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Zhang Q, Zhang ZC, He XY, Liu ZM, Wei GH, Liu X. Maternal smoking during pregnancy and the risk of congenital urogenital malformations: A systematic review and meta-analysis. Front Pediatr 2022; 10:973016. [PMID: 36263151 PMCID: PMC9575702 DOI: 10.3389/fped.2022.973016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Investigations regarding the association between maternal smoking and specific urogenital teratogenesis exist. However, an integrated systematic review and meta-analysis studying the relationship by encompassing the whole urogenital system is essential. OBJECTIVE Even though many studies about inborn urogenital malformations have been conducted, its etiologic factors and exact pathogenesis are still unclear. Our aim is to assess the risk of congenital urogenital malformations in offspring of smoking pregnant women. RESULTS The meta-analysis, covering 41 case-control and 11 cohort studies, suggested that maternal smoking was associated with an increased risk of urogenital teratogenesis (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.04-1.23, p = 0.005), cryptorchidism (OR = 1.18, 95%CI: 1.12-1.24, p = 0.0001), hypospadias (OR = 1.16, 95%CI: 1.01-1.33, p = 0.039), and kidney malformations (OR = 1.30, 95%CI: 1.14-1.48, p = 0.0001). Moreover, paternal smoking during the mother's pregnancy was also significantly associated (OR = 1.26, 95%CI: 1.03-1.55, p = 0.028). The association between smoking > 10 cigarettes/day was evident but was not significant (OR = 1.24, 95%CI:0.81-1.88, p = 0.323). CONCLUSION Our results showed that maternal smoking during pregnancy increased the risk of congenital urogenital malformations. In numerous epidemiological studies, maternal smoking during pregnancy has a significant role in fetal development. Therefore, quitting tobacco use may be an effective method for reducing the risk of congenital urogenital malformation in pregnant women.
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Affiliation(s)
- Qiang Zhang
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
| | - Zhi-Cheng Zhang
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
| | - Xue-Yu He
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
| | - Zhen-Min Liu
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
| | - Guang-Hui Wei
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.,Program for Youth Innovation in Future Medicine, Chongqing Medical University, Chongqing, China
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Yu C, Wei Y, Tang X, Liu B, Shen L, Long C, Lin T, He D, Wu S, Wei G. Maternal smoking during pregnancy and risk of cryptorchidism: a systematic review and meta-analysis. Eur J Pediatr 2019; 178:287-297. [PMID: 30465272 DOI: 10.1007/s00431-018-3293-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/14/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
Abstract
The risk factors for undescended testes in male infants and the underlying pathogenesis still remain unclear. The aim of this study is to identify the relationship between maternal smoking during pregnancy and risk of cryptorchidism. A systematic review was conducted using appropriate search terms to identify articles pertaining to maternal smoking during pregnancy and risk of cryptorchidism. Entries up to December 23, 2017 were taken into consideration, without any language or regional restriction. The crude ORs and their 95% CIs were computed by using the fixed-effect model. Twenty studies involving 111,712 infants were included in our meta-analysis. The risk of having a male infant with cryptorchidism was significantly different between mothers who smoked during pregnancy and those who did not (pooled crude OR 1.18, 95% confidence interval [CI] 1.12-1.24, p < 0.00001).Conclusion: Our findings suggest that smoking during pregnancy increased the risk of cryptorchidism by 1.18 times. Further investigations that are well-designed, multicentric studies measuring variables, such as the number of cigarettes smoked in a day and the stage of pregnancy during which the mothers smoked, are necessary to precisely determine the relationship between maternal smoking and risk of cryptorchidism. What is Known: • Preterm and low birth weight have been definitively shown to be risk factors for cryptorchidism. • The relationship between with maternal smoking during pregnancy and risk of cryptorchidism remains controversial all the time. What is New: • Mothers who smoked during pregnancy had a 1.18 times higher risk of having a child with cryptorchidism as compared to those who did not smoke. • Evidence has been found that maternal smoking during pregnancy is a definitive risk factor for cryptorchidism.
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Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xiangliang Tang
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Bin Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lianju Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Chunlan Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China. .,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (No. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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Hypertensive Disorders of Pregnancy and Genital Anomalies in Boys: A Danish Nationwide Cohort Study. Epidemiology 2019; 29:739-748. [PMID: 29912017 DOI: 10.1097/ede.0000000000000878] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although congenital abnormalities in the male reproductive tract are common, their causes remain poorly understood. We studied associations between hypertensive disorders of pregnancy (pregestational hypertension, gestational hypertension, and preeclampsia) and the genital anomalies, cryptorchidism (undescended testes), and hypospadias (ventrally displaced urethral meatus). METHODS We established a population of 1,073,026 Danish boys born alive between 1 January 1978 and 31 December 2012. By means of Cox regression analyses, we estimated hazard ratios with 95% confidence intervals for cryptorchidism and hypospadias according to type and severity of hypertensive disorder. Further, we used restricted cubic spline analyses to investigate the association between gestational age at onset of severe and moderate preeclampsia and the two genital anomalies. RESULTS We found associations between pregestational hypertension and cryptorchidism (HR: 1.3; 95% CI = 1.1, 1.6) and hypospadias (HR: 1.7; 95% CI = 1.3, 2.3), whereas gestational hypertension was only associated with cryptorchidism (HR: 1.2; 95% CI = 1.1, 1.4). Boys of mothers with preeclampsia had the highest occurrence of cryptorchidism and hypospadias, increasing with preeclampsia severity. Women with HELLP syndrome faced the highest risk of having a child with both cryptorchidism (HR: 2.1; 95% CI = 1.4, 3.2) and hypospadias (HR: 3.9; 95% CI = 2.5, 6.1). Further, the occurrence increased with early onset of preeclampsia diagnosis. CONCLUSIONS These findings support the hypotheses that preeclampsia and genital anomalies share common etiologic factors and that placental dysfunction and androgen deficiency in early pregnancy are important in the etiology of male genital anomalies.
