In Reply Otter et al correctly note that phthalate exposure is generally higher in the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study than in The Infant Development and the Environment Study (TIDES), as we discuss in our article and report in the supplementary material.1 These exposure differences are the result of differences in consumer pattern in the 2 countries. The widespread use of phthalate-containing polyvinyl chloride (PVC) flooring in Sweden has recently been reported to be a major source of human uptake of dibutyl phthalate and butyl benzyl phthalate.2 In the United States, where PVC floor covering is less commonly used, exposures are lower. Since we saw similar associations despite these exposure differences, pregnant women in the United States appear to be more sensitive to these exposures. Reasons for these differences in sensitivity are uncertain but may be related to other demographic differences between the populations.
Bornehag C, Reichenber A, Swan SH. Language Development of Young Children Is Not Linked to Phthalate Exposure—Reply. JAMA Pediatr. 2019;173(5):499. doi:10.1001/jamapediatrics.2019.0282
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