Foods we eat are covered in plastics that may be causing a rise in premature births, study says
Gigi Chen
News Article: https://www.cnn.com/2024/02/06/health/preterm-birth-phthalates-study-wellness/index.html
Journal Article: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00270-X/fulltext
Background:
Phthalates are plasticizers and one of the most common endocrine-disrupting chemicals (EDCs) in plastics.1 These compounds are present to increase the flexibility and plasticity of material and improve the workability, distensibility, and printability and are found in a variety of plastic products, including food packaging and personal care product packaging.2 However, these compounds have been suggested to either inhibit or stimulate hormone levels, altering pathways of movement and the overall function of these hormones. While not all the action mechanisms of EDCs are known, exposure to these compounds has been shown to cause reproductive, metabolic, neurologic disorders, inhibition of cardiovascular development, and cancer.3 Recently, there has been a push for replacement of di-2-ethylhexyl phthalate (DEHP) with phthalates that have been less correlated to adverse health problems; however these replacements and their effects on human health are poorly characterized and understood. Phthalates and their replacements may play a role in increasing the risk of preterm birth and shortened gestation, which is the leading cause of neonatal mortality.4 Additionally, preterm birth has potential negative psychological, behavioral, and educational outcomes during youth and an increased risk of cardiovascular disease and diabetes in adulthood.
Peer Reviewed Article:
The Lancet peer reviewed article titled “Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs” by Trasande et al. uses existing data from the U.S. National Institutes of Health Environmental influence on Child Health Outcomes (ECHO) to understand associations between di-2-ethylehexyl phthalate (DEHP) substitutions and adverse birth effects. The study measures phthalate metabolites in maternal urine and associates these values with the children's gestational age, birth weight, and birth length using correlational, statistical, and sensitivity analysis. The phthalate metabolite is considered to be present if it was present in 50% of all samples and the phthalate metabolites were detected in 1000 participant samples. The detected phthalate metabolites included phthalic acid, diisodecyl phthalate (DiDP), as well as 5 other phthalate metabolite groups: low molecular weight phthalates, high molecular weight phthalates, DEHP, di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP) metabolites. Overall, this study suggests that there are associations between phthalate exposure and higher risk of preterm birth across all three trimesters and an ethnically diverse sample size. All phthalates tested showed increased risks of preterm birth and low birth weight; however phthalic acid, DiNP, DiDP and DnOP specifically have the stronger association with preterm birth and low birth weight compared to DEHP. This raises the concern that DEHP replacements like DiNP and DiDP may actually be more harmful than DEHP. Due to the richness of the data, this study was also able to compare the correlation between phthalate exposure and preterm birth rate with other variables like age, race, ethnicity, tobacco use, education, and child sex. The study suggests apparent racial and ethnic disparities as Hispanic and non-Hispanic African American mothers had a lower birth weight and length and shortened gestation compared to White mothers. Higher maternal age and education are associated with higher birth weight and length, while tobacco usage is associated with reduced birth length but not gestational age or birth weight.
This study leverages a large, diverse sample size (n=5006) across time and provides insight on the possible connection between DEHP substitutes and the increase in preterm birth rates. As groupings within the ECHO’s database include data collected both before and after DEHP was substituted out, it provides a unique perspective of the short-term effects of these DEHP substitutes. Prior to looking at ECHO’s database, the authors did a literature survey and determined that other studies have suggested a relationship between phthalate exposures and increased risk of preterm birth. However, there was limited information on how this affected ethnically minority groups and the potential effects of DEHP substitutions, and the literature review results further supported the strengths of the Trasande et al. paper. Additionally, the concentration of phthalate metabolites in samples was within the analytical limit of detection (LOD), minimizing the use of values below the LOD. However, the authors also acknowledge the limitations of interpretation in their work, as their observational study includes potential for unmeasured confounders like dietary phthalate contaminants.
