Table 2.
Reference | Study description | Includes metabolites of: | Study evaluation | |||||||||||||
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Population | Exposure | Outcome | DEH-P | DIN-P | DB-P | DIB-P | BB-P | DE-P | Exposure | Outcome | Selection | Confounding | Analysis | Overall confidence | ||
Included | Hart et al. (2013) | Pregnancy cohort (N = 123 girls) in Australia | Blood samples at 18 and 34/36 wks gestation | Prospectively reported age at menarche | ✓ | ✓ | ✓ a | ✓ a | ✓ a | ✓ a | D | G | D | D | D | Low |
Mouritsen et al. (2013) | Cohort of children (N=84 girls) in Denmark enrolled at 6–12 yrs | Urine samples every 6 mo, at least 2 samples averaged | Tanner stages determined by pediatrician | ✓ | ✓ | ✓ b | ✓ b | ✓ | ✓ | G | G | D | D | D | Low | |
Su et al. (2014) | Pregnancy cohort (N = 69 girls) in Taiwan | Single urine sample (3rd trimester) | Tanner stages determined by single examiner | ✓ | ✓ | ✓ | ✓ | A/D | G | D | D | D | Low | |||
Watkins et al. (2017); Watkins et al. (2014) | Pregnancy cohort (N = 117 girls) in Mexico | Urine sample in each trimester | Tanner stages determined by pediatrician | ✓ | ✓ | ✓ | ✓ | ✓ | G | G | D | A | A | Medium | ||
Wolff etal. (2017); Wolff etal. (2014); Wolff etal. (2010) | Cohort of girls (N= 1,170) in U.S. enrolled at 6–8 yrs | Single urine sample at baseline | Repeated assessments of Tanner stages by trained examiners | ✓ | ✓ | ✓ | ✓ | ✓ | A/D | G | A | G | A | Medium | ||
Total Studies per Phthalate | 7 | 3 | 6 | 5 | 6 | 6 |
Excluded studies: Exposure measured after development of outcome: Buttke et al. (2012), Chen et al. (2013), Chou et al. (2009), Frederiksen et al. (2012), Hashemipour et al. (2018), Lomenick et al. (2010), Shi et al. (2015), Srilanchakon et al. (2017), Zhang et al. (2015). Exposure measured in blood: Buluş et al. (2016), Lee et al. (2009), Yum et al. (2013). Exposure measured by self-report: Garran and Shaw (2012). No comparison group: Rais-Bahrami et al. (2004). Critical deficiency in population selection: Smerieri et al. (2015).
Additional studies identified in the August 2018 literature update: Binder et al. (2018), Kasper-Sonnenberg et al. (2017). Watkins et al. (2017), an update of Watkins et al. (2014) was also identified in the search and incorporated into the synthesis.
G = good; A = adequate; D = deficient; A/P = adequate for short chain phthalates, deficient for long chain phthalates.
Study was considered critically deficient for this phthalate due to measurement in blood.
Study summed DBP and DIBP metabolites.