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Cortes D, Fischer MB, Hildorf AE, Clasen-Linde E, Hildorf S, Juul A, Main KM, Thorup J. Anogenital distance in a cohort of 169 infant boys with uni- or bilateral cryptorchidism including 18 boys with vanishing testes. Hum Reprod 2024; 39:689-697. [PMID: 38373213 PMCID: PMC10988100 DOI: 10.1093/humrep/deae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/21/2024] [Indexed: 02/21/2024] Open
Abstract
STUDY QUESTION Do different boys with different types of cryptorchidism exhibit different anogenital distances (AGDs)? SUMMARY ANSWER Length of AGD seemed to differ in different groups of patients with cryptorchidism. WHAT IS KNOWN ALREADY AGD, which is used as an indicator of prenatal androgen action, tends to be shorter in boys with cryptorchidism compared to unaffected boys. Shorter AGDs have also been reported in boys with hypospadias, in men with poor semen quality, and in men with testicular cancer. STUDY DESIGN, SIZE, DURATION A prospective descriptive cohort study was performed using data from consecutively selected boys with cryptorchidism (n = 169) operated in a single center over a period of 3 years (September 2019 to October 2022). PARTICIPANTS/MATERIALS, SETTING, METHODS AGD was measured in 169 infant boys, at 3 to 26 months of age, during anesthesia with a vernier caliper measuring the distance from the anus to the base of the scrotum (AGDAS) and from the anus to the anterior base of the penis (AGDAP) in two body positions according to the methods by 'The Infant Development and the Environment Study' (TIDES) and 'Cambridge Baby Growth Study', resulting in four mean values per patient (TIDES AGDAS/AP and Cambridge AGDAS/AP). Normal values for AGD by age were set by our hospital Department of Growth and Reproduction based on a large cohort of healthy infant boys (n = 1940). Testicular biopsies were performed at orchidopexy as a clinical routine. The germ cell number (G/T) and type Ad spermatogonia number (AdS/T) per cross-sectional tubule of at least 100 and 250 tubules, respectively were measured and related to normal samples. Blood samples were obtained by venipuncture for measuring serum LH, FSH, and inhibin B. They were analyzed in our hospital Department of Growth and Reproduction where the normal reference was also established. Correlations between the four mean AGD measurements for each boy were evaluated by Spearman rank correlation analyses. The AGD measurement of every boy was transferred to the multiple of the median (MoM) of the normal AGD for age and named MoM AGD. MAIN RESULTS AND THE ROLE OF CHANCE There were 104 boysoperated for unilateral, and 47 boys operated for bilateral, undescended testes, whereas 18 boys had vanished testis including one boy with bilateral vanished testes. Only 6% of cases with vanished testes had a MoM AGD higher than the normal median compared to 32% with undescended testes (P < 0.05). MoM AGD increased with the age at surgery for boys with vanished testis (Spearman r = 0.44), but not for boys with undescended testes (Spearman r = 0.14). Boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism (P < 0.005) and (P < 0.000001). LIMITATIONS, REASONS FOR CAUTION Although being the largest published material of AGD measurements of infant boys with cryptorchidism, one limitation of this study covers the quite small number of patients in the different groups, which may decrease the statistical power. Another limitation involves the sparse normal reference material on G/T and AdS/T. Finally, there are currently no longitudinal studies evaluating AGD from birth to adulthood and evaluating childhood AGD in relation to fertility outcome. Our study is hypothesis generating and therefore the interpretation of the results should be regarded as exploratory rather than reaching definite conclusions. WIDER IMPLICATIONS OF THE FINDINGS The study findings are in agreement with literature as the total included group of boys with cryptorchidism exhibited shorter than normal AGDs. However, new insights were demonstrated. Boys with vanished testis had shorter AGDs compared to unaffected boys and to boys with undescended testes. This finding challenges the current concept of AGD being determined in 'the masculinization programming window' in Week 8 to 14 of gestation. Furthermore, boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism, suggesting that the lack of fetal androgen in hypogonadotropic hypogonadism is not that significant. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used and no competing interests are declared. TRIAL REGISTRATION NUMBER The trial was not registered in an ICMJE-recognized trial registry.
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Affiliation(s)
- Dina Cortes
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Margit Bistrup Fischer
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Andrea E Hildorf
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone Hildorf
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Juul
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Katharina M Main
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Alabiad MA, Elhasadi I, Aljafil R, Shalaby AM, Alshaikh ABA, Edris FE, Heraiz AI, Alorini M, Aboregela AM, Mohamed AH. A novel triad for the diagnosis of endometriosis, the short anogenital distance combines with high endometrial BCL2 and low endometrial FASL. Int J Gynaecol Obstet 2024. [PMID: 38358296 DOI: 10.1002/ijgo.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/26/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To investigate the anogenital distance from the upper verge of the anus to the posterior fourchette (AGDAF ), FASL, and BCL2 combination as a reliable and non-invasive tool for the diagnosis of endometriosis. METHODS This study included 100 women with endometriosis and 50 women without endometriosis as the control group. All cases underwent history taking, body mass index (BMI) measurement, AGD measurement, and FASL and BCL2 immunohistochemical staining of the eutopic endometrial tissue. RESULTS This study included 150 women divided into endometriosis and control groups. Endometriosis cases significantly had shorter AGDAF , 22.9 ± 2.6 mm, compared with the control group, 27.3 ± 3.5 mm (P < 0.001). Lower FASL and higher BCL2 expression were associated with endometriosis (P < 0.001). The combined measurement of AGDAF (cut-off point 24.55 mm) with FASL and BCL2 was associated with endometriosis (P < 0.001). The combined diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of AGDAF , FASL, and BCL2 were 83%, 78%, 87.3%, and 69.6%, respectively. The area under the curve was greater for AGDAF , FASL, and BCL2 in combination than for individual measurements. CONCLUSION Combining short AGDAF with high BCL2 and low FASL is a highly sensitive, non-invasive diagnostic tool for endometriosis.