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Kjersgaard C, Arendt LH, Ernst A, Lindhard MS, Olsen J, Henriksen TB, Strandberg-Larsen K, Ramlau-Hansen CH. Lifestyle in pregnancy and cryptorchidism in sons: a study within two large Danish birth cohorts. Clin Epidemiol 2018; 10:311-322. [PMID: 29593434 PMCID: PMC5865585 DOI: 10.2147/clep.s150657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Cryptorchidism is the most frequent congenital malformation in boys and is associated with low sperm count, infertility and testicular cancer. Unhealthy maternal lifestyle during pregnancy such as smoking, high prepregnancy body mass index (BMI) as well as alcohol and caffeine intake may constitute possible risk factors for cryptorchidism, but results from the few previous studies are conflicting. We aimed to explore the association between maternal lifestyle factors and occurrence of cryptorchidism in sons. Patients and methods The Danish National Birth Cohort and the Aarhus Birth Cohort provided information on maternal lifestyle from early pregnancy. Data were linked to several Danish health registers, multiple imputation was used to handle missing data and Cox proportional hazards models were used to adjust for potential confounders. Results In total, 85,923 boys were included, and of them, 2.2% were diagnosed with cryptorchidism. We observed the strongest associations between maternal tobacco smoking and prepregnancy BMI and cryptorchidism. Sons of women who smoked 10–14 cigarettes/day had the highest hazard ratio (HR) for cryptorchidism (1.37; 95% CI: 1.06–1.76), and for maternal BMI ≥30 kg/m2, the HR was 1.32 (95% CI: 1.06–1.65). Binge drinking was associated with an HR <1, if the women had one or two episodes in pregnancy (HR: 0.81; 95% CI: 0.67–0.98). Average maternal alcohol intake and caffeine intake during pregnancy were not significantly associated with a higher occurrence of cryptorchidism detected at birth or later in life. Conclusion Maternal tobacco smoking, overweight and obesity in pregnancy were associated with higher occurrence of cryptorchidism in boys in this study.
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Affiliation(s)
- Camilla Kjersgaard
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus
| | - Linn Håkonsen Arendt
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus.,Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus
| | - Andreas Ernst
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus
| | | | - Jørn Olsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus
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5
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Abstract
Undescended testis - known as cryptorchidism - is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors that contribute to the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases in fetal development - between 8-15 weeks (the first phase of decent) and 25-35 weeks gestation (the second phase of descent); the failure of a testis to descend permanently is probably caused by disruptions to one or both of these phases, but the causes and mechanisms of such disruptions are still unclear. A broad range of putative risk factors have been evaluated in relation to the development of cryptorchidism but their plausibility is still in question. Consistent evidence of an association with cryptorchidism exists for only a few factors, and in those cases in which evidence seems unequivocal the factor is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor could vary considerably between mother-son pairs depending on an array of genetic, maternal, placental and fetal factors - all of which could vary between regions. Thus, the role of causative factors in aetiology of cryptorchidism requires further research.
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6
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Nicoletti D, Appel LD, Siedersberger Neto P, Guimarães GW, Zhang L. Maternal smoking during pregnancy and birth defects in children: a systematic review with meta-analysis. CAD SAUDE PUBLICA 2016; 30:2491-529. [PMID: 26247979 DOI: 10.1590/0102-311x00115813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
Abstract
This systematic review aimed to investigate the association between maternal smoking during pregnancy and birth defects in children. We performed an electronic search of observational studies in the databases ovid MEDLINE (1950 to April 2010), LILACS and SciELO. We included 188 studies with a total of 13,564,914 participants (192,655 cases). Significant positive associations were found between maternal smoking and birth defects in the following body systems: cardiovascular (OR: 1.11; 95%CI: 1.03-1.19), digestive (OR: 1.18; 95%CI: 1.07-1.30), musculoskeletal (OR: 1.27; 95%CI: 1.16-1.39) and face and neck (OR: 1.28; 95%CI: 1.19-1.37). The strength of association between maternal smoking and birth defects measured by the OR (95%CI) is significantly related to the amount of cigarettes smoked daily (χ2 = 12.1; df = 2; p = 0.002). In conclusion, maternal smoking during pregnancy is associated with congenital malformations in children and this association is dose-dependent.
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Affiliation(s)
- Dilvania Nicoletti
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | | | | | | | - Linjie Zhang
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
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7
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Fawzy F, Hussein A, Eid MM, El Kashash AM, Salem HK. Cryptorchidism and Fertility. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2015; 9:39-43. [PMID: 26740750 PMCID: PMC4689328 DOI: 10.4137/cmrh.s25056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
Abstract
Cryptorchidism, the failure of one or both testes to descend into the scrotum prenatally, occurs in 2.4%–5% of newborns. Many of these testes will descend spontaneously shortly after birth, but ~23% will remain undescended unless surgery is performed. Bilaterally cryptorchid men have a six times greater risk of being infertile when compared with unilaterally cryptorchid men and the general male population. Approximately 10% of infertile men have a history of cryptorchidism and orchidopexy. The main reasons for infertility in men with a history of cryptorchidism treated by orchidopexy are maldevelopment of the testes and an improper environment for the normal development of the testes, hyperthermia, and antisperm antibodies.
