Lactational exposure to phthalate monoesters among breastfed infants in Italy

Abstract Background Phthalates are chemicals widely used as additives in plastics, cosmetics and medical devices. Due to their endocrine disrupting action and ubiquitous environmental presence, the detection of their levels in breast milk is a crucial public health issue. However, up to date limited information exists on lactational exposure to phthalates in Italy. We aimed to determine the levels of 6 phthalate monoesters in breast milk of women living in Modena (Italy), to investigate the potential sources of exposure and to calculate the Estimated Daily Intake (EDI) for breastfed infants. Methods In this cross-sectional study 201 women (19-45 years) living in Modena (Northern Italy) provided a sample of breast milk (30-40 days postpartum) and filled in a questionnaire on personal data and on potential sources of exposure to phthalates. Samples were analyzed by triple Quad LC/MS Mass Spectrometry. Phthalates levels were used to calculate newborns' EDIs that were compared with the Tolerable Daily Intake (TDI) set up by the European Food Safety Authority (EFSA). Results Monoethyl phthalate (MEP) and monoisononyl phthalate (MiNP) were detected in most samples, respectively, in 173 (86%; mean: 14.50±80.88; range: 0.03-674 μg/l) and 160 samples (80%; mean: 1.41±2.48; range: 0.04-18.40 μg/l). Levels appeared higher in women more frequently consuming food and beverages preserved in plastic containers or using cosmetics, although differences were not significant. The EDI levels for MEP (mean: 2.08±11.39 µg/kg BW/day) and MiNP (mean: 0.20±0.33 µg/kg BW/day) appeared below the TDI values set up by EFSA. Conclusions Although the widespread diffusion of phthalate monoesters in breast milk, their levels resulted lower than those reported in other studies and the EFSA recommended values. Thus, the use of breast milk, a unique nourishment for infants, should not be discouraged. Key messages Monitoring phthalates’ levels in breast milk is crucial to check breastfed infants’ exposure and to prevent potential health risks associated with this exposure. It’s essential to adopt effective public health interventions to reduce phthalates dissemination in environment and food and consequently the maternal and infant exposure to these contaminants.