News Article:
Overall, the CNN Health article written by Sandee LaMotte effectively communicates the main findings of the Lancet article, clearly stating that the research suggested “a significant association of DEHP with shorter pregnancies and preterm birth.” LaMotte seemed to also have interviewed (although not explicitly stated nor cited) the authors of the paper and used their quotes to describe and summarize the scientific article’s main findings. The CNN article provides context surrounding phthalates, plastics, and preterm birth, contextualizing the research for a more general audience. However, LaMotte also includes various perspectives and arguments related to the effect of phthalates’ effect on preterm pregnancy. She cites other senior scientists in the field, environmental toxicologists who were not involved in the study, as well as the American Chemistry Council (a trade group that represents the plastic and polymer industry), presenting the audience with multiple perspectives towards the plastic pollution problem. For a general audience, I wonder if these varying perspectives may confuse readers and dilute the need to address the risk of phthalate exposure on preterm birth. In general, despite the very in depth context information describing the ongrowing problem of phthalates, the article uses very neutral language and mainly relies on quotes from various scientists.
When describing the experimental setup LaMotte talks about the sample size but excludes other important information like the diversity of the sample size and the ethnic disparity in the effect of phthalates on preterm birth. There is no mention of the ethnic disparity that was emphasized in the Trasande et al. article. Additionally, LaMotte does not discuss the various groups of phthalates and only touches upon DiDP, DnOP, and DiNP. She briefly mentions that DiDP, DnOP, and DiNP are replacements for DEHP but only limits her discussions to these specific phthalates. Overall, I also noticed how LaMotte puts this study into an economical perspective, often sprinkling how preterm births “cost to society of nearly $4 billion in that year alone” and comments how much scientists spend doing this type of research. While Trasande et al. briefly touches upon the costs of preterm birth, LaMotte heavily emphasizes this point rather than some of the other findings in Trasande et al. 's paper, which makes the CNN article feel vaguely dehumanizing.
In general, I think CNN health effectively explained the problem at hand, contextualizing it and highlighting its importance for the general population. However, the article spends too much time explaining and defining broad terms, making their description of the actual research seem like an afterthought. Also, I noticed that the video linked in the beginning of the article is actually about PFAS (and it's one we’ve seen in an article presented before) and not phthalates, which makes me wonder why it is included in this article as neither the CNN nor the Lancet article talks about PFAS at all. Overall, I would give the article an overall score of 7/10.
Citations
Great analysis! I agree with your overall score of the paper, the main findings and the data were very nicely presented, and cited many (crazy amounts) outside sources. I think LaMotte is trying to provide multiple perspectives to strengthen the article's impact and act as almost a review article for the audience. The overall tone of the language is very consistent, as you pointed out, very neutral, and relies on a lot of the quotes from the scientists. Given the amount of information LaMotte is trying to include in the article and its length, I think it is reasonable for her to exclude detailed information on DiDP or DnOP. I agree with you that the ethnic disparity in the effect of phthalates on preterm birth should be included, especially since it is one of the conclusions that the journal emphasized. I think the video at the top is there to provide a general idea of "forever chemical", but probably mainly for the ad time. Every time I tried to watch it, it'd give me a 30-second non-skippable ad.
ReplyDeleteHi Richard, I too, initially though that including multiple perspectives on this issue was a strength of this article. I later changed my mind as I thought it might dilute the importance of the issue. However, I do agree with you and think it is right that LaMotte excluded more detailed information on the different subclasses of phthalates given that this is for a general audience.
DeleteGreat job on this blog post! I agree with your rating of the CNN article. I think it does a nice job of covering the science from the Lancet article, but I think the information LaMotte presents about the DEHP replacements is enough for clarity so the reader does not get lost in the technicalities. I agree with you that the ethnic disparities should have been talked about and also think that the comment from the American Chemistry Council should have been addressed and not just left to stand alone in the article.
ReplyDeleteHi Sofia, thank you! You make a great point about the way LaMotte presents information. I think if I was judging this article based off different criteria (like clarity and contextualization) I would give it a much higher score. LaMotte provides a good breath of background including information about plasticizers, phthalates, and preterm birth which is great for a general audience. Overall, the CNN article was a great read even if it did cherry-pick what information they wanted to include from the journal article.