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Affiliation(s)
- Fatma Fawzy
- Resident, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amr Hussein
- Student, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Hosni Khairy Salem
- Professor of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt
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8
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Zhang L, Wang XH, Zheng XM, Liu TZ, Zhang WB, Zheng H, Chen MF. Maternal gestational smoking, diabetes, alcohol drinking, pre-pregnancy obesity and the risk of cryptorchidism: a systematic review and meta-analysis of observational studies. PLoS One 2015; 10:e0119006. [PMID: 25798927 PMCID: PMC4370654 DOI: 10.1371/journal.pone.0119006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background Maternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity are thought to increase the risk of cryptorchidism in newborn males, but the evidence is inconsistent. Method We conducted a systematic review and meta-analysis of studies on the association between maternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity and the risk of cryptorchidism. Articles were retrieved by searching PubMed and ScienceDirect, and the meta-analysis was conducted using Stata/SE 12.0 software. Sensitivity analysis was used to evaluate the influence of confounding variables. Results We selected 32 articles, including 12 case—control, five nested case—control, and 15 cohort studies. The meta-analysis showed that maternal smoking (OR = 1.17, 95% CI: 1.11–1.23) or diabetes (OR = 1.21, 95%CI: 1.00–1.46) during pregnancy were associated with increased risk of cryptorchidism. Overall, the association between maternal alcohol drinking (OR = 0.97, 95% CI: 0.87–1.07), pre-pregnancy body mass index (OR = 1.02, 95% CI: 0.95–1.09) and risk of cryptorchidism were not statistically significant. Additional analysis showed reduced risk (OR = 0.89, 95% CI: 0.82–0.96) of cryptorchidism with moderate alcohol drinking during pregnancy. No dose—response relationship was observed for increments in body mass index in the risk of cryptorchidism. Sensitivity analysis revealed an unstable result for the association between maternal diabetes, alcohol drinking and cryptorchidism. Moderate heterogeneity was detected in studies of the effect of maternal alcohol drinking and diabetes. No publication bias was detected. Conclusion Maternal gestational smoking, but not maternal pre-pregnancy overweight or obesity, was associated with increased cryptorchidism risk in the offspring. Moderate alcohol drinking may reduce the risk of cryptorchidism while gestational diabetes may be a risk factor, but further studies are needed to verify this.
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Affiliation(s)
- Lin Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- * E-mail:
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xin-Min Zheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Wei-Bin Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Hang Zheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Mi-Feng Chen
- Department of Obstetrical, Jingmen No. 2 People’s Hospital, Jingmen Hubei, People’s Republic of China
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9
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Håkonsen LB, Ernst A, Ramlau-Hansen CH. Maternal cigarette smoking during pregnancy and reproductive health in children: a review of epidemiological studies. Asian J Androl 2014; 16:39-49. [PMID: 24369132 PMCID: PMC3901880 DOI: 10.4103/1008-682x.122351] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Maternal cigarette smoking may affect the intrauterine hormonal environment during pregnancy and this early fetal exposure may have detrimental effects on the future trajectory of reproductive health. In this review, we discuss the epidemiological literature on the association between prenatal exposure to maternal cigarette smoking and several aspects of reproductive health. The literature points towards an increased risk of the urogenital malformation cryptorchidism, but a potential protective effect on the risk of hypospadias in sons following prenatal cigarette smoking exposure. Studies on sexual maturation find a tendency towards accelerated pubertal development in exposed boys and girls. In adult life, prenatally exposed men have impaired semen quality compared with unexposed individuals, but an influence on fecundability, that is, the biological ability to reproduce, is less evident. We found no evidence to support an association between prenatal cigarette smoking exposure and testicular cancer. Among adult daughters, research is sparse and inconsistent, but exposure to cigarette smoking in utero may decrease fecundability. In conclusion, prenatal exposure to cigarette smoking may cause some long-term adverse effects on the reproductive health.
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Affiliation(s)
- Linn Berger Håkonsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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10
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Mavrogenis S, Urban R, Czeizel AE, Acs N. Possible association of maternal factors with the higher risk of isolated true undescended testis: A population-based case-control study. Congenit Anom (Kyoto) 2014; 54:178-83. [PMID: 24754829 DOI: 10.1111/cga.12061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/07/2014] [Indexed: 02/02/2023]
Abstract
The objective of the study was to evaluate the possible association of maternal factors with the risk of isolated true undescended testis (ITUT) diagnosed at the third postnatal month because our knowledge is limited regarding the origin of ITUT. Acute and chronic diseases with related drug treatments were compared in the mothers of 2052 cases with ITUT, 24,814 male controls without any defects and 12,082 malformed male controls with other isolated defects in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. Prospective medically recorded endometriosis before conception of the study pregnancy in the mothers of 39 cases was associated with a higher risk of ITUT in their sons (odds ratio (OR) with 95% confidence interval [CI]: 2.42, 1.71-3.42). Dihydrogesterone treatment in the first trimester of pregnancy also showed association with the higher risk of ITUT but based on only five pregnant women. In conclusion, endometriosis before pregnancy may have a role in the origin of ITUT.
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Affiliation(s)
- Stelios Mavrogenis
- Department of Uro-oncology, National Institute of Oncology, Budapest, Hungary
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11
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Bay K, Anand-Ivell R. Human Testicular Insulin-Like Factor 3 and Endocrine Disrupters. VITAMINS & HORMONES 2014; 94:327-48. [DOI: 10.1016/b978-0-12-800095-3.00012-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Abstract
PURPOSE OF REVIEW To assess whether prenatal exposure to smoking is associated with impaired reproductive health in exposed men. RECENT FINDINGS Men who have been exposed to maternal smoking in utero have smaller testes and impaired semen quality as compared to nonexposed men, suggesting toxic effects on Sertoli and/or germ cells. According to meta-analyses there is only a weak or no association with fetal exposure to smoking and the incidence of testicular germ cell cancer, cryptorchidism, or hypospadias. SUMMARY Adverse effect of maternal smoking on sperm production capacity of their son is yet another good reason for women to quit smoking before pregnancy.
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Affiliation(s)
- Helena E Virtanen
- Departments of Physiology and Paediatrics, University of Turku, Turku, Finland
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Virtanen HE, Adamsson A. Cryptorchidism and endocrine disrupting chemicals. Mol Cell Endocrinol 2012; 355:208-20. [PMID: 22127307 DOI: 10.1016/j.mce.2011.11.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 10/15/2022]
Abstract
Prospective clinical studies have suggested that the rate of congenital cryptorchidism has increased since the 1950s. It has been hypothesized that this may be related to environmental factors. Testicular descent occurs in two phases controlled by Leydig cell-derived hormones insulin-like peptide 3 (INSL3) and testosterone. Disorders in fetal androgen production/action or suppression of Insl3 are mechanisms causing cryptorchidism in rodents. In humans, prenatal exposure to potent estrogen diethylstilbestrol (DES) has been associated with increased risk of cryptorchidism. In addition, epidemiological studies have suggested that exposure to pesticides may also be associated with cryptorchidism. Some case-control studies analyzing environmental chemical levels in maternal breast milk samples have reported associations between cryptorchidism and chemical levels. Furthermore, it has been suggested that exposure levels of some chemicals may be associated with infant reproductive hormone levels.
