Lactational exposure to phthalate monoesters among breastfed infants in Italy

Background

Phthalates are chemicals widely used as additives in plastics, cosmetics and medical devices. Due to their endocrine disrupting action and ubiquitous environmental presence, the detection of their levels in breast milk is a crucial public health issue. However, up to date limited information exists on lactational exposure to phthalates in Italy. We aimed to determine the levels of 6 phthalate monoesters in breast milk of women living in Modena (Italy), to investigate the potential sources of exposure and to calculate the Estimated Daily Intake (EDI) for breastfed infants.

Methods

In this cross-sectional study 201 women (19-45 years) living in Modena (Northern Italy) provided a sample of breast milk (30-40 days postpartum) and filled in a questionnaire on personal data and on potential sources of exposure to phthalates. Samples were analyzed by triple Quad LC/MS Mass Spectrometry. Phthalates levels were used to calculate newborns' EDIs that were compared with the Tolerable Daily Intake (TDI) set up by the European Food Safety Authority (EFSA).

Results

Monoethyl phthalate (MEP) and monoisononyl phthalate (MiNP) were detected in most samples, respectively, in 173 (86%; mean: 14.50±80.88; range: 0.03-674 μg/l) and 160 samples (80%; mean: 1.41±2.48; range: 0.04-18.40 μg/l). Levels appeared higher in women more frequently consuming food and beverages preserved in plastic containers or using cosmetics, although differences were not significant. The EDI levels for MEP (mean: 2.08±11.39 µg/kg BW/day) and MiNP (mean: 0.20±0.33 µg/kg BW/day) appeared below the TDI values set up by EFSA.

Conclusions

Although the widespread diffusion of phthalate monoesters in breast milk, their levels resulted lower than those reported in other studies and the EFSA recommended values. Thus, the use of breast milk, a unique nourishment for infants, should not be discouraged.

Key messages

Monitoring phthalates’ levels in breast milk is crucial to check breastfed infants’ exposure and to prevent potential health risks associated with this exposure. It’s essential to adopt effective public health interventions to reduce phthalates dissemination in environment and food and consequently the maternal and infant exposure to these contaminants.

Parental and offspring psychopathological disorders after the 2012 Italian earthquake

Background

Parental mental health can affect offspring Post-Traumatic Stress Disorder (PTSD), but up to now few data focused on families exposed to natural disasters. Thus, this study aimed at investigating the association between parental and youth psychopathology after the Italian earthquake of 2012.

Methods

In this cross-sectional study, 1162 parents and 682 children and adolescents (9-14 years) living in two districts, earthquake area (EA) and control area (CA), were assessed for psychopathological distress two years after the earthquake. Children filled in the UCLA PTSD-Index for DSM-IV, an exposure questionnaire, and the Strengths and Difficulties Questionnaire (SDQ); parents the Symptom Checklist-90 (SCL-90).

Results

Parents in EA showed a higher frequency of psychopathological difficulties than those in CA (28% vs 17.5% had a SCL-90 global score over the cutoff, p < 0.001). Sleep disturbances were the most prevalent disorder, followed by obsessive-compulsive disorder, depression, somatization and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample.

Both SCL90 total and symptom domain scores correlated with PTSD total and clusters scores, especially for hyperarousal and re-experiencing. Parental anxiety, depression and somatization showed the highest correlations. Considering SDQ, mothers' psychopathology resulted to be associated mainly with offspring's emotional and peer problems, while fathers' disorders affected mainly children's hyperactivity.

Conclusions

This study showed a significant association between parental mental health and both PTSD and emotional/behavioral problems among offspring after earthquake. These results should be carefully considered when planning mental health support interventions in areas affected by earthquakes.

Key messages

Parental psychopathology and PTSD and other emotional/behavioral difficulties in children tend to cluster in families exposed to natural disasters, especially earthquakes. Parental and offspring psychopathological disorders should be considered when planning mental health support interventions in areas affected by earthquakes.

Child growth, neurodevelopment and pre and postnatal exposure to phthalates: first exposure data

Background

Phthalates, potential endocrine disruptors added to plastics, are found in numerous products and contaminate many environmental matrices, resulting in a widespread human exposure virtually interfering with fetal and neonatal development. This study aims to evaluate, by repeated mothers and children urine monitoring, the exposure to phthalates in newborns and to investigate its potential effects in early life.

Methods

A cohort study, recruiting mothers and newborns at an Italian hospital, is ongoing. Prenatal exposure is assessed by measuring 6 phthalates in maternal and neonatal urine; while postnatal exposure is assessed in the infants urines at 3rd and 6th month. Infants undergo periodic visits (t0, t3, t6, t12, t24) to assess growth, neurocognitive development and urinary sex hormone levels; mothers fill in exposure questionnaires at t0 and t6.

Results

To date, 148 mother-child couples have been enrolled, 74 children checked at t3 and 35 at t6. The newborns (3.4±0.3kg weight, 50.2±1.7cm length), show physiological hormonal levels: LH 0.6±1.8mIU/ml; FSH 1.5±1.6mIU/ml, testosterone 10.3±4.8ng/ml, estradiol 843.9±972.4pg/ml. Phthalates appear highly widespread both in mothers and infants, although at low levels. MEP shows the highest levels (mothers: 37.3±83.2µg/L; infants: 19.6±32.8µg/L), followed by MnBP (mothers: 11.3±14.4µg/L; infants: 21.3±25.5µg/L) and MBzP (mothers: 3.9±3.9µg/L; infants: 8.1±9.8µg/L). All mothers report frequent contact with products potentially containing phthalates, however mother-child couples levels showed very low correlations.

Conclusions

Exposure to phthalates for infants appears widespread, albeit at low levels. Neonatal urine biomonitoring is a valid tool to evaluate child exposure, able to produce more accurate information than maternal urine.

Key messages

Biomonitoring of childhood urine produces accurate data on pre and postnatal exposure to phthalates. Biomonitoring of childhood urinary phthalates can enhance the assessment of their potential effects on growth and development.