DeleteI agree that it was weird that the video did not actually pertain to phthalates given those are the focus of the article, but I suppose the author or whoever included the video either a) didn't know the difference and assumed both were bad (Which would technically be true, they are both bad) or b) whoever selected the video did not read the article and was told to pick an article based on a plastic pollutant. Regardless it is just a little lazy. I also agree that the news article almost seems like it isn't about the journal article, rather about the general topics because of how much time they spend on background. Additionally, it was kind of a glaring piece of missing information to not cover ethnic disparities discussed in the journal article which is a very important topic generally. Given all of this, despite the article being, I'd argue, a good read, I would rate it a little lower, 6/10. It seems like a trend we've seen over this semester in a lot of these news articles is the lack of coverage for ethnic disparities in findings, do you have any ideas why this might be? Given the journal articles does the bulk of the work saying "Racial and ethnic disparities in birth outcomes were apparent (table 3), with shortened gestation and lower birthweight and length among non-Hispanic Black and Hispanic mothers compared with White mothers" it seems like it would be easy for the news article to include it.
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DeleteI think the question you pose is really interesting. Similar to what I’ve said in my response to Mia, I think the trend of exclusion of issues like racial disparities in news articles may be because racial disparities and human rights issues are (unfortunately) often related to politics, and politics have become quite a controversial topic to discuss in educational and professional settings. It is also likely that LaMotte may believe that bringing up the issue of racial disparity may take away from the other results of the paper that present as less controversial, more “objective” issues (like the correlation between phthalates and preterm birth). To reach more readers (potentially those who do not perceive/want to acknowledge issues like racial disparity) it is possible that news articles avoid such controversial and (unfortunately) polarizing topics. In other words, it may be because mainstream news articles are trying to maintain a perspective that is universally “politically correct” to cater to a wider range of general readers. Additionally, it may have to do with funding sources having a conservative bias (though I am not sure if that is the case with CNN).
Deletegreat analysis Gigi, I like how you scored the article given the many flaws addressed by you and our fellow classmates (information missing on ethnic disparities, a strange video choice to begin the article, and a lackluster description of the actual science). Something I actually appreciated in the news article compared to the scientific paper was the economic perspective. Oftentimes in environmental papers, there is an emphasis on the grave nature of an issue to the earth or to human health. Clearly, this matters and is certainly enough to encourage many of us to take a course entitled "Environmental Chemistry." However, I also think many people can passively ignore health issues so long as things are cheap (like gasoline production). All of this is to say that addressing economics is a helpful way to tie an issue across boundaries. I believe that a societal cost nearing $4 billion is significant enough for people who are not concerned about the environment or maternal health (again, very valid and arguably more important issues) to seriously interface with the issues with Phthalates. Since you considered LaMotte's discussion on economics slightly dehumanizing, I would like to hear your opinion.
ReplyDeleteHey Joe, that's a really thoughtful point. I think that maybe choosing the word "dehumanizing" might have been a bit extreme but I could not think of a better word to describe how I felt. Again, like you have said, certain populations (those who are not directly affected) may care more about the economics side of things. So, I do agree with you and think that it was great that LaMotte included this point. Rather than the mention of the economics on its own, I think it is that its is the emphasis on the economics in combination with the of lack of call for action, the lack of mentioning of the ethnic disparities, and the general neutral tone on the paper that makes the article overall slightly dehumanizing. I do think LaMotte could have added more of an emphasis on the grave nature of this issue while still mentioning the economic point of view to, as you said, connect the issue across boundaries.
DeleteGigi, I liked your analysis of the news article. I share your concern regarding the confusion amongst readers with the inclusion of multiple perspectives outside of the peer-reviewed article. While the outside perspectives, like from the toxicologist, Linda Birnbaum, helped clarify and emphasize certain points made from the peer-reviewed (Alternative phthalates that are replacing DEHP might have even worse environmental & health consequences), in my opinion, it takes away the impact of the peer-reviewed article and also takes away room from mentioning other important information from the peer-reviewed article. As you pointed out earlier, there was no mention of racial nor economic disparities found within the study.
ReplyDeleteDo you think the inclusion of other perspectives took too much room to mention any other findings regarding race or economic status of the mother? What other reasons can you think that made the news article author not mention these crucial findings?