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Affiliation(s)
| | - Ibtesam Elhasadi
- Pathology, Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Raja Aljafil
- Pathology, Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | | | - Ahmed Baker A Alshaikh
- Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Fawaz E Edris
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Assisted Conception Unit at the International Medical Center, Jeddah, Saudi Arabia
| | - Ahmed Ismail Heraiz
- Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Alorini
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Adel Mohamed Aboregela
- Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Basic Medical Sciences Department, College of Medicine, Bisha University, Bisha, Saudi Arabia
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Varde M, Newman RB, Wenzel AG, Kucklick JR, Wineland RJ, Brock JW, Bloom MS. Racial disparities affect the association between gestational urinary phthalate mixtures and infant genital measures. Front Reprod Health 2023; 5:1304725. [PMID: 38146361 PMCID: PMC10749323 DOI: 10.3389/frph.2023.1304725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023] Open
Abstract
Background Phthalates are ubiquitous anti-androgenic endocrine disrupting chemicals found in personal care products, medications, and many plastics. Studies have shown a racial disparity in phthalates exposure among U.S. women, which may also impact fetal development. Methods We conducted a prospective cohort study of gestational exposure to a phthalates mixture in a racially-diverse population to determine their association with genital development. Mid-gestation (18-22 weeks) urine was collected from 152 women who self-identified as non-Hispanic Black and 158 women who self-identified as non-Hispanic White in Charleston, South Carolina between 2011 and 2014. We measured eight phthalate monoester metabolites in urine using liquid chromatography tandem-mass spectrometry. Mid-gestational penile dimensions were measured using ultrasound and anogenital distances were measured postnatally. We used Bayesian kernel machine regression to estimate the associations among the mixture of phthalate metabolites and mid-gestation penile dimensions and postnatal anogenital distance measures among singleton male (n = 179) and female (n = 131) infants, adjusted for urinary specific gravity, maternal age, body mass index, education level, cigarette smoking, and gestational age at enrollment or birth weight z-score. Results We found a stronger association between greater phthalates and decreased anopenile distance among infants born to women who self-identified as Black. Mono (2-ethylhexyl) phthalate (MEHP) was the driving mixture component among Black women, and monobutyl phthalate (MBP) and monoethyl phthalate (MEP) were drivers among White women. We also identified a non-linear association between phthalates and lesser ultrasound penile volume among women who self-identified as Black with monoisobutyl phthalate (MiBP) and MBP being most important. We also found an association between greater phthalates and shorter anoclitoral distance among infants born to women who self-identified as Black, with MEP and monobenzyl phthalate (MBzP) contributing most to this association. Conclusion Our results suggest a disparity in the association between gestational exposure to a mixture of phthalates and fetal genital development among women who self-identified as Black compared to White.
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Affiliation(s)
- Meghana Varde
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - Abby G. Wenzel
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - John R. Kucklick
- Hollings Marine Laboratory, National Institute of Standards and Technology, Charleston, SC, United States
| | - Rebecca J. Wineland
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - John W. Brock
- Department of Chemistry, University of North Carolina Asheville, Asheville, NC, United States
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States
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Liu X, Ding D, Shen M, Yan D, Guo SW. Shorter Anogenital Distance in Women with Ovarian Endometriomas and Adenomyosis, but Not Uterine Leiomyomas. Biomedicines 2023; 11:2618. [PMID: 37892992 PMCID: PMC10603971 DOI: 10.3390/biomedicines11102618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
We investigated whether anogenital distance (AGD) is associated with adenomyosis, endometriosis and uterine leiomyomas (UL, also called uterine fibroids). We recruited 81 women with UL, 105 with ovarian endometrioma (OE), 116 with adenomyosis, 28 with both adenomyosis and UL, and 100 control subjects with other acquired gynecological conditions but not endometriosis, adenomyosis, UL, or polycystic ovarian syndrome. Measurements from the anterior clitoral surface to the center of the anus (AGDAC), from the tip of the clitoris to the center of the anus (AGDACt), and from the posterior fourchette to the center of the anus (AGDAF) were made in all subjects. Multiple regression was performed to estimate the association between AGDs and presence of OE, adenomyosis, and UL while controlling for possible confounding factors. We found that, compared with controls, women with OE and adenomyosis, but not UL, had significantly shorter AGDAF, but not AGDAC. However, the amount of variance that could be explained by the disease status is rather moderate, suggesting that factors other than disease status, bodyweight and height were also responsible for AGD. Thus, prenatal exposure to reduced levels of androgen may increase the risk of developing endometriosis and adenomyosis. However, other factors may also contribute to the pathogenesis of endometriosis and adenomyosis.
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Affiliation(s)
- Xishi Liu
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (X.L.); (D.D.); (M.S.); (D.Y.)
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai 200011, China
| | - Ding Ding
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (X.L.); (D.D.); (M.S.); (D.Y.)
| | - Minhong Shen
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (X.L.); (D.D.); (M.S.); (D.Y.)
| | - Dingmin Yan
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (X.L.); (D.D.); (M.S.); (D.Y.)