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Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update 2011; 17:589-604. [PMID: 21747128 PMCID: PMC3156888 DOI: 10.1093/humupd/dmr022] [Citation(s) in RCA: 409] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. METHODS Observational studies published 1959–2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for potential confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. RESULTS Significant positive associations with maternal smoking were found for: cardiovascular/heart defects [OR 1.09, 95% confidence interval (CI) 1.02–1.17]; musculoskeletal defects (OR 1.16, 95% CI 1.05–1.27); limb reduction defects (OR 1.26, 95% CI 1.15–1.39); missing/extra digits (OR 1.18, 95% CI 0.99–1.41); clubfoot (OR 1.28, 95% CI 1.10–1.47); craniosynostosis (OR 1.33, 95% CI 1.03–1.73); facial defects (OR 1.19, 95% CI 1.06–1.35); eye defects (OR 1.25, 95% CI 1.11–1.40); orofacial clefts (OR 1.28, 95% CI 1.20–1.36); gastrointestinal defects (OR 1.27, 95% CI 1.18–1.36); gastroschisis (OR 1.50, 95% CI 1.28–1.76); anal atresia (OR 1.20, 95% CI 1.06–1.36); hernia (OR 1.40, 95% CI 1.23–1.59); and undescended testes (OR 1.13, 95% CI 1.02–1.25). There was a reduced risk for hypospadias (OR 0.90, 95% CI 0.85–0.95) and skin defects (OR 0.82, 0.75–0.89). For all defects combined the OR was 1.01 (0.96–1.07), due to including defects with a reduced risk and those with no association (including chromosomal defects). CONCLUSIONS Birth defects that are positively associated with maternal smoking should now be included in public health educational materials to encourage more women to quit before or during pregnancy.
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Affiliation(s)
- Allan Hackshaw
- CRUK & UCL Trials Centre, University College London, , 90 Tottenham Court Road, London, UK.
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Adams SV, Hastert TA, Huang Y, Starr JR. No association between maternal pre-pregnancy obesity and risk of hypospadias or cryptorchidism in male newborns. ACTA ACUST UNITED AC 2011; 91:241-8. [PMID: 21462299 DOI: 10.1002/bdra.20805] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hypospadias and cryptorchidism, two relatively common male genital anomalies, may be caused by altered maternal hormone levels, blood glucose levels, or nutritional deficiencies. Maternal obesity, which increases risk of diabetes and could influence hormone levels, may, therefore, be associated with risk of hypospadias and cryptorchidism. The purpose of this study was to assess the association between pre-pregnancy maternal obesity and hypospadias and cryptorchidism. METHODS We conducted a case-control study of hypospadias and cryptorchidism in male singleton newborns using Washington State birth records from 1992 to 2008 linked to birth-hospitalization discharge records. Maternal pre-pregnancy body mass index (BMI) was calculated from pre-pregnancy weight and height. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for hypospadias or cryptorchidism were estimated by fitting multivariable logistic regression models adjusted for year of birth, and maternal age, education, parity, race, and cigarette smoking during pregnancy. RESULTS The complete-case analysis included 2219 hypospadias cases, 2563 cryptorchidism cases, and 32,734 controls. Maternal obesity (BMI ≥30 kg/m(2) ) was not associated with risk of hypospadias or cryptorchidism in male offspring: hypospadias (aOR, 1.07; 95% CI, 0.95-1.21); cryptorchidism (aOR, 0.99; 95% CI, 0.89-1.11), and no trend in risk with increasing maternal BMI was found. There was little indication of risk associated with BMI among any subgroup of mothers examined, including women with pre-existing diabetes or hypertension, women who developed preeclampsia, non-Hispanic white women, first-time mothers, or mothers aged ≥30 years. CONCLUSIONS The results of this study do not support the hypothesis that pre-pregnancy maternal obesity is a cause of hypospadias or cryptorchidism in male infants.
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Affiliation(s)
- Scott V Adams
- Department of Epidemiology, University of Washington, Seattle, USA.
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Zivkovic D, Varga J, Konstantinidis G, Vlaski J, Snyder HM, Hadziselimovic F. Regional differences in maturation of germ cells of cryptorchid testes: role of environment. Acta Paediatr 2009; 98:1339-43. [PMID: 19594475 DOI: 10.1111/j.1651-2227.2009.01325.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate differences in maturation of germ cells in cryptorchid testes in three different regions. PATIENTS AND METHODS A total of 103 consecutive patients were operated for unilateral undescended testis in Vojvodina, from March 2006 until September 2007, and had a testicular biopsy performed. Germ cells were counted, and the presence of Ad spermatogonia was noted. Biopsies were compared to biopsies of similar patients from two different regions: Philadelphia, USA (130), and Liestal, Switzerland (55 patients). RESULTS In Vojvodina, 84.5% of patients had Sertoli cells only, or some spermatogonia, but no Ad spermatogonia, and 15.5% had Ad spermatogonia. In Philadelphia, 59.3% of patients had poor testicular histology, and 40.7% had Ad spermatogonia. In Liestal, 61.8% of patients had no, or some, spermatogonia, but no Ad spermatogonia, and 38.2% had Ad spermatogonia. There was a difference (p = 0.000025) between the patients with normal testicular histology from Philadelphia and those from Vojvodina, as well as between the patients from Vojvodina and Liestal (p = 0.0027). CONCLUSION The reduction in the number of germ cells in patients with cryptorchidism from Vojvodina is more pronounced than patients from either Switzerland or USA. This is a unique observation, since such a study has not been published yet.
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Affiliation(s)
- Dragana Zivkovic
- Institute for Child and Youth Health Care of Vojvodina, Pediatric Surgery Clinic, 21000 Novi Sad, Serbia.
