## 3 Results and Discussion
### Urinary Concentrations of Phthalate and Alternative Plasticizer Metabolites
\begin{table}
\begin{tabular}{c c c c} \hline \hline
**Phhalates and** & **Measured \textgreater{}LOD** & **GM \(\pm\) GSD** & **Median (IQR)** \\
**Alternatives** & \(n\) **(\%)** & **(\(\upmu\)g/g creatinine)** & **(\(\upmu\)g/g creatinine)** \\ \hline MEHP & 27/30 (90) & 14.91 \(\pm\)13.19 & 14.39 (8.31–22.34) \\ MEOHP & 30/30 (100) & 18.53 \(\pm\)14.92 & 17.41 (11.45–28.22) \\ MEHHP & 30/30 (100) & 32.28 \(\pm\)23.40 & 31.07 (18.22–54.36) \\
2 cx-MMHP & 30/30 (100) & 20.84 \(\pm\)15.87 & 19.29 (13.86–26.90) \\
5 cx-MEPP & 30/30 (100) & 35.47 \(\pm\)33.24 & 28.48 (22.15–55.80) \\ MBzP & 29/30 (96.7) & 10.15 \(\pm\)12.52 & 8.73 (4.25–25.63) \\ MiBP & 30/30 (100) & 19.87 \(\pm\) 26.80 & 41.20 (7.73–47.63) \\ MEP & 27/30 (90) & 11.23 \(\pm\) 13.99 & 11.41 (7.06–29.87) \\ MnBP & 29/30 (96.7) & 32.54 \(\pm\) 27.28 & 37.76 (17.20–55.22) \\ MMP & 30/30 (100) & 9.73 \(\pm\) 11.61 & 6.79 (3.96–30.11) \\ MCPP & 22/30 (73.3) & 2.91 \(\pm\) 1.92 & 2.77 (1.94–3.96) \\ MiNP & 6/30 (20) & 1.16 \(\pm\) 1.36 & 1.17 (0.70–2.06) \\ OH-MiNP & 21/21 (100) & 4.35 \(\pm\) 2.89 & 4.24 (3.21–6.00) \\ MnOP & 0/30 (0) & NA & NA \\ MCHP & 0/30 (0) & NA & NA \\ cx-MiDP & 6/31 (28.6) & 1.42 \(\pm\) 1.20 & 1.56 (1.38–1.79) \\ MnPP & 1/30 (3.3) & 0.77 & 0.77 \\ MiPrP & 2/21 (9.5) & 0.23 \(\pm\) 0.55 & 0.23 (0.20–0.27) \\ MHxP & 4/21 (19) & 0.48 \(\pm\) 2.50 & 0.30 (0.19–2.20) \\ MEHTP & 4/21 (19) & 1.15 \(\pm\) 0.31 & 1.20 (1.03–1.29) \\
5 cxMEHTP & 21/21 (100) & 28.78 \(\pm\) 16.31 & 26.43 (22.77–44.47) \\
5 OH-MEHTP & 20/21 (95.2) & 4.07 \(\pm\) 2.24 & 3.69 (27.1–6.54) \\
5 OXO-MEHTP & 19/20 (95) & 2.35 \(\pm\) 1.62 & 2.12 (1.52–4.36) \\ MINCH & 1/21 (4.8) & 1.45 & 1.45 \\ OH-MINCH & 21/21 (100) & 0.66\(\pm\) 0.94 & 0.58 (0.41–0.84) \\ cx-MINCH & 16/21 (76.2) & 0.78\(\pm\) 1.21 & 0.82 (0.43–1.05) \\ \hline \hline \end{tabular} All phthalate and alternative plasticizer metabolites were creatinine (mg/dL) standardized. LOD= limit of detection; GM = geometric mean; GSD = geometric standard deviation; IQR = interquartile range; NA = not available.  
\end{table} 
Table 2: Urinary concentrations of phthalate and alternative plasticizer metabolites. ternative plasticizers is DEHTP, which is a structural isomer and a direct substitute for high-molecular-weight plasticizers of DEHP. Like DEHP, DEHTP is rapidly metabolized to its monoester and then further modified by a side-chain hydroxylation and oxidation reaction (SOH-MEHTP, 5 oxo-MEHTP, 5 cx-MEPTP, and 2 cx-MMHTP) [32]. Another alternative plasticizer, DINCH, is a non-aromatic compound similar in viscosity and flexibility to DEHP [33]. OH-MINCH is the predominant metabolite, followed by cx-MINCH and cyclohexane-1 [34]. DINCH has chemical properties comparable to those of DEHP; however, it has been reported to have very limited toxic effects in animal studies. Therefore, DINCH has been approved for the production of food packaging plastic material [35], and as a result it has almost completely replaced DEHP in plastic production in Europe [23]. Although there is increased use of alternatives and political focus on the phinging-out of phthalates, little information is available regarding the metabolic pathways as well as distribution of exposure to alternative plasticizers. From one birth cohort of Puerto Rico, DEHTP metabolites were detected in at least 82% of samples, representing widespread prenatal exposure [36]. DINCH metabolites were also detected in 18% to 35% of samples, but detection rates of DINCH metabolites also increased over time. Our results of alternative plasticizers had a similar pattern; however, the exposed levels of phthalate and alternative plasticizer metabolites should be considered as those in the specialized leiomyoma patients' group.