title: Endocrine disruptors in the workplace, hair spray, folate supplementation, and risk of hypospadias: case-control study.
abstract: BACKGROUND
  Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys. Prevalence estimates in Europe range from 4 to 24 per 10,000 births, depending on definition, with higher rates reported from the United States. Relatively little is known about potential risk factors, but a role for endocrine-disrupting chemicals (EDCs) has been proposed.
  
  
  OBJECTIVE
  Our goal was to elucidate the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals, use of folate supplementation during pregnancy, and vegetarianism.
  
  
  METHODS
  We designed a case-control study of 471 hypospadias cases referred to surgeons and 490 randomly selected birth controls, born 1 January 1997-30 September 1998 in southeast England. Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism. We used a job exposure matrix to classify occupational exposure.
  
  
  RESULTS
  In multiple logistic regression analysis, there were increased risks for self-reported occupational exposure to hair spray [exposed vs. nonexposed, odds ratio (OR) = 2.39; 95% confidence interval (CI), 1.40-4.17] and phthalate exposure obtained by a job exposure matrix (OR = 3.12; 95% CI, 1.04-11.46). There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy (OR = 0.64; 95% CI, 0.44-0.93). Vegetarianism was not associated with hypospadias risk.
  
  
  CONCLUSIONS
  Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that antiandrogenic EDCs may play a role in hypospadias. Folate supplementation in early pregnancy may be protective.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Gillian
authors.initials: G
authors.lastname: Ormond
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.forename: Paul
authors.initials: P
authors.lastname: Nelson
authors.forename: Mireille B
authors.initials: MB
authors.lastname: Toledano
authors.forename: Nina
authors.initials: N
authors.lastname: Iszatt
authors.forename: Sara
authors.initials: S
authors.lastname: Geneletti
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D002648:Child; D003358:Cosmetics / Q000009:adverse effects* / Q000032:analysis; D019587:Dietary Supplements; D052244:Endocrine Disruptors / Q000009:adverse effects / Q000032:analysis*; D004739:England; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005865:Gestational Age; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D011247:Pregnancy; D012959:Socioeconomic Factors; D017132:Workplace; D055815:Young Adult
chemical_list: D003358:Cosmetics; D052244:Endocrine Disruptors; D005492:Folic Acid