Exposure risks to phthalates by cosmetics and personal care products in pregnant women and early life: Urinary levels, mechanisms, biomarkers, and mitigation strategies: a review.

The increasing use of personal care products (PCPs) and cosmetics have increased the risk of exposure to phthalates, especially in the early stages of life for maternal-fetal-infant. This review aimed to determine the phthalates exposure risk through the consumption of PCPs and cosmetics in Pregnant women and early life, determine the mechanisms, biomarkers, and mitigation strategies for phthalates. The highest phthalates exposure levels of pregnant women (as well as fetal exposure through placenta and infants through breast milk) who used PCPs and cosmetics continuously or in larger quantities, especially lipstick, deodorants, and nail polish, were related to MEP˃ MnBP˃ MEHHP, respectively. The greatest phthalates exposure health risks in early life include hormonal disorders, especially cholesterol, thyroid, estrogen, and androgen, and toxicity to the liver, kidney, and thyroid, skin inflammation and irritation, and reproductive system toxicity, including premature birth and menopause, miscarriage, low birth weight and height, and early puberty. Maternal and placenta hormones disorders, such as gonadotropin-releasing hormone (GnRH) and estrogen, and decreases in steroid hormones such as SHBG (sex-hormone binding globulin) and testosterone, were the main mechanisms for phthalates exposures. Suitable biomarkers for assessing phthalates exposure by PCPs were changes in DNA methylation, placental-derived extracellular vehicles related to microRNAs (EV-miRNAs), maternal glycemia and lipid profiles, and malondialdehyde (MDA) level. Replacing high-risk phthalates with less toxic substances, like citrates, during the PCPs production is a suitable way to lower phthalate exposure. It is recommended that monitoring of phthalates biomarkers in the early years of life in future studies.