers - substances added to plastics, particularly PVC, to make them more flexible and durable. They appear in a broad range of consumer and industrial products, including food packaging, medical devices, cosmetics, personal care products, detergents, and insect repellents. Because phthalates are not chemically bonded to the plastic they are added to, they can migrate out of products and enter the human body through ingestion, inhalation, and skin contact. Decades of research have associated exposure to certain phthalates with disruptions to the endocrine system, reproductive harm, cardiovascular disease, and developmental problems in children - making them a central concern in environmental health science and a growing focus of international regulatory debate.

Overview

A Chemical in Cosmetics and Food Packaging May Be Triggering Preterm Births Worldwide

Exposure to a chemical commonly used to make plastic more flexible may have contributed to about 1.97 million preterm births in 2018 alone, or more than 8 percent of the world's total, a new analysis of population surveys shows. The chemical was also linked to the deaths of 74,000 newborns, the researchers further estimate.

The toxin, di-2-ethylhexylphthalate (DEHP), is part of a group of chemicals called phthalates, which appear in cosmetics, detergents, bug repellents, and other household products. Experts have found that these substances can break down into microscopic particles and enter the body through food, air, and dust.

Global Study Puts a Number on Plastic's Pregnancy Risk - and It's Alarming

Led by NYU Langone Health researchers, the new study focused on preterm birth, which is a major risk factor for lasting learning and developmental issues and is a leading cause of infant death, according to the World Health Organization. The new analysis provides the first global estimate of preterm births connected to exposure to DEHP and explores which parts of the world are most affected, according to the authors. A report on the findings will be published online March 31 in the journal eClinicalMedicine.

"By estimating how much phthalate exposure may contribute to preterm birth worldwide, our findings highlight that reducing exposure, especially in vulnerable regions, could help prevent early births and the health problems that often follow," said study lead author Sara Hyman, MS.

Past studies have linked DEHP exposure to cancer, heart disease, and infertility, among many other health concerns, added Hyman, an associate research scientist at NYU Grossman School of Medicine. There is also a large body of research connecting the chemical to preterm birth.

According to the new work, DEHP exposure may have contributed to 1.2 million years lived with disability, a measure of all the years that people have lived or will live with illnesses, injuries, and other health issues caused by being born prematurely.

Hyman said that while the phthalate is in widespread use, certain regions are estimated to bear a much larger share of the health impacts than others, with the Middle East and South Asia representing 54 percent of estimated illness from preterm birth. These areas have rapidly growing plastics industries and high levels of global plastic waste. Africa, which accounted for 26 percent of health problems from DEHP-linked preterm birth, has a disproportionate share of deaths compared with its share of overall premature cases. The researchers said this reflects the region's higher underlying death toll from preterm birth.

How the Study Was Conducted

For the study, the research team estimated DEHP exposure in 2018 across 200 countries and territories by pulling data from large national surveys in the United States, Europe, and Canada. They also used estimates from earlier investigations to fill in regions that did not have their own data. The team then drew on earlier research that assessed how phthalate exposure may affect preterm birth and combined those findings with their global exposure estimates. Finally, they combined this information with worldwide figures on preterm births and deaths to gauge what share of these outcomes might be linked to DEHP.

The scientists repeated these steps for another phthalate called diisononyl phthalate (DiNP), a common replacement for DEHP. According to the results, DiNP may pose a similar risk as DEHP, having contributed to about 1.88 million preterm births around the world. The financial costs associated with newborn deaths ranged from millions to hundreds of billions of dollars for both phthalates.

A Call for Stronger Oversight

"Our analysis makes clear that regulating phthalates one at a time and swapping in poorly understood replacements is unlikely to solve the larger problem," said study senior author Leonardo Trasande, MD, MPP, the Jim G. Hendrick, MD, Professor of Pediatrics at NYU Grossman School of Medicine. "We are playing a dangerous game of Whac-A-Mole with hazardous chemicals, and these findings highlight the urgent need for stronger, class-wide oversight of plastic additives to avoid repeating the same mistakes."

Dr. Trasande, who is also a professor in the Department of Population Health and director of the Division of Environmental Pediatrics and the Center for the Investigation of Environmental Hazards, cautions that the investigation was not designed to establish that DEHP and DiNP directly or alone cause preterm birth, nor did it take into account other types of phthalates.

