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Interview with Antonio Ragusa, Director of the Operative Unit of Obstetrics and Gynecology of the Fatebenefratelli Hospital of Rome.

His research focuses on the “Art of birth”. He has published more than one hundred scientific articles both nationally and internationally and has been the advisor of the Ministry of Health for the issues of birth and obstetrics.

He is the first author of the study published in Environment International in December 2020, which proved the presence of 12 particles of microplastics in four human placentas out of six analysed for the first time.

1. When and why did you start investigating and researching for microplastic in the human body?

I’ll tell you a short story.

The dunes of Piscinas in Sardinia are a place for the soul. There you can experience “The emotion that is a gift that comes by surprise, a mythical statement rather than a human property. It announces a movement in the soul, it is the enunciation of the process taking place in a myth that we can perceive in the fantastic images that accompany the emotion.” (James Hillman. Re-vision of psychology.)

It was a late April day, four years ago, when I had the intuition. Spring hadn’t arrived yet, you could still feel the cold, helped by a ruthless wind.

I was walking on the beach, together with Cinzia, my wife. The sun was absent, but it peeked out at times, above clouds that ran fast, driven by a north wind. I instinctively grabbed the sand in my hands and let it flow through my fingers. It was then when I saw small multicolored particles, which were at first sight fascinating… “I don’t quite understand what it is”, I told Cinzia, who replied: “It’s plastic”. “Plastic?” I echoed, “And where would plastic come from, in a pleasant and apparently paradise place like this?”, that was the question that popped into my mind.

The dunes of Piscinas are in western Sardinia, near the municipality of Arbus. There are no paved roads to get there, and after having crossed the suggestive and fascinating ghost town of Ingurtosu, you have to travel a dirt road for more than six kilometers.

No trace of humans outside the bathing season. Once you arrive, as far as the eye can see, you can only see euphorbias, tamarisks, junipers, lentisk, brooms, and rushes, Mediterranean scrub, and white sand dunes. So, I repeated myself this question: where does the plastic come from?

Well, I started from this, but being an obstetrician, this question was immediately translated into another one: if plastic finds its way to this uncontaminated place, can it reach the most sacred place in the world, the maternal womb as well? From that first question I started researching, to give what the scientific world calls “materials and methods”, to make this intuition a scientific reality.

One of the most difficult things about the study was organizing the plastic-free placenta harvesting protocol. In the end, when everything was ready and we had the first placenta on the way (a mother was giving birth) we realized that there were no plastic-free containers in the hospital!

At that point, we had to stop everything and we ended up losing the placenta from the first donor mother.

I tried to look for plastic free containers from suppliers of medical supplies, I got help from my hospital pharmacist, but we were unable to find them, it seems incredible, but plastic is everywhere!

So, I tried to look for plastic free containers outside the healthcare circuit and finally, in a peripheral shop in Rome, I managed to find small glass salt shakers with metal caps by a couple of Chinese traders, so I bought 30 of them, with great joy.

Once we gathered the placentas and the containers, we cut the samples, stored them (finally without plastic contamination) and sent them to the Polytechnic University of Marche, where Professor Giorgini’s team examined them with Raman microscopy, using a micro Raman spectrometer.

This instrument is obtained by integrating a Raman spectrometer with an optical microscope, in order to have the possibility of obtaining Raman radiation signals from tiny microscopic samples or from microscopic parts of larger samples and being able to simultaneously see them under the microscope.
The microparticles we found in the placentas measured around 10 microns, with the exception of two smaller fragments (around 5 microns). These are values compatible with possible transport into the body through maternal blood. Previous analysis carried out using electron microscopy coupled with an X-ray microprobe had already revealed the presence of particles 5-10 microns in diameter in human internal organs. Particles of this size are therefore able to enter the human body through various routes (percutaneous, gastrointestinal, respiratory) and circulate more or less freely.

The dimensions between 5 and 10 microns could in fact be called “cellular” as many human cells, especially circulating ones, have similar dimensions (red blood cells, for example, measure around 8 microns), and non-human cells also exploit this dimensional range to enter our body: bacterial cells, in fact, have an average length that varies between 0.5 and 5 microns, although there are bacteria that can also be seen with the naked eye because they are large.

But how did we understand that those twelve small pieces we found inside the human placentas were made of plastic? Their color and more specifically their pigmentation gave us the answer. All were in fact pigmented. The Raman spectra of the samples revealed, more than anything else, the pigments used to color the plastics, this is because the very structure of the pigment molecules increases the Raman signal emitted with microspectroscopy. At this point it was enough to compare the spectra found in the samples with the over 12,000 spectra present in the largest spectral reference database in the world, to discover which pigments were contained in the placental fragments.

2. What are the consequences of microplastic presence for humans and babies’ health? where were microplastics specifically found? 

Science needs time to prove observations with evidence and this could take a long time. We do not yet have definitive evidence of toxic effects of microplastics in humans’ bodies. However, there is very clear evidence in experimental animals that microplastics and nanoplastics that enter the body through respiration, skin and gastrointestinal tract, reach all the main tissues, organs and systems, where they can determine toxic and harmful effects.