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Martin O, Shialis T, Lester J, Scrimshaw M, Boobis A, Voulvoulis N. Testicular dysgenesis syndrome and the estrogen hypothesis: a quantitative meta-analysis. CIENCIA & SAUDE COLETIVA 2009; 13:1601-18. [PMID: 18813661 DOI: 10.1590/s1413-81232008000500024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/07/2007] [Indexed: 05/25/2023] Open
Abstract
Male reproductive tract abnormalities such as hypospadias and cryptorchidism, and testicular cancer have been proposed to comprise a common syndrome together with impaired spermatogenesis with a common etiology resulting from the disruption of gonadal development during fetal life, the testicular dysgenesis syndrome (TDS). The only quantitative summary estimate of the link between prenatal exposure to estrogenic agents and testicular cancer was published over 10 years ago; other reviews of the link between estrogenic compounds, other than the potent pharmaceutical estrogen diethylstilbestrol (DES), and TDS end points have remained inconclusive. We conducted a quantitative meta-analysis of the association between the end points related to TDS and prenatal exposure to estrogenic agents. Inclusion in this analysis was based on mechanistic criteria, and the plausibility of an estrogen receptor (ER)-alpha-mediated mode of action was specifically explored. Eight studies were included, investigating the etiology of hypospadias and/or cryptorchidism that had not been identified in previous systematic reviews. Four additional studies of pharmaceutical estrogens yielded a statistically significant updated summary estimate for testicular cancer. Results of the subset analyses point to the existence of unidentified sources of heterogeneity between studies or within the study population.
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Affiliation(s)
- Olwenn Martin
- Centre for Environmental Policy, Imperial College London, London, UK
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18
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Damgaard IN, Jensen TK, Petersen JH, Skakkebaek NE, Toppari J, Main KM. Risk factors for congenital cryptorchidism in a prospective birth cohort study. PLoS One 2008; 3:e3051. [PMID: 18725961 PMCID: PMC2516600 DOI: 10.1371/journal.pone.0003051] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 08/04/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Risk factors for congenital cryptorchidism were investigated in a prospective birth cohort study in Denmark and Finland from 1997 to 2001. METHODOLOGY AND PRINCIPAL FINDINGS In total, 2,496 boys were examined for cryptorchidism at birth (cryptorchid/healthy: 128/2,368) and three months old (33/2,215). Information on risk factors was obtained antenatally (questionnaire/interview) or at birth from birth records. Use of nicotine substitutes during pregnancy (n = 40) and infertility treatment by intrauterine insemination (n = 49) were associated with an increased risk for cryptorchidism, adjusted odds ratio (95% confidence interval) (OR (95%CI)) 3.04 (95%CI 1.00-9.27) and 3.01 (95%CI 1.27-7.15), respectively. No association was seen for mothers (n = 79) who had infertility treatment in form of intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) treatment (OR 0.71 95%CI 0.21-2.38). In total, 728 (29%) reported to have smoked during pregnancy, however, no increased risk among maternal smokers was found. Furthermore, we found statistically significant associations between cryptorchidism and low birth weight, prematurity, being small for gestational age, substantial vaginal bleeding, and breech presentation, which are in accordance with other studies. CONCLUSIONS AND SIGNIFICANCE Our study revealed two novel risk factors for cryptorchidism: intrauterine insemination and the use of nicotine substitutes in pregnancy. This suggests that cryptorchidism may not only be associated to genetic factors, but also to maternal lifestyle and exposure.
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Affiliation(s)
- Ida N Damgaard
- University Department of Growth and Reproduction, GR-5064 Rigshospitalet, Copenhagen, Denmark.
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Martin OV, Shialis T, Lester JN, Scrimshaw MD, Boobis AR, Voulvoulis N. Testicular dysgenesis syndrome and the estrogen hypothesis: a quantitative meta-analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:149-57. [PMID: 18288311 PMCID: PMC2235228 DOI: 10.1289/ehp.10545] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/07/2007] [Indexed: 05/22/2023]
Abstract
BACKGROUND Male reproductive tract abnormalities such as hypospadias and cryptorchidism, and testicular cancer have been proposed to comprise a common syndrome together with impaired spermatogenesis with a common etiology resulting from the disruption of gonadal development during fetal life, the testicular dysgenesis syndrome (TDS). The hypothesis that in utero exposure to estrogenic agents could induce these disorders was first proposed in 1993. The only quantitative summary estimate of the association between prenatal exposure to estrogenic agents and testicular cancer was published over 10 years ago, and other systematic reviews of the association between estrogenic compounds, other than the potent pharmaceutical estrogen diethylstilbestrol (DES), and TDS end points have remained inconclusive. OBJECTIVES We conducted a quantitative meta-analysis of the association between the end points related to TDS and prenatal exposure to estrogenic agents. Inclusion in this analysis was based on mechanistic criteria, and the plausibility of an estrogen receptor (ER)-alpha-mediated mode of action was specifically explored. RESULTS We included in this meta-analysis eight studies investigating the etiology of hypospadias and/or cryptorchidism that had not been identified in previous systematic reviews. Four additional studies of pharmaceutical estrogens yielded a statistically significant updated summary estimate for testicular cancer. CONCLUSIONS The doubling of the risk ratios for all three end points investigated after DES exposure is consistent with a shared etiology and the TDS hypothesis but does not constitute evidence of an estrogenic mode of action. Results of the subset analyses point to the existence of unidentified sources of heterogeneity between studies or within the study population.