| | - Sun-Wei Guo
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai 200011, China
- Research Institute, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
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Salami SA, Oreagba FO, Salahdeen HM, Olatunji-Bello II, Murtala BA. Vitamin C supplementation modulates crude oil contaminated water induced gravid uterine impaired contractile mechanism and foetal outcomes in Wistar rats. J Complement Integr Med 2023; 20:548-555. [PMID: 37300330 DOI: 10.1515/jcim-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Crude oil is a common environmental contaminant that impacts the reproductive functions of women. Understanding the contractile mechanism of the gravid uterus and how it impacts fetal outcomes during crude oil-contaminated water (CCW) exposure is still evolving. This study investigates the effect of vitamin C supplementation during the ingestion of CCW from Bayelsa, Nigeria, on the contractile mechanism of the gravid uterus and fetal outcomes. METHODS Fifteen nulliparous pregnant rats were randomly divided into 3 groups of 5 rats each and treated with normal saline (control), CCW (2.5 mL), and CCW + vitamin C (10 mg/kg bwt), respectively. Treatments were via oral gavage from gestation days 1-19. Gas chromatography-mass spectrometry of CCW, uterine oxidative biomarkers, and in vitro contractile activity of excised uterine tissue to acetylcholine, oxytocin, magnesium, and potassium were determined. Furthermore, uterine responses to acetylcholine after incubation with nifedipine, indomethacin, and N-nitro-L-arginine methyl ester were also recorded using the Ugo Basile data capsule acquisition system. Fetal weights, morphometric indices, and anogenital distance were also determined. RESULTS Acetylcholine, oxytocin, magnesium, diclofenac, and indomethacin-mediated contractile mechanisms were significantly impaired with CCW exposure; however, vitamin C supplementation significantly attenuated the impaired uterine contractile activity. Maternal serum estrogen, weight, uterine superoxide dismutase, fetal weight, and anogenital distance were significantly reduced in the CCW group compared to the vitamin C supplemented group. CONCLUSIONS Ingestion of CCW impaired the uterine contractile mechanism, fetal developmental indices, oxidative biomarkers, and estrogen. Vitamin C supplementation modulated these by elevating uterine antioxidant enzymes and reducing free radicals.
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Affiliation(s)
| | - Fatai O Oreagba
- Department of Physiology, Lagos State University College of Medicine, Lagos, Nigeria
| | - Hussein M Salahdeen
- Department of Physiology, Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Babatunde A Murtala
- Department of Physiology, Lagos State University College of Medicine, Lagos, Nigeria
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Crespi BJ, Evans SF. Prenatal Origins of Endometriosis Pathology and Pain: Reviewing the Evidence of a Role for Low Testosterone. J Pain Res 2023; 16:307-316. [PMID: 36762368 PMCID: PMC9904225 DOI: 10.2147/jpr.s389166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Endometriosis is a polygenic, estrogen-dependent, inflammatory disorder of uncertain aetiology associated with pain, infertility and reduced quality of life. While the positive association between endometriosis and estrogen is established, a suite of recent studies has demonstrated an inverse association between the presence of endometriosis lesions and levels of testosterone both prenatally and postnatally. The following narrative review provides new insights into the roles of testosterone in the aetiology, diagnosis, and management of endometriosis and associated symptoms, especially pain. A relatively short anogenital distance (AGD) is indicative of lower levels of testosterone during fetal development. A shorter AGD has recently been correlated with both a higher risk of developing endometriosis in adult life, and with known correlates of endometriosis including earlier onset of reproductive cycling, lower ovarian follicle number, lower postnatal testosterone, and premature ovarian insufficiency. During adult life, lower levels of testosterone are positively associated with key comorbidities of endometriosis, including days per month of pelvic pain and increased pain sensitivity. Biochemically, lower levels of testosterone are associated with higher levels of pro-inflammatory IL-1β and lower levels of β-endorphin. In rodents, prenatal administration of testosterone to females reduces their pain sensitivity in adulthood. The emerging convergent links of endometriosis with low prenatal and postnatal testosterone provide evidence of a centrally mediated effect beginning in early prenatal development, and persisting through adult life, with notable effects on pain sensitivity. They generate a novel conceptual framework for understanding, studying and treating this disorder, whereby endometriosis is mediated by a combination of high estrogen in endometrial tissue with low systemic and ovarian testosterone.
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Affiliation(s)
- Bernard J Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada,Correspondence: Bernard J Crespi, Email
| | - Susan F Evans
- Adelaide Medical School, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Chen Y, Liang H, Ji H, Sun X, He G, Wang Y, Dai W, Miao M, Yuan W. Associations between maternal urinary isoflavone concentrations and anogenital distance of offspring throughout infancy: a prospective cohort study. Hum Reprod 2023; 38:277-292. [PMID: 36331496 DOI: 10.1093/humrep/deac234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
STUDY QUESTION Are maternal urinary isoflavone (ISO) concentrations during pregnancy associated with anogenital distance (AGD) in infants at birth, and at 6 and 12 months of age? SUMMARY ANSWER Higher maternal urinary ISO concentrations during pregnancy were associated with longer AGD in infants of both sexes, and equol (EQU) and daidzein (DAD) were identified as the important ISO mixture components in the observed associations. WHAT IS KNOWN ALREADY Evidence of the association of prenatal exposure to ISO with offspring's AGD is mainly derived from animal studies, which used different study designs and had inconsistent results. Only one human study has been reported and it found null associations between maternal ISO exposure during pregnancy and AGD among boys at birth, with a small sample size and a wide range of exposure windows. No human study on girls was found. STUDY DESIGN, SIZE, DURATION Prospective cohort study (Shanghai-Minhang Birth Cohort Study), with pregnant women recruited at 12-16 weeks of gestation in Shanghai, China between April and December 2012. One thousand two hundred and twenty-five live singletons were left in the cohort at delivery of which 480 mother-infant pairs had data on