Exposure to chemicals commonly used to make plastics more flexible may have contributed to about 1.97 million premature births in 2018 alone, more than 8 percent of the global total, a new analysis of the population study shows. Researchers also estimate that the chemical has been linked to 74,000 newborn deaths.
This toxin, di-2-ethylhexyl phthalate (DEHP), is part of a group of chemicals called phthalates that are found in cosmetics, detergents, insect repellents, and other household products. Experts have found that these substances can break down into tiny particles and enter the body through food, air, and dust.
The new study, led by researchers at New York University Langone Health, focused on premature birth, a major risk factor for persistent learning and developmental problems and a leading cause of infant death, according to the World Health Organization.
The new analysis provides the first worldwide estimates of preterm births associated with exposure to DEHP and examines which regions of the world are most affected, the authors said. A report on the findings was published in an online journal on March 31. e-clinical medicine.
By estimating how much phthalate exposure contributes to preterm births around the world, our findings highlight that reducing exposure, especially in vulnerable communities, may help prevent preterm births and associated health problems. ”
Sarah Hyman, MSc, lead research author
Hyman, an associate research fellow at New York University’s Grossman School of Medicine, added that past studies have linked exposure to DEHP to cancer, heart disease and infertility, among many other health concerns. A number of studies have also linked this chemical to premature birth.
Exposure to DEHP may have contributed to 1.2 million years of disability, a measure of all the years people have lived or will live with illnesses, injuries, and other health problems caused by being born prematurely, according to a new study.
Hyman said that although phthalates are widely used, certain regions are estimated to account for a larger proportion of health effects than others, with the Middle East and South Asia accounting for 54% of estimated illnesses due to preterm birth. The plastics industry is growing rapidly in these regions, creating a large amount of global plastic waste.
In Africa, which accounts for 26% of health problems due to DEHP-related preterm births, the proportion of deaths is disproportionate to the overall proportion of preterm births. Researchers said this reflected the high potential death toll from premature birth in the region.
For the study, the researchers extracted data from large national surveys in the United States, Europe, and Canada to estimate DEHP exposure in 2018 across 200 countries and territories. We also used estimates from previous studies to fill in areas where we didn’t have our own data.
The team then drew on previous studies that assessed how phthalate exposure affects preterm birth and combined those results with global exposure estimates. Finally, they combined this information with global figures on preterm labor and birth to determine what proportion of these outcomes could be related to DEHP.
The scientists repeated these steps for another phthalate called diisononyl phthalate (DiNP), a common substitute for DEHP. The results show that DiNP causes approximately 1.88 million premature births worldwide and may pose similar risks as DEHP. The economic costs associated with neonatal deaths range from millions to hundreds of billions of dollars for both phthalates.
“Our analysis reveals that regulating phthalates one at a time or replacing them with poorly understood alternatives is unlikely to solve the larger problem,” said study lead author Leonardo Trasande, MD, M.P., and Jim G. Hendrick, M.D., professor of pediatrics at New York University Grossman School of Medicine. “We are playing a dangerous game of whack-a-mole with harmful chemicals. These findings highlight the urgent need for increased class-wide oversight of plastic additives to avoid repeating the same mistakes.”
Dr. Trasande, a professor in the Department of Population Health and director of the Department of Environmental Pediatrics and Center for Environmental Hazard Investigation, cautioned that the study 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.
Additionally, because there is some uncertainty in the data, the researchers considered a range of possible values rather than just one estimate. This range of uncertainty indicates that the actual impact of DEHP could be up to four times smaller or slightly larger than the main estimate. Hyman said the results indicate a significant health burden, even by the most conservative estimates.
Despite the limitations of this type of global modeling, this study lays an important foundation for future research to confirm and refine these results, beginning to close a major gap in understanding the extent to which plastic chemicals influence preterm births around the world, Hyman added.
Funding for this research was provided by National Institutes of Health Grant P2CES033423 and Beyond Petrochemicals.
Dr. Trasande has received travel and conference support from the Endocrine Society, the World Health Organization, the United Nations Environment Programme, the Japanese Ministry of Environment and Health, and the American Academy of Pediatrics. He has also received royalties and licenses from Houghton Mifflin Harcourt, Audible, Paidos, and Kobunsha, and has served in leadership or fiduciary roles with Beautycounter, Ahimsa, Grassroots Environmental Education, and Footprint. None of these activities are related to the current study. The terms and conditions of all these relationships are governed by NYU Langone Health.
Along with Mr. Hyman and Dr. Trasande, a co-investigator from New York University Langone was Jonathan Acevedo, MPH.
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Reference magazines:
Hyman, S. others. (2026). Preterm birth caused by exposure to chemicals used in plastic materials: global estimates. e-clinical medicine. DOI: 10.1016/j.eclinm.2026.103842. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00089-1/fulltext