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Affiliation(s)
- Olwenn V. Martin
- Centre for Environmental Policy and
- Experimental Medicine and Toxicology Group, Imperial College London, United Kingdom
| | | | - John N. Lester
- Centre for Water Sciences, Cranfield University, Cranfield, United Kingdom
| | - Mark D. Scrimshaw
- Institute for the Environment, Brunel University, Uxbridge, United Kingdom
| | - Alan R. Boobis
- Experimental Medicine and Toxicology Group, Imperial College London, United Kingdom
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Mongraw-Chaffin ML, Cohn BA, Cohen RD, Christianson RE. Maternal smoking, alcohol consumption, and caffeine consumption during pregnancy in relation to a son's risk of persistent cryptorchidism: a prospective study in the Child Health and Development Studies cohort, 1959-1967. Am J Epidemiol 2008; 167:257-61. [PMID: 18024986 DOI: 10.1093/aje/kwm311] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Child Health and Development Studies is a > or =40-year follow-up of 20,754 pregnancies occurring between 1959 and 1967 in California. There were 84 cases of undescended testes at birth persisting to at least age 2 years among 7,574 liveborn sons whose mothers were interviewed in early pregnancy. Cases were matched to three controls on birth year and race. Compared with mothers of controls, mothers of cryptorchid boys consumed more caffeine during pregnancy (odds ratio = 1.4, 95% confidence interval: 1.1, 1.9 for an interquartile range equivalent to three cups of coffee per day) but were not more likely to smoke or drink alcohol when all behaviors were considered together. Other maternal and perinatal risk factors were not significantly associated with persistent cryptorchidism and did not confound the association with caffeine.
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Affiliation(s)
- Morgana L Mongraw-Chaffin
- Child Health and Development Studies, Center for Research on Women's and Children's Health, Public Health Institute, Berkeley 94709, CA
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21
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Fowler PA, Cassie S, Rhind SM, Brewer MJ, Collinson JM, Lea RG, Baker PJ, Bhattacharya S, O'Shaughnessy PJ. Maternal smoking during pregnancy specifically reduces human fetal desert hedgehog gene expression during testis development. J Clin Endocrinol Metab 2008; 93:619-26. [PMID: 18000085 DOI: 10.1210/jc.2007-1860] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Maternal cigarette smoking during gestation increases cryptorchidism and hypospadias and reduces testis size and fertility in sons by unknown mechanisms. OBJECTIVE The objective of the study was to determine whether maternal smoking is linked with changes in male human fetal endocrinology, testis gene expression, and liver concentrations of cigarette smoke chemicals. DESIGN This was an observational study of the male fetus, comparing pregnancies during which the mothers either did or did not smoke. SETTING The study was conducted at the universities of Aberdeen, Glasgow, and Nottingham and Macaulay Institute (Aberdeen). PATIENTS/PARTICIPANTS Testes, blood, and livers were collected from 69 morphologically normal human male fetuses of women undergoing elective termination of normal second-trimester pregnancies. MAIN OUTCOME MEASURES Testosterone, human chorionic gonadotropin, LH, and cotinine; expression of 30 reproductive/developmental genes; liver concentrations of 16 polycyclic aromatic hydrocarbons; and Leydig, Sertoli. and germ cell numbers were determined. RESULTS There were no significant differences in fetal size, testis weight, cell numbers, seminiferous tubule diameter, or circulating LH and testosterone. Fetuses from smoking mothers had smoking range cotinine levels and liver concentrations of polycyclic aromatic hydrocarbons that were significant predictors of maternal smoking (P < 0.001). Only the Sertoli cell-specific gene, desert hedgehog (DHH), was significantly altered by maternal smoking (reduced 1.8-fold, P = 0.013). CONCLUSIONS The consequences of reduced DHH signaling in men and mice are consistent with epidemiology for effects of gestational maternal smoking on sons. Given the absence of other observed effects of maternal smoking, we concluded that reduced DHH is part of a mechanism linking maternal gestational smoking with impaired reproductive development in male offspring.
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Affiliation(s)
- Paul A Fowler
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
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Abstract
AIM A recently published study reported markedly increased risk of cryptorchidism among boys whose mothers had an average gestational alcohol intake of five or more drinks per week. The aim of this study is to follow up on this finding by estimating the association between prenatal alcohol exposure and persistent cryptorchidism. METHODS We used prospectively collected information on prenatal exposures and obstetric information on the birth of 5716 boys, collected from 1984 to 1987. During the 16-19 years of follow-up in a nationwide patient register, 270 cases of cryptorchidism were diagnosed and 185 of these boys underwent orchiopexy. RESULTS No positive association between the mothers' average weekly alcohol consumption and persistent cryptorchidism was observed. Binge drinking was nonsignificantly associated with an excess risk of orchiopexy (adjusted RR = 1.4; 95% CI 0.9-2.1), but not with having a diagnosis of cryptorchidism without orchiopexy. CONCLUSIONS Mothers' average weekly alcohol intake was not associated with persistent cryptorchidism, but binge drinking may be a risk factor.
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Affiliation(s)
- M S Jensen
- Department of Occupational Medicine, University Hospital of Aarhus, Aarhus, Denmark.
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23
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Abstract
In this issue, Jensen et al (Epidemiology. 2007;18:220-225) publish new evidence linking maternal smoking with cryptorchidism. These new data make the cumulative evidence for a true association persuasive enough to be seriously considered. Possible biologic mechanisms may include endocrine disruption by cigarette smoke, although the role of endocrine disruptors in cryptorchidism more generally has been inconsistent. There are important research questions suggested by the link between mother's smoking and cryptorchidism, including a possible role of father's smoking, the role of genetic susceptibility, and the effects of mother's smoking on further aspects of her son's reproductive health.
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Affiliation(s)
- Martha Werler
- Sloan Epidemiology Unit, Brookline, Massachusetts 02146, USA.
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Jensen MS, Toft G, Thulstrup AM, Bonde JP, Olsen J. Cryptorchidism according to maternal gestational smoking. Epidemiology 2007; 18:220-5. [PMID: 17202869 DOI: 10.1097/01.ede.0000254061.90686.9f] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been suggested that maternal smoking during pregnancy is a risk factor for low sperm counts and testicular cancer in the offspring. Cryptorchidism is associated with both of these disorders and might share causal mechanisms. METHODS We used prospective information on prenatal exposures and obstetric information on the birth of 5716 boys, collected from 1984 to 1987. During the 16-19 years of follow-up, 270 cases of cryptorchidism were diagnosed, and 185 of these boys underwent orchiopexy. RESULTS Compared with nonsmokers, the adjusted risk ratio for being diagnosed with cryptorchidism was 1.1 (95% confidence interval = 0.8-1.6) if the mothers smoked 10-19 cigarettes/day and 2.3 (1.1-5.0) if they smoked > or = 20 cigarettes/day. The risk ratios for orchiopexy were 1.4 (0.9-2.1) and 1.8 (0.6-5.0), respectively. CONCLUSION An excess risk of cryptorchidism was observed among sons of mothers who smoked 10 cigarettes or more per day during pregnancy. In recognition of the limited power of this study, the findings should be replicated in larger cohorts.