both maternal urinary ISO concentrations and at least one AGD measurement and were included in the present study. Anopenile distance (AGDAP) and anoscrotal distance (AGDAS) of boys and anoclitoral distance (AGDAC) and anofourchette distance (AGDAF) of girls were measured at birth and at 6 and 12 months of age. PARTICIPANTS/MATERIALS, SETTING, METHODS Multiple linear regression models were used to examine the associations between maternal ISO concentrations and AGD. Bayesian kernel machine regression (BKMR) was implemented to examine both the overall effects of ISO mixture and the single effect of each ISO and identify important components of ISO mixture. MAIN RESULTS AND THE ROLE OF CHANCE A general profile of higher concentrations of maternal ISO associated with longer AGD in infants of both sexes was observed, when maternal education, parity, BMI before pregnancy (BMI, categorical variable), passive smoking during early pregnancy, age at delivery, gestational weeks and infant body size were adjusted for. Among boys, EQU was associated with increased AGDAS at birth and at 6 and 12 months, and DAD was associated with increased AGDAP at birth. Among girls, the associations of EQU and DAD with increased AGDAC and AGDAF at birth were found. When gestational weight gain and feeding patterns of infants in the first 6 months were additionally adjusted for, and maternal BMI was adjusted for as a continuous variable, more pronounced associations were observed, especially for associations of genistein (GEN), DAD and glycitein (GLY) with increased AGDAP and AGDAS at 6 months in boys. However, these associations were not always observed in the highest tertile group, and no consistent dose-response relationships were found. Similar results were observed in BKMR models, showing positive correlations of concentration of ISO mixture with increased AGDAS at both 6 and 12 months among boys, and increased AGDAC and AGDAF at birth among girls. Statistically significant increments of 4.96 mm (95% credible interval (CrI): 1.40, 8.52) and 1.07 mm (95% CrI: 0.02, 2.13) in AGDAS at 6 months among boys and AGDAC at birth among girls, respectively, were observed at the 75th percentile of ISO mixture, compared with 25th percentile. EQU and DAD were identified as the important components among ISO-AGD associations. LIMITATIONS, REASONS FOR CAUTION First, due to the short half-lives of ISO, the accuracy of a single spot urine sample reflecting ISO exposure during pregnancy may be limited, and thus may cause non-differential misclassification. Second, despite the adjustments for several important covariates in the study, unmeasured and residual confounding factors may remain a concern. Third, false discovery due to multiple testing may remain. Finally, the reduced sample sizes attributed to the loss of follow-up and missing data of confounders may limit our ability to detect an association, if any existed. WIDER IMPLICATIONS OF THE FINDINGS Prenatal ISO exposure may affect the reproductive development of offspring. As ISO can be widely detected in pregnant women, especially in Eastern countries, more studies are warranted to provide evidence of the effects of prenatal ISO exposure on long-term reproductive outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from the National Key Research and Development Program of China (2021YFC2701003), the National Natural Science Foundation of China (22076123), the Science and Technology Commission of Shanghai Municipality (21ZR1454700 and 20ZR1448000), the Shanghai Municipal Health Commission (20194Y0160) and Innovation-oriented Science and Technology Grant from NHC Key Laboratory of Reproduction Regulation (CX2022-04). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Yao Chen
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Hong Liang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Honglei Ji
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xiaowei Sun
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Gengsheng He
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Yan Wang
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China
| | - Wentao Dai
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Maohua Miao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Wei Yuan
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
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Kloboves ME, Pacyga DC, Gardiner JC, Flaws JA, Schantz SL, Strakovsky RS. Associations of maternal anthropometrics with newborn anogenital distance and the 2:4 digit ratio. Hum Reprod 2022; 37:2154-2166. [PMID: 35802047 PMCID: PMC9801973 DOI: 10.1093/humrep/deac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Indexed: 01/07/2023] Open
Abstract
STUDY QUESTION Are maternal anthropometrics associated with anogenital distance (AGD) and 2:4 digit ratio (2:4D) in newborns? SUMMARY ANSWER Select maternal anthropometrics indicative of obesity or increased adiposity are associated with elongated AGD in daughters. WHAT IS KNOWN ALREADY Excessive maternal weight or adiposity before or in early pregnancy may impact child reproductive, and other hormonally mediated, development. AGD and 2:4D are proposed markers of in utero reproductive development. STUDY DESIGN, SIZE, DURATION This study includes 450 mother/newborn dyads participating in the Illinois Kids Development Study (I-KIDS), a prospective pregnancy cohort from Champaign-Urbana, IL, USA. Participants included in the current study enrolled between 2013 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Most mothers in this study were college-educated (82%) and non-Hispanic White (80%), and 55% were under- or normal weight before pregnancy. Pregnant women aged 18-40 years reported pre-pregnancy weight and height to calculate pre-pregnancy BMI. At 8-15 weeks gestation, we measured waist and hip circumference, and evaluated weight, % body fat, visceral fat level, % muscle and BMI using bioelectrical impedance analysis. Within 24 h of birth, we measured newborn 2nd and 4th left/right digits to calculate the 2:4D. In daughters, we measured AGDAF (anus to fourchette) and AGDAC (anus to clitoris). In sons, we measured AGDAS (anus to scrotum) and AGDAP (anus to base of the penis). MAIN RESULTS AND THE ROLE OF CHANCE Select maternal anthropometrics were positively associated with AGD in newborn daughters, but not sons. For example, AGDAC was 0.73 mm (95% CI: 0.15, 1.32) longer for every interquartile range (IQR) increase in pre-pregnancy BMI and 0.88 mm (95% CI: 0.18, 1.58) longer for every IQR increase in hip circumference, whereas AGDAF was 0.51 mm (95% CI: 0.03, 1.00) and 0.56 mm (95% CI: 0.03, 1.09) longer for every IQR increase in hip and waist circumference, respectively. Quartile analyses generally supported linear associations, but additional strong associations emerged in Q4 (versus Q1) of maternal % body fat and visceral fat levels with AGDAC. In quartile analyses, we