Date of Graduation

Fall 11-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Torry Cobb, DHSc, MPH, PA-C

Second Advisor

Mark S. Pedemonte, MD

Abstract

Background: Phthalates are highly used chemical additives, plasticizers, and solvents found in a wide range of consumer products from auto parts and toys to personal care products and foods. Being so ubiquitous in our daily environments, phthalates have been studied to evaluate their potential for adverse affects on animals, and were found to cause anti-androgenic affects in rats, low birth weight, shortened gestational period as well as birth defects. Newer studies are beginning to look at these factors as they relate to humans. This systematic review used GRADE to evaluate the quality of evidence in the most recent studies on newborn birth outcomes that were exposed prenatally to phthalates.

Methods: A systematic review of studies written between 2000 and 2010, using published literature in the English-language, was conducted using MEDLINE, Evidence-Based Medicine Reviews Multifile, and Web of Science using keywords phthalate, phthalates, prenatal, anogenital distance, AGD, birth, low birth weight and birth outcomes. Articles that examined the birth outcomes of birth weight, birth length, head circumference and gestational age after in utero exposure to phthalates were selected. Four studies were analyzed for result outcomes.

Results: Three of the four studies have demonstrated that in utero exposure to environmental phthalates is associated with either newborn birth weight, birth length, head circumference or gestational age. The forth study reported no significant relationships between prenatal exposure to phthalates and any of the birth outcomes.

Conclusion: The findings deduced in this study using the GRADE process, suggest that, at the current level of exposure, phthalates may have subtle affects on the fetus in relation to certain birth outcomes. However, the evidence is of low quality and further investigation is needed to truly report that these findings are not due to other limitations such as other environmental chemicals not evaluated or confounding factors such as self-reported values.

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