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Damgaard IN, Jensen TK, Petersen JH, Skakkebaek NE, Toppari J, Main KM. Cryptorchidism and maternal alcohol consumption during pregnancy. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:272-7. [PMID: 17384777 PMCID: PMC1817679 DOI: 10.1289/ehp.9608] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 12/04/2006] [Indexed: 05/08/2023]
Abstract
BACKGROUND Prenatal exposure to alcohol can adversely affect the fetus. We investigated the association between maternal alcohol consumption during pregnancy and cryptorchidism (undescended testis) among newborn boys. METHODS We examined 2,496 boys in a prospective Danish-Finnish birth cohort study for cryptorchidism at birth (cryptorchid/healthy: 128/2,368) and at 3 months of age (33/2,215). Quantitative information on alcohol consumption (average weekly consumption of wine, beer, and spirits and number of binge episodes), smoking, and caffeine intake was obtained by questionnaire and/or interview once during the third trimester of pregnancy, before the outcome of the pregnancy was known. For a subgroup (n = 465), information on alcohol consumption was obtained twice during pregnancy by interviews. RESULTS We investigated maternal alcohol consumption both as a continuous variable and categorized. The odds for cryptorchidism increased with increasing weekly alcohol consumption. After adjustment for confounders (country, smoking, caffeine intake, binge episodes, social class, maternal age, parity, maturity, and birth weight) the odds remained significant for women with a weekly consumption of five or more alcoholic drinks (odds ratio = 3.10; 95% confidence interval, 1.05-9.10). CONCLUSIONS Regular alcohol intake during pregnancy appears to increase the risk of congenital cryptorchidism in boys. The mechanisms for this association are unknown. Counseling of pregnant women with regard to alcohol consumption should also consider this new finding.
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Affiliation(s)
- Ida N Damgaard
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
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McGlynn KA, Zhang Y, Sakoda LC, Rubertone MV, Erickson RL, Graubard BI. Maternal Smoking and Testicular Germ Cell Tumors. Cancer Epidemiol Biomarkers Prev 2006; 15:1820-4. [PMID: 17035387 DOI: 10.1158/1055-9965.epi-06-0389] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Testicular germ cell tumors (TGCT) are the most common cancer among men ages 15 to 35 years in the United States. The well-established TGCT risk factors cryptorchism, prior diagnosis of TGCT, and family history of testicular cancer indicate that exposures in early life and/or in the familial setting may be critical to determining risk. Previous reports of familial clustering of lung cancer in mothers and testicular cancers in sons suggest that passive smoking in childhood may be such an exposure. To clarify the relationship of passive smoking exposure to TGCT risk, data from 754 cases and 928 controls enrolled in the Servicemen's Testicular Tumor Environmental and Endocrine Determinants study were analyzed. Data from 1,086 mothers of the cases and controls were also examined. Overall, there was no relationship between maternal [odds ratio (OR), 1.1; 95% confidence interval (95% CI), 0.9-1.3] or paternal smoking (OR, 1.0; 95% CI, 0.8-1.3) and TGCT risk. Although living with a non-parent smoker was marginally related to risk (OR, 1.4; 95% CI, 1.0-2.1), there was no relationship with number of smokers, amount smoked, or duration of smoking. Responses from both case-control participants and mothers also revealed no relationship between either maternal smoking while pregnant or while breast-feeding. Results did not differ by TGCT histology (seminoma, non-seminoma). These results do not support the hypothesis that passive smoking, either in utero or in childhood, is related to risk of TGCT. Other early life exposures, however, may explain the familial clustering of lung cancer in mothers and TGCT in sons.
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Affiliation(s)
- Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, MD, USA.
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Thorup J, Cortes D, Petersen BL. The incidence of bilateral cryptorchidism is increased and the fertility potential is reduced in sons born to mothers who have smoked during pregnancy. J Urol 2006; 176:734-7. [PMID: 16813933 DOI: 10.1016/j.juro.2006.03.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Recent studies have demonstrated a high prevalence of cryptorchidism, decreasing semen quality and increasing incidence of testicular cancer. These changes seem to be interrelated, and may be symptoms of a common underlying entity with foundations in fetal life. We investigated the influence of maternal smoking on fertility status in offspring cryptorchidism. MATERIALS AND METHODS We prospectively studied consecutive patients presenting to the pediatric surgery department between 1996 and 2005. A total of 157 boys 1 to 5.9 years old underwent surgery for cryptorchidism with simultaneous testicular biopsy, and exhibited well preserved testicular parenchyma. Only white patients with Danish-speaking mothers who had reported pregnancy history including smoking habits during pregnancy and history of the offspring were included. The patients had cryptorchidism only and none received hormonal treatment before surgery. The number of spermatogonia and gonocytes per tubule cross-section was assessed and compared to normal values from autopsy material. RESULTS The group of boys with cryptorchidism whose mothers had smoked heavily during pregnancy (ie more than 10 cigarettes daily throughout the pregnancy) had a significantly increased risk of bilateral cryptorchidism (52%, or 11 of 21 patients), and a decreased number of spermatogonia and gonocytes per tubule cross-section, which was absolute (0.097 [0 to 0.75]) and age related (14% [0% to 198%] of normal for age) compared to boys whose mothers did not smoke (20%, or 22 of 112 patients, 0.140 [0 to 2.14] and 37% [0% to 563%] of normal for age, p <0.01, p <0.05 and p <0.05, respectively). CONCLUSIONS A close relationship between maternal smoking during pregnancy and adverse trends in offspring reproductive health in relation to cryptorchidism was observed.