observed only a few modest associations of maternal anthropometrics with 2:4D, which differed by hand (left versus right) and newborn sex. Although there is always the possibility of spurious findings, the associations for both measures of female AGD were consistent across multiple maternal anthropometric measures, which strengthens our conclusions. LIMITATIONS, REASONS FOR CAUTION Our study sample was racially and ethnically homogenous, educated and relatively healthy, so our study may not be generalizable to other populations. Additionally, we may not have been powered to identify some sex-specific associations, especially for 2:4D. WIDER IMPLICATIONS OF THE FINDINGS Increased maternal weight and adiposity before and in early pregnancy may lengthen the female AGD, which warrants further investigation. STUDY FUNDING/COMPETING INTEREST(S) This publication was made possible by the National Institute for Environmental Health Sciences (NIH/NIEHS) grants ES024795 and ES022848, the National Institute of Child Health and Human Development grant R03HD100775, the U.S. Environmental Protection Agency grant RD83543401 and National Institute of Health Office of the Director grant OD023272. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the US EPA or NIH. Furthermore, the US EPA does not endorse the purchase of any commercial products or services mentioned in the publication. This project was also supported by the USDA National Institute of Food and Agriculture and Michigan AgBioResearch. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Maria E Kloboves
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA,Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Diana C Pacyga
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA,Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jodi A Flaws
- Department of Comparative Biosciences, Urbana-Champaign, IL, USA
| | - Susan L Schantz
- Department of Comparative Biosciences, Urbana-Champaign, IL, USA,Beckman Institute, University of Illinois, Urbana-Champaign, IL, USA
| | - Rita S Strakovsky
- Correspondence address. Department of Food Science and Human Nutrition, 236C Trout Building, 469 Wilson Road, East Lansing, MI 48824, USA. E-mail:
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9
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Tadokoro-Cuccaro R, Fisher BG, Thankamony A, Ong KK, Hughes IA. Maternal Paracetamol Intake During Pregnancy-Impacts on Offspring Reproductive Development. Front Toxicol 2022; 4:884704. [PMID: 35499038 PMCID: PMC9047911 DOI: 10.3389/ftox.2022.884704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023] Open
Abstract
Paracetamol (acetaminophen) is the preferred antipyretic/analgesic for pregnant women as it is believed there are no adverse fetal effects at the recommended dose. However, emerging evidence suggests that intrauterine paracetamol exposure may be associated with certain urogenital/reproductive disorders in the offspring. In this mini-review, we describe human fetal sex development and possible pharmacological mechanisms by which paracetamol may disrupt this process, including reduced testicular production of testosterone and/or insulin-like peptide 3. We then review the available epidemiological literature on associations between maternal paracetamol exposure and offspring sexual development. Three epidemiological studies have reported associations between maternal paracetamol intake and increased risk of cryptorchidism, although five others have not. None have found associations with hypospadias or penile length. Two out of three studies have reported a shorter anogenital distance (a marker of androgen action during the masculinisation programming window, ∼8-14 weeks of gestation) in male infants antenatally exposed to paracetamol. One study has described a dose-dependent relationship between maternal paracetamol consumption and earlier female (but not male) attainment of puberty. Such epidemiological analyses are complicated by various factors, including method of paracetamol exposure assessment (usually retrospective self-report), variation in diagnostic accuracy, selection bias, confounding by clinical indication, and demographic/genetic differences between geographically separated populations. There is an urgent need for stronger evidence in this area, from both relevant experimental studies and large, carefully-designed prospective studies. In the meantime, a precautionary attitude to gestational paracetamol usage should be considered as the evidence for clinically significant reproductive effects in humans is limited.
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Affiliation(s)
| | - Benjamin G. Fisher
- Wellcome/Cancer Research UK Gurdon Institute, University of Cambridge, Cambridge, United Kingdom,*Correspondence: Benjamin G. Fisher,
| | - Ajay Thankamony
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom,Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom,MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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10
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Cao W, Ding X, Dong Z, Tang H. Reference Values for and Correlation Analysis of the Anogenital Distance of Chinese Han Full-Term Singleton Neonates. Front Pediatr 2022; 10:905421. [PMID: 35722496 PMCID: PMC9203026 DOI: 10.3389/fped.2022.905421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anogenital distance (AGD) is a biomarker used for the evaluation of fetal androgen action. The disruption of fetal androgen action can affect the development of the reproductive system and adversely affect future reproductive functions. However, AGD may differ by race. Currently, there is a lack of data regarding the evaluation of AGD in large Han Chinese samples. OBJECTIVE AGD for neonates in Shanghai, China, was measured, and relevant factors that influenced AGD were analyzed. METHODS The AGD of full-term singleton neonates was measured within 3 days of birth, and the results were grouped according to gestational age and body weight at birth. In addition, relevant factors that influenced AGD were investigated. RESULTS A total of 1,867 full-term singleton neonates were enrolled in this study. All the neonates were Han Chinese; among them, 986 were male, and 881 were female. Male AGD was 23.18 ± 3.17 mm, and female AGD was 11.65 ± 1.53 mm. Male AGD was 1.99 times longer than female AGD. With the increase in gestational age and body weight, AGD gradually increased. AGD was correlated with gestational age, body weight, and head circumference. The correlation between body weight at birth and AGD was highly significant. CONCLUSION This study, for the first time, reported AGD measurement data for Chinese Han neonates. The results indicated that AGD was correlated with gestational age, body weight, and head circumference. The correlation between body weight at birth and AGD was highly significant.
