Ultrasound gel as an unrecognized source of exposure to phthalates and phenols among pregnant women undergoing routine scan

Abstract

Background Systemic absorption of phthalates and parabens has been demonstrated after dermal application of body lotion, and medical devices such as intravenous bags and tubing have been identified as a source of exposure to di(2-ethylhexyl) phthalate (DEHP). However, use of products during medical procedures such as aqueous gel applied during obstetrical ultrasound in pregnancy has not been investigated as a potential source of endocrine disrupting chemical (EDC) exposure. Human studies have associated EDCs with various adverse pregnancy outcomes. There is a need to identify sources of inadvertent exposure to EDCs especially during vulnerable developmental periods such as pregnancy. Objectives We conducted a pilot study to determine whether use of gel during routine obstetrical ultrasound increased urinary concentrations of phthalate and phenol biomarkers. Methods We recruited 13 women from the Massachusetts General Hospital who provided spot urine samples at the time of their second trimester anatomic survey. The first sample was collected prior to the procedure (pre-exposure, time 1), and two additional samples were obtained at approximately 1–2 hours (time 2) and 7–12 hours (time 3) post-exposure following the scan. Results Urinary concentrations of several DEHP metabolites and metabolite of diisononyl cyclohexane-1,2-dicarboxylate (DINCH) increased across time. For example, the geometric mean concentrations of mono(2-ethyl-5-hydroxyhexyl) phthalate increased from 3.1 ng/ml to 7.1 ng/ml (p-value=0.03) between time 1 and time 3. We also observed significant differences in concentrations of metabolites of butylbenzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), and di-isobutyl phthalate (DiBP). For example, mono-n-butyl phthalate (metabolite of DnBP) decreased from 3.5 ng/ml to 1.8 ng/ml (p-value=0.04) between time 1 and time 2, but then increased to 6.6 ng/ml (p-value=0.002) at time 3. Propylparaben concentrations increased from 8.9 ng/ml to 33.6 ng/ml between time 1 and time 2 (p-value=0.005), followed by a decrease to 12.9 ng/ml at time 3 (p-value=0.01). However, we cannot rule out the possibility that some of the observed differences are due to other sources of exposure to these compounds. Conclusions While additional research is needed, this pilot study potentially identifies a previously unknown source of phthalate and paraben exposure among pregnant women undergoing routine ultrasound examination.

Phthalate and BPA Exposure in Women and Newborns through Personal Care Product Use and Food Packaging

“…69 Alterations were also seen for thyroid hormones 70 and semen parameters 71 in this same study. Messerlian et al 72 showed an increase in DEHP metabolites following dermal application of ultrasound gel during routine obstetrical scans at 20 weeks. Using results from NHANES (from 1999 to 2000 through 2013 and 2014) Romano et al 73 found an association between regular use of multivitamin/multimineral supplements and increased concentrations of MEP (11% higher) compared to nonusers; however, no association was seen with MBP.…”

Phthalate Metabolites in Maternal and Cord Plasma and Their Relations to Other Selected Endocrine Disruptors and Steroids

“…Both phthalates are then conjugated as glucuronides and to a small extent sulfates, and excreted via the urine (Phthalates 2008). Systemic absorption of phthalates has also been observed after the dermal application of personal care products (Janjua et al 2007, Witorsch andThomas 2010) including various antistretch mark creams and ultrasound gel products (Messerlian et al 2017). Some phthalate monoesters are products from more than one parent compound.…”

Phthalate exposure and odds of bacterial vaginosis among U.S. reproductive-aged women, NHANES 2001–2004

“…Vaginal douches have been implicated as a source of DEP among reproductive-aged women [31]. Other products used intravaginally or in the genital area, such as lubricant [26], ultrasound gel [32], and wipes [33], may also be sources of phthalate exposure. These exposures are widespread: in nationally representative surveys of U.S. women, 25% reported using vaginal lubricants in the past month [34], 62% reported ever using lubricant [34], and 18% reported douching in the past year [35].…”