biostudies-literatureTrasande LNational Institute of Environmental Health SciencesNIEHS NIH HHSNational Institutes of HealthNIH HHSOffice of Behavioral and Social Sciences Researche74-e85https://www.ebi.ac.uk/biostudies/studies/S-EPMC11444077biostudies-literatureUnknown8(2)<h4>Background</h4>Phthalates are synthetic chemicals widely used in consumer products and have been identified to contribute to preterm birth. Existing studies have methodological limitations and potential effects of di-2-ethylhexyl phthalate (DEHP) replacements are poorly characterised. Attributable fractions and costs have not been quantified, limiting the ability to weigh trade-offs involved in ongoing use. We aimed to leverage a large, diverse US cohort to study associations of phthalate metabolites with birthweight and gestational age, and estimate attributable adverse birth outcomes and associated costs.<h4>Methods</h4>In this prospective analysis we used extant data in the US National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program from 1998 toThe Lancet. Planetary healthPrenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs.PMC11444077UH3OD023318UH3OD023251U24 OD023319UH3OD023272UH3 OD023290UH3OD023271UG3 OD023251UH3 OD023251P30 ES017885UH3OD023290UH3 OD023272UH3 OD023271U24OD023382U2C OD023375UH3 OD023318U24 OD023382UH3OD023305UG3 OD023305UH3OD023248U24OD023319P2C ES033423P30 ES010126UH3OD023342P2CES033423UH3OD023285U2COD023375UH3 OD023285UH3 OD023342UH3 OD023248UH3 OD023305Newschaffer CCatellier DJNelson MESmith PBElliott MStarling APVolk HDabelea DKerver JMNewby KLBarone CSchmidt RNaidu MZhao QGershon RRomano MEKarr CRuden DMSchantz SLLyall KDunlop ALTylavsky FNguyen RJacobson LPSathyanarayana Sprogramme collaborators for Environmental influences on Child Health OutcomesBush NMason ABarrett ESMeeker JDAlshawabkeh ACordero JBuckley JPHerbstman JBLeWinn KZSwan SFussman CPadula AMHamra GBCella DTrasande LPaneth NfalsePrenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs.<h4>Background</h4>Phthalates are synthetic chemicals widely used in consumer products and have been identified to contribute to preterm birth. Existing studies have methodological limitations and potential effects of di-2-ethylhexyl phthalate (DEHP) replacements are poorly characterised. Attributable fractions and costs have not been quantified, limiting the ability to weigh trade-offs involved in ongoing use. We aimed to leverage a large, diverse US cohort to study associations of phthalate metabolites with birthweight and gestational age, and estimate attributable adverse birth outcomes and associated costs.<h4>Methods</h4>In this prospective analysis we used extant data in the US National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program from 1998 to2024-01-01T00:00:00Z2024 Feb2026-06-06T22:23:40.373Z2025-04-03T23:48:50.969ZS-EPMC114440773833153310.1016/S2542-5196(23)00270-X