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Affiliation(s)
- Wei Cao
- Department of Pediatrics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowei Ding
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haiting Tang
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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11
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Alfuraih AM, Alotaiby SA, Alsaadi MJ, Bukhari HA, Aldhebaib AM, Mohtasib RS. Predictive value and reference ranges of anogenital distance for determining fetal gender in the first trimester: A retrospective cohort study. Saudi Med J 2021; 42:1057-1064. [PMID: 34610998 PMCID: PMC9129234 DOI: 10.15537/smj.2021.42.10.20210468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the usefulness of sonographically measured anogenital distance (AGD) in predicting fetal gender in Saudi fetuses during the first trimester and to provide normal reference centiles for AGD. METHODS A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia between November 2020 and May 2021. The ultrasound scans of 313 singleton pregnancies between 11-13 plus 6 gestational weeks and their gender-at-birth were collected. Anogenital distance was measured from the inferior base of the genital tubercle to the rump. Binominal logistic regression and receiver operating characteristic curves (ROC) evaluated the predictive performance of AGD for determining fetal gender. RESULTS There was a significant difference of approximately 15% in mean AGD between female (5.92 mm [95% CI= 6.70, 6.14]) and male (6.80 mm [95% CI= 6.61,7.00]) fetuses (p<0.001). Anogenital distance significantly correlated with gestational age (r=0.573, p<0.001) and crown-rump length (r=0.562, p<0.001). The logistic regression determined AGD as a significant predictor of fetal gender (p<0.001). However, ROC analysis showed that overall accuracies were low at 68% (p=0.001) for 11 weeks, 70% (p<0.001) for 12 weeks, and 64% (p=0.017), and for 13 weeks. The average AGD of our Saudi cohort was longer than what the literature reported from other populations. CONCLUSION The first-trimester ultrasound evaluation of AGD was feasible and reliable. It showed a difference between the genders but did not yield high predictive accuracy. Future research should consider racial factors when evaluating AGD.
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Affiliation(s)
- Abdulrahman M. Alfuraih
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Abdulrahman M. Alfuraih, Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-4655-7248
| | - Samiah A. Alotaiby
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed J. Alsaadi
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Hanifa A. Bukhari
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ali M. Aldhebaib
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Rafat S. Mohtasib
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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12
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Giovanni SM, Letizia AAM, Chiara M, Vincenzo S, Erika P, Marta S. The Male Reproductive System and Endocrine Disruptors. Endocr Metab Immune Disord Drug Targets 2021; 22:686-703. [PMID: 34607552 DOI: 10.2174/1871530321666211004100633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
The male reproductive system is exposed to a great number of chemical substances which can interfere with the normal hormonal milieu and reproductive function; these are called endocrine disruptors (EDs). Despite a growing number of studies evaluating the negative effects of EDs, their production is continuously growing although some of which have been prohibited. The prevalence of poor semen quality, hypospadias, cryptorchidism, and testicular cancer have increased in the last decades, and recently, it has been postulated that these could all be part of a unique syndrome called testicular dysgenesis syndrome. This syndrome could be related to exposure to a number of EDs which cause imbalances in the hormonal milieu and oestrogenic over-exposure during the foetal stage. The same EDs can also impair spermatogenesis in offspring and have epigenetic effects. Although studies on animal and in vitro models have raised concerns, data are conflicting. However, these studies must be considered as the basis for future research to promote male reproductive health.
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Affiliation(s)
| | | | - Maneschi Chiara
- Department of Internal Medicine, Villa Salus Hospital, Mestre (VE). Italy
| | - Sciabica Vincenzo
- Department of Internal Medicine, Villa Salus Hospital, Mestre (VE). Italy
| | - Pigatto Erika
- Department of Internal Medicine, Villa Salus Hospital, Mestre (VE). Italy
| | - Sanna Marta
- Department of Internal Medicine, Villa Salus Hospital, Mestre (VE). Italy
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13
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Grala TM, Price MD, Kuhn-Sherlock B, Burke CR, Meier S. Investigating anogenital distance and antral follicle count as novel markers of fertility within a herd of cows with positive or negative genetic merit for fertility traits. J Dairy Sci 2021; 104:12939-12952. [PMID: 34593228 DOI: 10.3168/jds.2020-19948] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/09/2021] [Indexed: 11/19/2022]
Abstract
Using early-in-life markers of reproductive characteristics may enhance the speed and success of genetic improvement in fertility. We investigated 2 phenotypes that can be measured early in life and are moderately heritable to determine their association with traditional measures of reproductive success and genetic variation under a seasonal-calving, pasture-based system. Cows were bred to be divergent in the New Zealand Fertility Breeding Value, which estimates genetic merit for fertility. Cows consisted of 2 groups with an average positive (+5%) or negative (-5%) genetic merit for fertility traits and were expected to have large diversity in reproductive outcomes. Calves were genotyped at 41 ± 3.1 d of age (mean ± SD; n = 538), and antral follicle counts (AFC) were measured when they were postpubertal heifers before their first breeding (416 ± 15 d old; 92-d range; n = 520). The anogenital distance (AGD) was measured in 478 primiparous cows of this same population 50 to 60 d after the breeding start date when they were 881 ± 25 d old (145-d range). The AGD was shorter in animals with a positive genetic merit for fertility traits (based on parent averages). An indicator of herd reproductive success in a seasonal-calving system (recalving by 6 wk in lactation 2) was chosen for logistic regression with cross-validation, and if significant, a cut-off was calculated that categorized animals into groups. Both linear and quadratic regression was undertaken, and the model with the greatest sensitivity for detection of nonpregnant cows used. The AGD linear model was significant with a sensitivity of 64% and a specificity of 48%. This model resulted in a cut-off of 102 mm, which we used to classify cows as short (≤102 mm) or long (>102 mm) AGD animals. Primiparous cows with a short AGD were more likely to be pregnant within the first 3 and 6 wk of mating, and become pregnant as a primiparous cow, than those with a long AGD. The time from calving to conception was 20 d earlier in short AGD compared with long-AGD cows. None of the models tested for AFC were significant; therefore cows were categorized into 3 groups based on previous work in seasonal systems. However, associations between fertility phenotypes and AFC group were limited. Genomic regions of interest for AGD and AFC did not overlap, indicating phenotypes were genetically independent. Overall, AGD appears as a promising early marker of fertility in seasonal grazing systems.