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DeleteMia! Hello! I do think the inclusion of other perspectives took up too much room and LaMotte should have mentioned other findings like racial economic intersectionality and perhaps the environmental racism that is tied to this issue. For a general reader, the way LaMotte was almost playing devil's advocate in the perspectives she was presenting may (to some people) withdraw the severity and adverse impacts of this issue. LaMotte seemed to want to keep the article as neutral and unbiased as possible (which is valid), but I wish she provided more context to the points of view of Linda Birnbaum and the American Chemistry Council. As for your second question, my response will probably be similar to one of my other responses to some of these comments. Here is my take: science is often perceived as a gold standard of objectivity and should not be in any way biased. To some extent science is accepted to be void of emotion and apolitical as it should focus on facts and “truth.” I think scientists understand the nuances of the production of knowledge and how things are much more of a work in progress whereas a more general audience would perceive a peer-reviewed article as an objective fact. Unfortunately, topics like human rights and ethnic disparities are often perceived as “political,” and “politics,” in current society, has become somewhat of a controversial subject. I think we see this trend in news articles that shy away from mentioning ethnic disparities to limit controversy and encourage all audiences (including those who may not believe in or perceive racial disparities) to read their news articles. Not to spiral too much into anthropology/philosophy, this really makes me question to what extent does pursuit of objectivity in the field of science disconnect this “science” from human and societal applicability. I actually want to read more about this topic and maybe I'll get back to you with papers/sources about this.
DeleteGreat analysis! We've seen previous comments made about having multiple perspectives in news articles including those that aren't in the interest of health or the environment. Do you think the LaMotte should've elaborated on what the goals of the ACC are for transparency's sake? I agree with your point in that introducing a multitude of sources risks diluting the overall message of the journal article. Along those lines, we have an idea of what type of action people from the EWG or the National Institute for Environmental Health Sciences want but by describing the ACC as "industry trade association for US chemical companies," instead of maybe mentioning some of their initiatives that promote the importance of plastics and chemical industry products in every day life, is vague enough to obscure or weaken the message of the journal article from the perspective of the general public.
ReplyDeleteThis was a really great article selection and an interesting read. I was very suspicious of the CNN article because LaMotte quoted the authors of the scientific article that phthalates COULD be a factor, and then made a definitive statement that phthalates have caused 57,000 premature births. This value was obtained from an article in The Lancet, and it is an estimated value of 56,595. However, this is data from only one of the models in the paper. Other models project much higher values ranging anywhere from 56,595 to 120,116 premature births. Due to the high variability of data, it is important to remember that these are estimations, and I wish that was made clear in the CNN article.
ReplyDeleteI felt that LaMotte should have included some information about some of the other variables that impacted the study. There are so many factors that could cause premature births, both environmental and genetic. Data for the study was provided from participants in the ECHO (Environmental influences on Child Health Outcomes) program: "Eligibility criteria for mother–child dyads from the ECHO Program to be included in the current analysis were: one or more urinary phthalate measurements during the index pregnancy; data on child’s gestational age and birthweight; and singleton delivery." To be a participant in the study, you only needed to fulfill the aforementioned criteria. Subgroups that were identified by the researchers were sex of the child, maternal education, race, and tobacco use. I think it would have been important for LaMotte to mention the effects of these variables on the study. I also would have liked for the researchers to have more information about how genetic conditions are potentially aggravated by phthalates. They only mentioned two: "gestational diabetes and hypertensive disorders that might mediate or moderate observed associations, we separately added gestational diabetes and hypertensive disorders to full models and assessed the effects on regression coefficients." Obviously there are so many conditions that can impact a woman's pregnancy. But, if phthalates are responsible for conditions like cardiovascular issues, cancer, and asthma, I think it would be prudent to screen for those conditions in the pregnant women studied.
In both the scientific article and the CNN article, the authors communicated the costs associated with premature births. I completely agree with you that it seemed dehumanizing. My reaction was that it was very belittling, especially when I read in the article what the breakdown of the costs were: "We calculated total costs of preterm birth attributable to in-utero exposure by adding preterm birth-associated costs of hospitalization for medical care to lost lifetime economic productivity, operationalized as loss of intellectual quotient points due to preterm birth." Do we really need to discuss the economics of why premature births from phthalates can be damaging? Are the health impacts on women and infants not enough to warrant more research to mitigate the problem?
The CNN article contained many small errors and imperfections that make me question how it was written. Many of the quotes were followed by "said X person in an email". The repeated use of the phrase "in an email" is not something I have seen other news articles use before and I question why LaMotte decided to write it like that. The article includes the phrase "The 5% to 10% percentage" and grammatical errors are scattered throughout. The general lack of polish makes me wonder whether AI was used in the writing of this article, or if it was simply a rush job. Either way, the science is being done a disservice.
