Umutcan KAYIKCI, Mujde CAN IBANOGLU, Yaprak ENGIN USTUN
Gynecology Obstetrics & Reproductive Medicine - 2025;31(3):183-190
OBJECTIVE: The study aimed to investigate the association between maternal serum di-2-ethylhexyl phthalate (DEHP) levels-DEHP is a chemical widely used in plastics, as well as in the food and cos-metics industries-and fetal growth restriction (FGR, a condition where the fetus fails to achieve expected growth). STUDY DESIGN: This study included 84 women between April and July 2019: 40 with fetal growth re- striction and 44 gestational age-matched controls. Maternal plasma levels of DEHP were measured with sensitive, specific immunoassays and with Ultra Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS). RESULTS: Patient ages ranged from 18 to 40 years (mean 27.16+/-5.70). Age, BMI, and smoking distri- butions did not differ significantly between groups (p>0.05). Serum DEHP levels were significantly higher in the FGR (+) group than in the FGR (-) group (p=0.001; p<0.01). Based on this, we calculated a serum DEHP cut-off using ROC analysis and diagnostic screening. The area under the ROC curve was 0.693 [95% CI: 0.580-0.807; p=0.002; p<0.01]. At a cut-off >107.93, sensitivity was 70.0%, specificity 68.2%, PPV 66.7%, NPV 71.4%, accuracy 69.1%, and Youden index 0.382. CONCLUSION: This study demonstrates a significant association between higher maternal phthalate levels and fetal growth restriction. These findings contribute to emerging evidence linking phthalate ex-posure to impaired fetal development; however, maternal serum phthalate levels are not currently suit-able for clinical prediction or early detection of FGR. To address these limitations, further studies with larger cohorts and longitudinal designs are needed to confirm these associations and explore underly-ing mechanisms.