In an interesting study, Deng et al. used fluorescent and pristine polystyrene microplastic particles with two diameters (5 μm and 20 μm) to investigate the tissue distribution, accumulation, and tissue-specific health risk of MPs in mice. MPs accumulated in the liver, kidney, and gut, with a tissue-accumulation kinetics and distribution pattern that was strongly dependent on the MPs particle size. Analyses of multiple biochemical biomarkers and metabolomic profiles suggested that MPs exposure induced disturbance of energy and lipid metabolism as well as oxidative stress.

Another interesting study by Jeong B et al showed that maternal administration of polystyrene nanoplastic in mice during gestation and lactating periods altered the functioning of neural cell compositions and brain histology in progeny.

Furthermore, polystyrene nanoplastic induced molecular and functional defects also in cultured neural cells in vitro. The abnormal brain development caused by exposure to high concentrations of polystyrene nanoplastic results in neurophysiological and cognitive deficits in a gender-specific manner.

The effects of plastic are very important, especially on the central nervous system. Adult offspring of female mice (L-DE-71 F1) exhibit short- and long-term deficient social recognition, reduced sociability, and increased repetitive behavior when they were exposed to the Polybrominated diphenyl ethers, these effects are very similar to those found in autistic humans. Ultimately, exposure to Polybrominated diphenyl ethers, during intrauterine development produces neurochemical, olfactory, and behavioral processes that are relevant and very similar to those of autism spectrum disorders (ASD) in humans. These effects can reprogram early neurological development within central memory and social networks. Importantly, autism spectrum disorders prevalence in humans has dramatically increased in recent years. Oral administration of monodispersed polystyrene causes damage to the visceral organs in mice. The main toxicities are the damage to the liver function and the lipid metabolism abnormality.

Additionally, chronic exposure to monodispersed polystyrene significantly increases plasma glucose levels and ROS level, but does not influence plasma insulin secretion. Ultimately oral administration of monodispersed polystyrene increases ROS, liver triglycerides and determines the accumulation of cholesterol in mice.

To summarize, also in humans the presence of MPs in placenta samples, could contribute to the activation of pathological traits, such as oxidative stress, apoptosis, and inflammation, characteristic of metabolic disorders, which underlie future diseases, such as obesity, diabetes, metabolic syndrome, and many other pathologies, which have their roots in oxidative stress damage and organelle dysfunction. But while this is a certainty in laboratory animals, in humans there is still yet no evidence. This fact explains well the previous evaluations of the European Food Safety Authority (EFSA 2016), the Food and Agriculture Organization of the United Nations (Lusher et al. 2017) and Science Advice for Policy by European Academies (Koelmans et al. 2019).

Recently, microplastics have been discovered in the human placenta (Ragusa et al. 2021), meconium and feces of babies (Zhang et al. 2021; Schwabl et al. 2019; Braun et al. 2021).

Yet, the impacts of exposure to plastic particles during early windows of vulnerability are almost entirely unknown. Our lack of knowledge of the health impacts of nano- and microplastics and the chemicals they contain prevents evidence-based assessment and effective management of potential health risks from exposure to plastics (Senathirajah et al. 2021).

The fundamental questions remain open: to what extent are humans exposed to nano and micro plastics, especially during pregnancy and the first years of life? And what are the long-term effects on human health?

All the babies in whose placentas we found microplastics were healthy at birth.

However, potentially, MPs, and in general microparticles, may alter several cellular regulating pathways in placenta, such as immunity mechanisms. The presence of MPs in the placenta tissue requires the reconsideration of the immunological mechanism of self-tolerance, a mechanism that may be perturbed by the presence of MPs. In fact, it is reported that, once present in the human body, MPs may accumulate and exert localized toxicity by inducing and/or enhancing immune responses. This could potentially reduce the defense mechanisms against pathogens and alter the utilization of energy stores. Given that, it is likely that the presence of microplastics can change the ways in which the body, even of an adult, manages fat metabolism, likely through epigenetic modifications. (Antonio Ragusa, Giulia Principi, Maria Matta. Pregnancy in the Era of the Environmental Crisis: Plastic and Pollution. Clin. Exp. Obstet. Gynecol. 2022, 49(10),216).

3. What good practices can be adopted to reduce the accumulation of microplastics in the human body?

In my book: “Birth with a plastic jacket” I explained in detail the possible strategies to reduce plastic accumulation as well us pollution. We can all reduce plastic waste by reusing and recycling plastic, and not buying plastic objects of dubious utility when possible. Replacing them with other things made from recyclable materials, not using water bottles and carbonated plastic drinks and single-use plastic bags for our daily shopping, not using cosmetics that contain MPs, instead using wooden toothbrushes and toothbrushes without MPs, not heating food in the microwave in plastic containers (even those officially authorized for this use actually dispose of large amounts of micro and nanoplastics in food) and the list of best practices could go on!

We can all use alternatives to plastic: fabric shopping bags, biodegradable plastic bags, jute bags, metal straws and non-plastic cutlery. Almost half (44.8%) of plastic polymer production is used for packaging: we can all support local companies that promote an ecological approach to the production and trade of their products and disadvantage companies that do not use this approach, let’s stop filling our daily life with unnecessary plastic.

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