In addition, because there is some uncertainty in the data, the researchers looked at a range of possible values rather than just one estimate. This uncertainty range showed that the true impact of DEHP could be up to four times smaller than the main estimate or slightly higher. Even under the most conservative estimates, the results point to a substantial health burden, said Hyman.

Despite the limits of this kind of global modeling, added Hyman, the work lays important groundwork for future studies to confirm and refine these results and begins to fill a major gap in understanding the extent to which plastic chemicals affect preterm birth worldwide.

Funding and Disclosures

Funding for the study was provided by National Institutes of Health grant P2CES033423 and by Beyond Petrochemicals. Along with Hyman and Dr. Trasande, an NYU Langone co-investigator was Jonathan Acevedo, MPH.

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

What everyday products are most likely to contain DEHP?

DEHP is used to soften polyvinyl chloride, so it commonly appears in vinyl flooring, shower curtains, garden hoses, food packaging and cling films, and certain medical devices such as IV bags and tubing. It can also be present in some cosmetics, fragrances, and personal care items, which means exposure often comes from a combination of sources rather than any single product.

How can pregnant women reduce their exposure to phthalates?

Practical steps include storing and heating food in glass or stainless steel rather than plastic, avoiding microwaving food in plastic containers, choosing fragrance free personal care products, and washing hands before eating to remove dust. Eating more fresh, minimally processed food also helps, because phthalates can enter the food supply through plastic used in processing and packaging.

Are phthalates already banned or restricted anywhere?

Several phthalates including DEHP are restricted in specific uses in the European Union, and a number of countries limit them in children's toys and childcare articles. Regulation varies widely by region and by product category, and many uses remain permitted, which is part of why the study authors argue for broader class wide oversight rather than case by case bans.

What is the difference between a preterm birth and a low birth weight birth?

A preterm birth is one that occurs before 37 completed weeks of pregnancy, defined by timing, while low birth weight refers to a baby weighing less than about 2,500 grams regardless of how early it arrived. The two often overlap because babies born early tend to weigh less, but a full term baby can also have low birth weight and a preterm baby can sometimes be relatively heavy.

What does years lived with disability mean in this research?

Years lived with disability is a public health measure that adds up the time people spend living with the health consequences of a condition, weighted by how severe those effects are. In this study it captures the lasting learning, developmental, and physical problems that can follow a premature birth, giving a sense of the long term burden beyond the immediate count of early births and deaths.

Can phthalates affect children and adults beyond pregnancy?

Yes, research has connected phthalate exposure to endocrine disruption, cardiovascular problems, metabolic effects, and reproductive concerns across different age groups, not only during pregnancy. Children can be especially exposed through toys, flooring, and dust because of hand to mouth behavior, though this particular study focused specifically on the link between prenatal DEHP exposure and preterm birth.

How do scientists measure a person's phthalate exposure?

Because phthalates break down quickly in the body, researchers usually measure their metabolites in urine, which reflects recent exposure over the preceding hours or days. Large national health surveys collect these measurements across populations, and the study drew on such data from the United States, Europe, and Canada to estimate exposure levels worldwide.

Why did the study find the heaviest burden in the Middle East, South Asia, and Africa?

The authors link the higher estimated burden in the Middle East and South Asia to rapidly expanding plastics industries and elevated levels of plastic waste in those regions. Africa's disproportionate share of deaths reflects its higher underlying mortality from preterm birth generally, meaning that where medical resources to support early babies are scarcer, the same exposure can translate into worse outcomes.

Insights, Analysis, and Developments

Editorial Note: What makes this study particularly significant is not just the scale of the numbers - nearly 2 million preterm births tied to a single chemical in a single year - but the way it shifts the conversation about plastic safety from vague concern to measurable, documented harm. The research team is careful to note the limits of global modeling, and they acknowledge real uncertainty in the data. But even the most conservative reading of their findings points to a serious, ongoing public health crisis that falls hardest on regions with the least regulatory capacity to respond. The call for class-wide oversight of plastic additives rather than a one-at-a-time swap system is long overdue, and this paper gives that argument a firm scientific footing.*

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by NYU Langone Health / NYU Grossman School of Medicine and published on 31 Mar 2026, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.