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Affiliation(s)
- J Thorup
- Department of Pediatric Surgery, Rigshospitalet, University of Copenhagen, Denmark
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Storgaard L, Bonde JP, Olsen J. Male reproductive disorders in humans and prenatal indicators of estrogen exposure. Reprod Toxicol 2006; 21:4-15. [PMID: 16005180 DOI: 10.1016/j.reprotox.2005.05.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 04/03/2005] [Accepted: 05/30/2005] [Indexed: 11/18/2022]
Abstract
Male reproductive disorders in humans and prenatal indicators of estrogen exposure. A review of published epidemiological studies. Reports of an increase in male reproductive disorders in several countries led to the hypothesis that estrogens during fetal life may cause reduced sperm counts, cryptorchidism, hypospadias and testicular cancer. So far the hypothesis is based on animal studies and reports from the wild life. We systematically searched the epidemiological literature for evidence linking indicators of prenatal serum levels of maternal estrogens with sperm density, hypospadias, cryptorchidism and testicular cancer in humans. Indicators of fetal estrogen exposure included direct measurements, recorded intake of hormones (diethylstilbestrol (DES), oral contraceptives (OCs) and estrogens), pregnancy conditions with known deviant estrogen level as for instance twin pregnancies and some environmental exposures. Among 425 papers we reviewed 81 publications with appropriate information. With the possible exception of testicular cancer there is no strong epidemiological evidence to indicate that prenatal exposure to estrogen are linked to disturbed development of the male reproductive organs.
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Affiliation(s)
- Lone Storgaard
- Department of Occupational Medicine, University Hospital of Aarhus, Nørrebrogade 44, DK 8000 Aarhus C, Denmark.
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Bhatia R, Shiau R, Petreas M, Weintraub JM, Farhang L, Eskenazi B. Organochlorine pesticides and male genital anomalies in the child health and development studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:220-4. [PMID: 15687061 PMCID: PMC1277868 DOI: 10.1289/ehp.7382] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Increasing rates of cryptorchidism and hypospadias in human populations may be caused by exogenous environmental agents. We conducted a case-control study of serum levels of p,p'-dichlorodiphenyltrichloroethane (DDT) and its major metabolite, p,p'-dichlorodiphenyldichloroethylene (DDE), and cryptorchidism and hypospadias in the Child Health and Development Study, a longitudinal cohort of pregnancies that occurred between 1959 and 1967, a period when DDT was produced and used in the United States. Serum was available from the mothers of 75 male children born with cryptorchidism, 66 with hypospadias, and 4 with both conditions. We randomly selected 283 controls from the cohort of women whose male babies were born without either of these conditions. Overall, we observed no statistically significant relationships or trends between outcomes and serum measures. After adjusting for maternal race, triglyceride level, and cholesterol level, compared with boys whose mothers had serum DDE levels < 27.0 ng/mL, boys whose mothers had serum DDE levels > or = 61.0 ng/mL had odds ratios of 1.34 [95% confidence interval (CI), 0.51-3.48] for cryptorchidism and 1.18 (95% CI, 0.46-3.02) for hypospadias. For DDT, compared with boys whose mothers had serum DDT levels < 10.0 ng/mL, boys whose mothers had serum DDT levels > or = 20.0 ng/mL had adjusted odds ratios of 1.01 (95% CI, 0.44-2.28) for cryptorchidism and 0.79 (95% CI, 0.33-1.89) for hypospadias. This study does not support an association of DDT or DDE and hypospadias or cryptorchidism.
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Affiliation(s)
- Rajiv Bhatia
- San Francisco Department of Public Health, San Francisco, California 94102, USA
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Thonneau PF, Gandia P, Mieusset R, Candia P. Cryptorchidism: incidence, risk factors, and potential role of environment; an update. JOURNAL OF ANDROLOGY 2003; 24:155-62. [PMID: 12634298 DOI: 10.1002/j.1939-4640.2003.tb02654.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick F Thonneau
- Human Fertility Research Group, Urology and Andrology Department, La Grave Hospital, Toulouse, France.
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Abstract
A nested case-control study of cryptorchidism (i.e. undescended testicles) was undertaken as part of a hospital-based cohort study of 6699 singleton male neonates in New York City. Since some of the cryptorchid infants experienced spontaneous descent of their testes, separate analysis was performed for this third group of 'late descenders' (n=140). Cases (n=63) represented infants whose testes remained undescended at the one year assessment. Controls (n=219) represented the next male infant who was delivered immediately after an infant who was cryptorchid at birth. The only independent risk factors for cryptorchidism were Asian ethnic group (adjusted odds ratio (OR) = 3.90, 95% confidence interval (CI) = 1.22-12.41), swollen legs or feet during pregnancy (adjusted OR = 2.16, 95% CI = 1.15-4.04), a family history of cryptorchidism (adjusted OR = 4.32, 95% CI = 1.91-9.80), low birthweight (adjusted OR = 4.10, 95% CI = 1.39-12.08), and use of analgesics during pregnancy (adjusted OR = 1.93, 95% CI = 1.03-3.62). Multiple logistic regression analysis was also performed to identify those factors that were associated with late testicular descent. In this analysis the independent risk factors were black or Hispanic ethnicity (adjusted OR = 2.05, 95% CI = 1.09-3.83), a family history of cryptorchidism (adjusted OR = 4.25, 95% CI = 1.84-9.78), consumption of cola-containing drinks during the pregnancy (adjusted OR = 2.09, 95% CI = 1.10-3.99), a low birthweight delivery (adjusted OR = 9.78, 95% CI = 3.39-28.20), and preterm birth (adjusted OR = 4.01, 95% CI = 1.66-9.70).
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Affiliation(s)
- G S Berkowitz
- The Departments of Obstetrics, Gynecology and Reproductive Science, and Community Medicine, The Mount Sinai School of Medicine, New York, USA
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