Association of intrauterine and early-life exposures with diagnosis of uterine leiomyomata by 35 years of age in the Sister Study.
BACKGROUND
Early-life exposures to hormonally active compounds and other factors may affect later response to estrogen or progesterone and hence may influence development of uterine leiomyomata (fibroids).


OBJECTIVE
We evaluated associations of in utero and early-life exposures, including soy formula, with self-report of physician-diagnosed fibroids by 35 years of age.


METHODS
Our study included 19,972 non-Hispanic white women who were 35-59 years of age when they enrolled in the Sister Study in 20032007. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using log-binomial regression models for fibroid associations with adjustment for participant's age and education, maternal age at participant's birth, birth order, and childhood family income.


RESULTS
Greater risk of early fibroid diagnosis was associated with soy formula during infancy (RR = 1.25; 95% CI, 0.971.61), maternal prepregnancy diabetes (RR = 2.05; 95% CI, 1.163.63), low childhood socioeconomic status (RR = 1.28; 95% CI, 1.011.63), and gestational age at birth (RR = 1.64; 95% CI, 1.272.13, for being born at least 1 month early). In utero diethylstilbestrol (DES) exposure was also associated with early fibroid diagnosis (RR = 1.42; 95% CI, 1.131.80), but this association was driven by women reporting probable rather than definite exposure.


CONCLUSIONS
There are plausible biological pathways by which these early-life factors could promote fibroid pathogenesis. This is the first epidemiologic study to evaluate such exposures, with the exception of in utero DES, in relation to fibroid risk, and replication of findings in other populations is needed.
D'Aloisio
Aimee A
AA
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina 27709, USA. daloisio@niehs.nih.gov
Baird
Donna D
DD
DeRoo
Lisa A
LA
Sandler
Dale P
DP
D000328:Adult; D017668:Age of Onset; D016640:Diabetes, Gestational; D004054:Diethylstilbestrol / Q000633:toxicity*; D004968:Estrogens, Non-Steroidal / Q000633:toxicity*; D005260:Female; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D007234:Infant, Premature; D007889:Leiomyoma / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D018811:Maternal Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D011647:Puerto Rico / Q000453:epidemiology; D035781:Siblings; D012959:Socioeconomic Factors; D013025:Glycine max; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol