Urinary Concentrations of Phthalate Metabolites and Pregnancy Loss Among Women Conceiving with Medically Assisted Reproduction.
Urinary Concentrations of Phthalate Metabolites and Pregnancy Loss Among Women Conceiving with Medically Assisted Reproduction.
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邻苯二甲酸酯代谢产物的尿液浓度和受过医学辅助繁殖的妇女的妊娠损失。
DOI：
10.1097/ede.0000000000000525
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
Earth Study Team
中科院分区：
文献类型：
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作者：
Messerlian C;Wylie BJ;Mínguez-Alarcón L;Williams PL;Ford JB;Souter IC;Calafat AM;Hauser R;Earth Study Team
动物研究表明，几种邻苯二甲酸盐对胚胎有毒性，并与增加妊娠丢失和畸形有关。关于邻苯二甲酸盐和妊娠丢失的人体研究结果并不一致。我们在接受医学辅助生殖的妇女中，前瞻性地研究了妊娠丢失与尿邻苯二甲酸盐代谢产物浓度的关系。我们使用了从马萨诸塞州综合医院生育中心招募的256名女性的数据，这些女性在2004年至2012年间怀孕了303例。我们量化了11种邻苯二甲酸酯代谢物的浓度，并计算了4种邻苯二甲酸二(2-乙基己基)代谢物(Σ)的摩尔总和。我们使用重复测量对数二项模型，根据年龄、体重指数、吸烟和不孕症诊断进行了调整，估计了四分位数中生化丢失和总妊娠丢失(妊娠20周)的风险比(RR)和95%可信区间(CI)。在303例妊娠中，83例(27%)在妊娠20周内以流产结束，其中31例(10%)以生化丢失结束。尽管不准确，但生化损失的RRS在∑DEHP和三种单独的DEHP代谢物的四分位数中增加。对于∑DEHP，二、三和四分位数的RRS(Cis)分别为2.3(0.6 3，8.5)、2.0(0.5 8，7.2)和3.4(0.97，11.7)，与1相比(p-趋势=0.0 4)。在Σ、DEHP和三种DEHP代谢物的最高四分位数中，总妊娠丢失的RR升高。评估的其余七种邻苯二甲酸酯代谢物浓度与上述两种结果均无关联。我们发现，在接受医学辅助生殖的妇女中，受孕周期特定的DEHP代谢物的尿液浓度与生化和完全妊娠损失之间存在一种提示模式。
Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified eleven phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical loss and total pregnancy loss (<20 weeks’ gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis. Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks’ gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of ∑DEHP and three individual DEHP metabolites. For ∑DEHP, the RRs (CIs) were: 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three and four, compared to one, respectively (p-trend=0.04). RRs for total pregnancy loss were elevated in the highest quartiles of ΣDEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome. We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction.