Association between co-exposure to phenols and phthalates mixture and infertility risk in women

Wenqiang Zhan; Hua Yang; Jun Zhang; Qian Chen

doi:10.1016/j.envres.2022.114244

Association between co-exposure to phenols and phthalates mixture and infertility risk in women

Environ Res. 2022 Dec;215(Pt 1):114244. doi: 10.1016/j.envres.2022.114244. Epub 2022 Sep 2.

Authors

Wenqiang Zhan¹, Hua Yang², Jun Zhang¹, Qian Chen³

Affiliations

¹ Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Hainan Women and Children's Medical Center, Haikou, Hainan, China.
³ Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: chenqian01@xinhuamed.com.cn.

PMID: 36058272
DOI: 10.1016/j.envres.2022.114244

Abstract

Background: Exposure to phenols and phthalates has been separately linked to increased risks of infertility in women of reproductive age. However, the combined effect of phenols and phthalates exposure on infertility has not been explored.

Methods: Data from the National Health and Nutrition Examination Surveys (NHANES) were used. A total of 857 women of reproductive age (18-45 years) with available information on urinary phenol and phthalate metabolites, reproductive questionnaires, and covariates were included in the present study. The definition of infertility was based on self-reports. Multivariable logistic regression, principal component analysis (PCA), and Bayesian kernel machine regression (BKMR) with stratified variable selection were applied to determine what associations were found between combined exposure to these mixtures and risk of infertility among women of reproductive age.

Results: After adjusting for potential confounders, bisphenol A (BPA), mono(3-carboxypropyl) phthalate (MCPP) and four di(2-ethylhexyl) phthalate (DEHP) metabolites [mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP)] were positively associated with infertility. PCA revealed that the DEHP-BPA factor's PC score was significantly positively related to the likelihood of infertility [adjusted odds ratio (aOR) = 1.45; 1.08, 1.82]. The DEHP-BPA component consistently had the highest group posterior inclusion probability (PIP) in BKMR models. The BKMR model also found that MEOHP, MEHHP, and BPA were positively associated with infertility risk when the remaining combination concentrations were held at their median values. In addition, we observed that the probability of infertility increased dramatically as the quantiles of total mixture concentration increased.

Conclusion: Our findings indicate that a combination of phenol and phthalate metabolites is linked to infertility among reproductive-age women. BPA and DEHP, in particular, are significantly related to the risk of infertility.

Keywords: BPA; Co-exposure; DEHP; Infertility.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Bayes Theorem
Benzhydryl Compounds
Diethylhexyl Phthalate* / analogs & derivatives
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Environmental Pollutants* / analysis
Female
Humans
Infertility*
Middle Aged
Nutrition Surveys
Phenol
Phenols / analysis
Phenols / toxicity
Phthalic Acids* / metabolism
Phthalic Acids* / toxicity
Young Adult

Substances

Benzhydryl Compounds
Environmental Pollutants
Phenols
Phthalic Acids
Phenol
phthalic acid
Diethylhexyl Phthalate
mono-(2-ethylhexyl)phthalate
bisphenol A