The safety of phthalate-containing medications used during pregnancy

ABSTRACT

Introduction

Phthalates freely cross the placenta and have the potential to influence pregnancy outcomes, with evidence of an increased incidence of preterm birth, low birth weight, pregnancy loss, and gestational diabetes. There is no regulation of phthalate concentrations in medications, which is often found in enteric coatings. Ingestion of phthalate containing medication during pregnancy may result in materno-fetal harm.

Areas Covered

Phthalate subtypes, sources of phthalate exposure, mechanisms of phthalate toxicity, associations between phthalate exposure and incidence of preterm birth, low birth weight, fetal growth, gestational diabetes, and placental development.

Expert Opinion

There is robust evidence to link exposure to phthalates in medical products including preterm birth, gestational diabetes, pregnancy-induced hypertension, and miscarriage. Nevertheless, future studies need to address standardization to avoid the heterogeneity of current studies. In future, the use of naturally occurring biopolymers may be safer, and the role of vitamin D as an immune modulator also has promise.

KEYWORDS:

• Birth weight
• Gestational diabetes mellitus
• Intrauterine growth restriction
• phthalates
• pre-eclampsia
• pregnancy
• pregnancy-induced hypertension
• preterm birth

Article highlights

• Phthalates are ubiquitous molecules with most humans demonstrating systemic exposure from the environment.

• There are no restrictions on phthalate concentrations in medications.

• Phthalates can cross the placenta.

• Phthalates are associated with gestational diabetes, low birth weight, preterm birth, low birth weight, and hypertensive disorders in pregnancy

• The mechanisms of phthalate-induced pregnancy complications include endocrine disruption, placental inflammation, and epigenetic modifications, which could create a hostile intrauterine environment.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

All three authors conceived the overall idea, of the manuscript. A Ali and RF Lamont wrote and corrected the original manuscript. JS Jørgensen critically reviewed and corrected the manuscript.

Additional information

Funding

This paper was not funded.