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Affiliation(s)
- T M Grala
- DairyNZ Ltd., Cnr Ruakura and Morrinsville Rds, Newstead, Hamilton 3201, New Zealand.
| | - M D Price
- DairyNZ Ltd., Cnr Ruakura and Morrinsville Rds, Newstead, Hamilton 3201, New Zealand
| | - B Kuhn-Sherlock
- DairyNZ Ltd., Cnr Ruakura and Morrinsville Rds, Newstead, Hamilton 3201, New Zealand
| | - C R Burke
- DairyNZ Ltd., Cnr Ruakura and Morrinsville Rds, Newstead, Hamilton 3201, New Zealand
| | - S Meier
- DairyNZ Ltd., Cnr Ruakura and Morrinsville Rds, Newstead, Hamilton 3201, New Zealand
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14
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Dalgaard CM, Andersen MS, Jensen RC, Larsen PV, Find LG, Boye H, Jensen TK, Bilenberg N, Glintborg D. Maternal polycystic ovary syndrome and attention deficit hyperactivity disorder in offspring at 3 years of age: Odense Child Cohort. Acta Obstet Gynecol Scand 2021; 100:2053-2065. [PMID: 34490610 DOI: 10.1111/aogs.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous data suggested a link between maternal polycystic ovary syndrome (PCOS) and offspring attention deficit hyperactivity disorder (ADHD), which could be mediated by higher prenatal androgen exposure. MATERIAL AND METHODS The study was part of the prospective Odense Child Cohort and included 1776 pregnant women, 165 (9%) with PCOS and 1607 (91%) controls. ADHD symptoms at 3 years of age were defined using the parent-reported questionnaire Child Behavior Checklist/1.5-5 (scores >90th centile of Danish national standard). Maternal blood samples were collected in the third trimester measuring total testosterone by mass spectrometry, sex hormone-binding globulin, and calculated free testosterone. Offspring anogenital distance was measured at 3 months of age. Regression models were performed with presence of ADHD symptoms as the dependent variable and adjusted for maternal age, body mass index, parity, smoking status, educational level, and parental psychiatric diagnoses. RESULTS ADHD symptoms were present in 105/937 (11%) boys and 72/839 (9%) girls. In boys, maternal PCOS was positively associated with ADHD symptoms (unadjusted odds ratio [OR] 1.91, 95% CI 1.07-3.43, p = 0.03, adjusted OR 2.20, 95% CI 1.20-4.02, p = 0.01), whereas maternal PCOS was not associated with ADHD symptoms in girls. Maternal total testosterone, free testosterone, and offspring anogenital distance were not associated with higher risk of ADHD symptoms in the offspring. CONCLUSIONS Higher risk of ADHD in boys born of mothers with PCOS were not associated with maternal third-trimester testosterone levels or offspring anogenital distance.
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Affiliation(s)
- Cilia M Dalgaard
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Marianne S Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Richard C Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia V Larsen
- Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Laura G Find
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Hospital for Children, Odense University Hospital, Odense, Denmark.,OPEN Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Tina K Jensen
- Odense Child Cohort, Hans Christian Andersen Hospital for Children, Odense University Hospital, Odense, Denmark.,OPEN Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark.,Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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15
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Leite Leão D, Vasconcelos Sampaio W, da Cunha Sousa P, Oskam IC, Rodrigues Dos Santos R, Souza Domingues SF. The use of anogenital distance as a non-invasive predictor of seminal quality in captive squirrel monkey (Saimiri collinsi Osgood 1961). J Med Primatol 2021; 50:299-305. [PMID: 34476816 DOI: 10.1111/jmp.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/12/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anogenital distance is considered a non-invasive measure to assess the development and functionality of sexual organs in different animal species. Hence, this measurement could potentially be used during the selection of non-human primates for reproductive biotechnology programs. The aim of this study was to assess the correlation between anogenital distance and reproductive parameters in captive Saimiri collinsi. METHODS Eight mature S. collinsi males were evaluated. Body weight, reproductive hormone levels, testicular volume, and seminal parameters were determined, and their relationship with anogenital distance measurements was assessed. RESULTS Anogenital distance was correlated with seminal volume, sperm motility, vigor, and plasma membrane integrity, but not with body weight, reproductive hormones, and testicular volume. CONCLUSION The determination of anogenital distance is a non-invasive method to predict seminal quality. This procedure has the advantage of providing andrologic information without a negative impact on animal welfare.
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Affiliation(s)
- Danuza Leite Leão
- Laboratory of Wild Animal Biotechnology and Medicine, Federal University of Pará, Belém, Brazil
| | - Wlaisa Vasconcelos Sampaio
- Laboratory of Wild Animal Biotechnology and Medicine, Federal University of Pará, Belém, Brazil.,Postgraduate Program in Animal Health and Production in the Amazon, Federal Rural University of the Amazon, Belém, Brazil.,Federal Rural University of the Amazon, Parauapebas, Brazil
| | - Patrícia da Cunha Sousa
- Laboratory of Wild Animal Biotechnology and Medicine, Federal University of Pará, Belém, Brazil
| | - Irma Caroline Oskam
- The Livestock Production Research Centre, Norwegian University of Life Sciences, Oslo, Norway
| | | | - Sheyla Farhayldes Souza Domingues
- Laboratory of Wild Animal Biotechnology and Medicine, Federal University of Pará, Belém, Brazil.,Postgraduate Program in Animal Health and Production in the Amazon, Federal Rural University of the Amazon, Belém, Brazil
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16
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Chin HB, Kelly A, Adgent MA, Patchel SA, James K, Vesper HW, Botelho JC, Chandler DW, Zemel BS, Schall JI, Ford EG, Darge K, Stallings VA, Baird DD, Rogan WJ, Umbach DM. Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys? J Clin Endocrinol Metab 2021; 106:2635-2645. [PMID: 34013335 PMCID: PMC8372659 DOI: 10.1210/clinem/dgab354] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. OBJECTIVE To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. METHODS The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. RESULTS Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. CONCLUSION Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.
