Levels of Phthalate Metabolites in Urine of Pregnant Women and Risk of Clinical Pregnancy Loss

Toxicological studies have shown that phthalate esters (PAEs), a class of widely used and environmentally prevalent chemicals, can increase the abortion rate in animals, but epidemiological evidence is scarce. This study aimed to explore the relationship between the urinary concentration of phthalate metabolites and the risk of clinical pregnancy loss. A total of 132 women who underwent clinical pregnancy loss (cases) and 172 healthy pregnant women (controls) were recruited from Beijing, China. Eight phthalate metabolites in urine were determined by ultraperformance liquid chromatography tandem mass spectrometry (UPLC–MS/MS). Five phthalate metabolites, monomethyl phthalate (MMP), monoethyl phthalate (MEP), monoisobutyl phthalate (MiBP), mono-<i>n</i>-butyl phthalate (MnBP), and mono­(2-ethlyhexyl) phthalate (MEHP), were detected in at least 95% of the urine samples, with the highest median concentration of 51.0 μg/g of creatinine for MnBP of all participants. The differences in urinary concentrations of phthalate metabolites between cases and controls were evaluated using the Mann–Whitney <i>U</i> test. The concentrations of MEP (median of 18.7 μg/g of creatinine), MiBP (23.3 μg/g of creatinine), and MnBP (58.2 μg/g of creatinine) detected in the cases were significantly higher than those (15.7 μg/g of creatinine for MEP, 19.4 μg/g of creatinine for MiBP, and 43.9 μg/g of creatinine for MnBP) in the controls (<i>p</i> < 0.05). Increasing risks of clinical pregnancy loss were observed from the first to fourth quartiles of the MEP, MiBP, and MnBP concentrations (<i>p</i> < 0.05 for trend). We concluded that exposure to MEP, MiBP, and MnBP was associated with an increased risk of clinical pregnancy loss