preterm birth linked to exposure to the plastic additive di-2-ethylhexylphthalate (DEHP) now has a first global estimate: researchers trace roughly 1. 97 million early deliveries in 2018 to DEHP and estimate 74, 000 newborn deaths associated with that exposure. That finding, produced by a team led by NYU Langone Health and published online March 31 in the journal eClinicalMedicine, reframes plastic chemical exposure as a measurable contributor to global infant illness and mortality.
What is the current state of preterm birth risk?
NYU Langone Health researchers combined exposure estimates for DEHP across 200 countries and territories with existing evidence on how phthalate exposure affects pregnancy and global counts of preterm births and deaths. The analysis estimates that DEHP exposure may have contributed to about 1. 97 million preterm births in 2018, representing more than 8 percent of the worldwide total, and to 74, 000 newborn deaths. The work also translates those outcomes into 1. 2 million years lived with disability tied to being born prematurely.
The research team drew DEHP exposure information from large national surveys in the United States, Europe, and Canada and used estimates from earlier investigations where national data were lacking. The study highlights geographic concentration of harms: the Middle East and South Asia together account for 54 percent of estimated illness from DEHP-linked preterm birth, while Africa represents 26 percent of health problems and carries a disproportionate share of deaths relative to its share of premature cases. The World Health Organization is cited in the study as emphasizing that preterm birth is a leading cause of infant death and a risk factor for long-term developmental issues.
What forces are driving these outcomes?
The study identifies a set of proximate drivers present in the analysis. DEHP is part of a class of chemicals called phthalates used to make plastics more flexible; these chemicals appear in cosmetics, detergents, bug repellents, and other household products and can break down into microscopic particles that enter the body through food, air, and dust. Rapidly growing plastics industries and high levels of global plastic waste are concentrated in regions showing the largest estimated health impacts.
Study authors frame regulatory and substitution dynamics as a structural force. Dr. Leonardo Trasande, the study senior author, said, “regulating phthalates one at a time and swapping in poorly understood replacements is unlikely to solve the larger problem. ” Past research cited by the authors links DEHP exposure with cancer, heart disease, and infertility, reinforcing the concern that exposures have multiple, overlapping health consequences.
What happens next? Scenario mapping and recommended actions
- Best case: Coordinated exposure reduction in vulnerable regions—guided by measurement and targeted interventions—reduces DEHP-linked preterm births substantially, lowering both early mortality and years lived with disability. Study lead author Sara Hyman, MS, said, “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. ”
- Most likely: Partial regulatory action and uneven implementation lead to modest declines in exposure in some countries while replacements and local plastic waste continue to drive harm in areas with expanding plastics industries; global impacts decline slowly and remain concentrated in a few regions.
- Most challenging: Fragmented policy responses and substitution with poorly studied chemicals maintain or shift risk, leaving the current burden of DEHP-linked early deliveries and newborn deaths largely intact and perpetuating geographic disparities in outcomes.
Key near-term actions implicit in the analysis include improved measurement of phthalate exposure where national data are missing, targeted exposure-reduction efforts in the Middle East, South Asia, and Africa, and regulatory approaches that address classes of chemicals rather than piecemeal substitution. The study’s methodology—linking exposure estimates from large national surveys with established exposure–outcome relationships and global birth and death counts—offers a replicable pathway for tracking impact over time.
Policymakers, public health officials, and industrial actors should treat the study’s estimates as a call to prioritize exposure reduction in the places where DEHP appears to be producing the greatest harm and to design regulations that avoid simple one-by-one substitution. Absent coordinated measures, the patterned burden of premature illness and death illuminated by the NYU Langone Health-led analysis will persist, leaving preventable consequences of preterm birth
