Endocrine disruptors in the workplace, hair spray, folate supplementation, and risk of hypospadias: case-control study.
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.
Ormond
Gillian
G
Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
Nieuwenhuijsen
Mark J
MJ
Nelson
Paul
P
Toledano
Mireille B
MB
Iszatt
Nina
N
Geneletti
Sara
S
Elliott
Paul
P
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
D003358:Cosmetics; D052244:Endocrine Disruptors; D005492:Folic Acid