The risk of endometriosis after exposure to endocrine-disrupting chemicals: a meta-analysis of 30 epidemiology studies

Abstract

Endocrine-disrupting chemicals (EDCs) are suspected to be associated with endometriosis (EMs). This study aimed to synthesize published data and evaluate the relationship between four classic EDCs exposure and the risk of EMs. A systematic literature search for original peer reviewed papers was performed in the databases PubMed, EMBASE, and Web of Science based on inclusion criteria up to January 2018. Subsequently, a total of 20 papers conducting 30 studies fulfilled the eligibility criteria and were included in this meta-analysis (four studies for bisphenol A (BPA), 12 studies for polychlorinated biphenyls (PCBs), eight studies for organochlorine pesticides (OCPs), and six studies for phthalate esters (PAEs)). The overall odds ratio (OR) across all exposures and EMs was 1.41 (95% confidence interval (CI): 1.23–1.60). When assessing four specific chemicals, respectively, consistent increases in the risk of EMs were found in PCBs group (OR = 1.58; 95% CI: 1.18–2.12), OCPs group (OR = 1.40; 95% CI: 1.02–1.92) and PAEs group (OR = 1.27; 95% CI: 1.00–1.60), while BPA showed no significant association with EMs. Besides, in the di-(2-ethylhexyl)-phthalate (DEHP) group – the most commonly used PAEs, significant risk was also found (OR = 1.42; 95% CI: 1.19–1.70). The current meta-analysis strengthens the evidence that specific EDCs or their metabolites may promote the occurrence of EMs.

摘要

内分泌干扰物（EDCs）可疑与子宫内膜异位症（EMs）相关。本研究旨在综合已发表的资料, 并评估四种典型的EDCs暴露与Ems发生风险之间的关系。按照入选标准在PubMed、EMBASE和Web of Science数据库对截止2018年1月的文献进行了系统的文献检索。共有20篇论文30项研究纳入该项荟萃分析, 其中有4项双酚A （BPA）的研究, 12项多氯联苯（PCBs）的研究, 8项有机氯农药（OCPs）的研究, 6项邻苯二甲酸酯（PAEs）的研究。所有分泌干扰物暴露与子宫内膜异位症风险的OR值为1.41（95%置信区间：1.23-1.60）。当分别评估4种分泌干扰物时, 均发现会增加子宫内膜异位症的风险, PCBs组的OR值为1.58（95%置信区间：1.18-2.12）, OCPs组OR值为1.40（95%置信区间：1.02-1.92）, PAEs OR值为1.27（95%置信区间：1.00-1.60）, BPA与子宫内膜异位症无明显相关性。此外, 在邻苯二甲酸酯组（DEHP）, 应用最多的是PAEs, DEHP 组OR值为1.42（95%置信区间：1.19-1.70）。目前荟萃分析增强了特定内分泌干扰物及其他们代谢物会促进子宫内膜异位症发生的证据。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Endometriosis
• bisphenol A
• polychlorinated biphenyls
• organochlorine pesticides
• phthalate esters

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by National Natural Science Foundation of China under Grant 81771543.