ReplyDeleteAdditionally, as we talked about last week, the American Chemistry Council being cited simply gives more context and allows both sides to 'say their piece', but to frame them as a chemical trade organization and not acknowledge their history as the American Plastics Council is irresponsible reporting.
Finally, near the end of the article, LaMotte writes that "All of these medical expenses add up, allowing Trasande and his coauthors to estimate the cost to the US in medical care and lost economic productivity from preterm births to be “a staggering $3.8 billion,”". This minimization of millions of women's traumatic experiences is incredibly callous. The CNN article left out many other sections of the paper yet chose to include this, which leaves a very bad taste in my mouth.
With the numerous amount of plastic acronyms, it was evident that this paper was going to be hard to summarize for CNN. With the authors mentioning the limitations of interpretation in their work along with the potential for unmeasured confounders like dietary phthalate contaminants, it made it hard for CNN to produce a thought provoking conclusion or a defined call to action, which perhaps led to its unpolished structure and plentiful small errors. For example, I think that the term defining should have been placed in the front of the article rather than the end (e.g when the article started to define preterm births).
ReplyDeleteThough the average reader would see most of the article as assorted scientific mumbo jumbo, I believe that the CNN article did a good job at least at informing the readers on future precautions. Reducing plastic footprint, avoiding microwaving food or beverages in plastic, and checking recycling codes 3 are simple and digestible ways for the public to gain more insight against premature births. I think that this is a good practice for news articles covering scientific papers so that at least the reader can remain vigilant and wiser with everyday objects without freaking out their grandmas.
First off, great job on the blog post. I found your analysis to be very insightful. I agree with the rating of 7/10. I personally was getting confused about when the research article was actually being cited or discussed. There were many other sources included in the article which helped with context, but to a certain extent took away from the point of the article for me. I just wonder what you think about the inclusion of a plethora of outside resources helps or hindered your rating of the article.
ReplyDeleteI personally found the emphasis on the phthalate replacements interesting. It seemed to be some sort of call to action, but I felt that the quotations from toxicologist Linda Birnbaum were saddening. The tone of her quotes made it feel as though there is little to be done to help improve this problem. I wonder if the general audience of this new articles is disturbed by the lack of longterm solutions.
I very much agree with your points made here. I think the omission of ethnic disparity data feels counterintuitive, given the intentions and content of the article attempting to further the social content of the article. With regards to the video, which has come up in a few comments: I think that might not be entirely LaMotte's fault, as given the amount of editors that articles in enormous publications such as CNN go through, it was probably added after the fact by someone who didn't even read the research paper. I agree with Chadwin's comment that there definitely should have been an alteration in the pacing and organization of the article, given the implicit limitations in writing an article for such a broad publication such as CNN. Its establishing of the terminology should have at least been more deftly woven into the piece.
ReplyDeleteGreat analysis Gigi! I think a 7/10 for this article could be fair, though I’d argue a lower score like 6/10 might be more appropriate. Like many comments have stated, this CNN article neglects the racial disparities in phthalate exposure and premature births, which was a major focus of the Lancet study. Not only is ignoring a huge part of the study leaving out key results, but it neglects the issue of environmental racism, and the necessity of centering racial and environmental justice in climate action.
ReplyDeleteI also agree that it seemed odd to include very brief quotes from other sources like the EWG and American Chemistry Council, especially citing them as emails. I believe it is important to include other voices, whether supporting or contradicting, so readers are at least aware of both sides, and that it is also appropriate to give more time to peer reviewed data rather than lobbying groups. However, using an email instead of an interview seems like a rushed effort to get more voices in.
A couple of other minor things from the article seemed odd to me. In the 4th paragraph, LaMotte quotes Trasande ““In our new study, we found DEHP and three similar chemicals could be responsible for 5% to 10% of all the preterm births in 2018”, which neglects the fact that those three similar chemicals are the replacements for DEHP and were actually found to have a bigger impact. While this was discussed later on, this quote puts disproportionate emphasis on DEHP rather than the ongoing problem with its replacements.
Additionally, the title describes “Foods we eat are covered in plastics”, which isn’t technically false but with all the news about microplastics, isn’t the most accurate choice for this article that talks about plastic additives, rather than the polymers themselves and can be misleading to readers who mainly know about microplastics.