title: In utero exposures and endometriosis: the Endometriosis, Natural History, Disease, Outcome (ENDO) Study.
abstract: OBJECTIVE
  To assess in utero exposures and the odds of an endometriosis diagnosis.
  
  
  METHODS
  Matched cohort design.
  
  
  METHODS
  Fourteen participating clinical centers in geographically defined areas in Utah and California.
  
  
  METHODS
  Operative cohort comprised 473 women undergoing laparoscopy/laparotomy, and an age- and residence-matched population cohort comprising 127 women undergoing pelvic magnetic resonance imaging (MRI), 2007-2009.
  
  
  METHODS
  None.
  
  
  METHODS
  Women completed standardized interviews before surgery or MRI regarding in utero exposures: mothers' lifestyle during the index pregnancy, and the index woman's gestation and birth size. Endometriosis was defined as visually confirmed disease in the operative cohort, and MRI visualized disease in the population cohort. The odds of an endometriosis diagnosis and corresponding 95% confidence intervals (CI) were estimated for each exposure by cohort using logistic regression and adjusting for current smoking, age at menarche, body mass index, and study site.
  
  
  RESULTS
  Endometriosis was diagnosed in 41% and 11% of women in the operative and population cohorts, respectively. In the primary analysis, adjust odds ratios (AORs) were elevated for maternal vitamin usage (1.27; 95% CI, 0.85-1.91), maternal cigarette smoking (1.16; 95% CI = 0.61-2.24), and low birth weight (1.1; 95% CI, 0.92-1.32). Reduced odds were observed for maternal usage of caffeine (0.99; 95% CI, 0.64-1.54), alcohol (0.82; 95% CI, 0.35-1.94), paternal cigarette smoking (0.72; 95% CI, 0.43-1.19), and preterm delivery (0.98; 95% CI, 0.47-2.03). Sensitivity analyses mostly upheld the primary results except for a decreased AOR for preterm birth (0.41; 95% CI, 0.18-0.94) when restricting to visualized and histologically confirmed endometriosis in the operative cohort.
  
  
  CONCLUSIONS
  In utero exposures were not statistically significantly associated with the odds of an endometriosis diagnosis in either cohort.
authors.affiliation: Unit on Reproductive and Regenerative Medicine, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. erin.wolff@nih.gov
authors.forename: Erin Foran
authors.initials: EF
authors.lastname: Wolff
authors.forename: Liping
authors.initials: L
authors.lastname: Sun
authors.forename: Mary L
authors.initials: ML
authors.lastname: Hediger
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Sundaram
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Peterson
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D004715:Endometriosis / Q000453:epidemiology* / Q000601:surgery; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D010049:Ovarian Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014589:Utah / Q000453:epidemiology; D055815:Young Adult