A new study found that a chemical that is all around us could have contributed to 2 million preterm births. But not all parts of the world are affected to the same extent.
A substance that appears in many products we use every day and whose microscopic particles enter the body through food, air, and dust has likely contributed to almost 2 million preterm births worldwide.
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The toxin di-2-ethylhexylphthalate (DEHP) appears in cosmetics, detergents, bug repellents, and other household products. It has in the past been linked to cancer, heart disease, and infertility, among many other health concerns.
A new study focused on preterm birth led by NYU Langone Health researchers has linked the additive to early births. While medical causes of premature birth are well understood, the role of environmental exposure has been harder to measure - until now.
"We are playing a dangerous game of Whac-A-Mole with hazardous chemicals," said Leonardo Trasande, the study's senior author and Professor of Paediatrics at NYU Grossman School of Medicine.
The researchers estimate that in 2018 DEHP contributed to about 1.97 million preterm births and was linked to around 74,000 infant deaths worldwide.
How phthalates lead to early birth
Scientists believe phthalates like DEHP may increase the risk of premature birth by disrupting hormones that regulate pregnancy. This can trigger inflammation and stress in the placenta, or affect how it functions, potentially leading to labour starting too early.
While the exact mechanisms are still being studied, the chemicals are widely recognised as endocrine disruptors. These can interfere with fetal development.
Preterm birth remains one of the leading causes of infant death and long-term disability. According to the World Health Organisation a child being born before 37 weeks of pregnancy has a higher risk of struggling with lifelong learning and development. Premature births are also the leading cause of infant death.
DEHP exposure is higher in certain areas
While earlier research has linked phthalate exposure to premature birth, most evidence has come from small-scale or regional studies. This analysis is the first to estimate the global burden, combining exposure data and health outcomes across more than 200 countries.
The impact of the chemical is far from evenly spread. The study shows that the Middle East and South Asia bear more than half of the global burden linked to DEHP exposure, where rapid industrialisation and rising plastic use drive higher exposure levels. In Africa, the pattern is even starker: while fewer cases are recorded, newborns are more likely to die, reflecting gaps in access to care.
Researchers say this creates a double disadvantage, where higher environmental risks collide with weaker health systems, amplifying the toll in already vulnerable regions.
What the study does and doesn’t show
Beyond the health risks, the study raises questions about how chemicals are regulated. Phthalates are often addressed individually, yet the analysis suggests that replacement substances may pose similar risks, creating a cycle of substitution rather than solution: They found that DiNP, a common replacement for DEHP, may carry similar risks, raising concerns about replacing one harmful chemical with another.
“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. Leonardo Trasande, MD, MPP, the Jim G. Hendrick, MD, Professor of Pediatrics at NYU Grossman School of Medicine was quoted as saying on the NYU Langone website.
The researchers caution that the findings do not establish a direct cause-and-effect relationship. Instead, they are based on modelling that combines existing exposure data with known health risks, meaning the true impact could be lower or higher.
However, the results still point to a substantial global health burden with need for further investigation. Trasande and his colleagues are calling for broader, class-based regulation of plastic additives, arguing that improved monitoring and waste management are also needed to reduce exposure.