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Affiliation(s)
- Helen B Chin
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA
| | - Andrea Kelly
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Endocrinology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Margaret A Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - Kerry James
- Social & Scientific Systems, Inc., Durham, NC 27703, USA
| | - Hubert W Vesper
- Clinical Standardization Programs, CDC, Atlanta, GA 30341, USA
| | - Julianne C Botelho
- Division of Laboratory Sciences, National Center for Environmental Health, CDC, Atlanta, GA 30341, USA
| | | | - Babette S Zemel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Joan I Schall
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Eileen G Ford
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kassa Darge
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Virginia A Stallings
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | - Walter J Rogan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | - David M Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
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17
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Priskorn L, Kreiberg M, Bandak M, Lauritsen J, Daugaard G, Petersen JH, Aksglaede L, Juul A, Jørgensen N. Testicular cancer survivors have shorter anogenital distance that is not increased by 1 year of testosterone replacement therapy. Hum Reprod 2021; 36:2443-2451. [PMID: 34223605 DOI: 10.1093/humrep/deab162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is anogenital distance (AGD) shorter in testicular cancer (TC) survivors than in men from the general population, and is AGD affected by testosterone replacement therapy in adulthood? SUMMARY ANSWER AGD, measured as distance from anus to scrotum (AGDas), is shorter in TC survivors and does not change as a result of testosterone replacement therapy. WHAT IS KNOWN ALREADY Animal studies have shown that AGD is a postnatal 'read-out' of foetal androgen action, and short AGD in male offspring is considered a sign of feminization caused by in utero disruption of the reproductive system. Likewise, measurement of AGD in human studies has suggested AGD to be part of the testicular dysgenesis syndrome hypothesis, which proposes that male reproductive disorders, such as hypospadias, cryptorchidism, some cases of impaired semen quality and TC, all share a common foetal origin. STUDY DESIGN, SIZE, DURATION The aim was to assess AGD in men with a history of TC and controls, and furthermore to examine AGD during testosterone replacement therapy in adulthood. Study participants were TC survivors with a mild Leydig cell insufficiency who participated in a randomized double-blind study of testosterone replacement therapy versus placebo for 52 weeks (N = 69). Men from the general population were prospectively included from a study on testicular function as controls (N = 67). PARTICIPANTS/MATERIALS, SETTING, METHODS We measured two variants of AGD; as our primary outcome the anoscrotal distance (AGDas) measured from the centre of the anus to the posterior base of the scrotum, and secondarily the anopenile distance (AGDap) measured from the anus to the cephalad insertion of the penis. Using multiple regression analysis, the mean difference in AGD between TC survivors and men from the general population was assessed, adjusted for height, BMI and examiner. Next, AGD was measured before and after 52 weeks of treatment with testosterone or placebo, and with covariance analysis differences between the two groups at follow-up was assessed after adjustment for baseline AGD, examiner, BMI and change in BMI during treatment. MAIN RESULTS AND THE ROLE OF CHANCE TC survivors had a shorter AGDas (-0.84 cm, 95% CI: -1.31; -0.37) compared to men from the general population, and AGDas did not differ between the testosterone and placebo treated group at follow-up (0.11 cm, 95% CI: -0.22; 0.44). In contrast, AGDap was not shorter in TC survivors after adjustment (0.05 cm, 95% CI: -0.30; 0.39), and was 0.48 cm longer (95% CI: 0.13; 0.82) at follow-up in the testosterone treated compared to the placebo-treated group. LIMITATIONS, REASONS FOR CAUTION A limitation of the study is that the number of included men was limited, and results need confirmation in a larger study. Furthermore, TC survivors were significantly older than controls. For the comparison of AGD in TC survivors and controls, it was not possible to conduct the examinations with the examiner being blinded to which group he was examining, and it cannot be excluded that this can cause a bias. WIDER IMPLICATIONS OF THE FINDINGS The shorter AGDas in TC survivors compared to controls, which did not change upon adult testosterone replacement therapy, supports the hypothesis that reduced AGD is part of the testicular dysgenesis syndrome and may be a marker of disrupted foetal testicular development. By contrast, AGDap was not shorter in TC survivors and might be modestly sensitive to adult testosterone treatment, and thus inferior to AGDas as a constant postnatal marker of the foetal androgen environment. STUDY FUNDING/COMPETING INTEREST(S) Expenses were paid by the Department of Oncology, Copenhagen University Hospital, Rigshospitalet. Kiowa Kirin International covered expenses for Tostran and placebo. The Danish Cancer Society, The Danish Cancer Research Foundation, the Preben & Anna Simonsen Foundation, and Rigshospitalet have supported the study. L.P. was financed by the Research Fund of the Capital Region of Denmark. The authors have no competing interests. TRIAL REGISTRATION NUMBER Part of the study is based on men participating in a randomized controlled trial registered at ClinicalTrials.gov, NCT02991209, 25 November 2016.
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Affiliation(s)
- L Priskorn
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - M Kreiberg
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - M Bandak
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J H Petersen
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - L Aksglaede
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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18
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Dinsdale NL, Crespi BJ. Endometriosis and polycystic ovary syndrome are diametric disorders. Evol Appl 2021; 14:1693-1715. [PMID: 34295358 PMCID: PMC8288001 DOI: 10.1111/eva.13244] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
Evolutionary and comparative approaches can yield novel insights into human adaptation and disease. Endometriosis and polycystic ovary syndrome (PCOS) each affect up to 10% of women and significantly reduce the health, fertility, and quality of life of those affected. PCOS and endometriosis have yet to be considered as related to one another, although both conditions involve alterations to prenatal testosterone levels and atypical functioning of the hypothalamic-pituitary-gonadal (HPG) axis. Here, we propose and evaluate the novel hypothesis that endometriosis and PCOS represent extreme and diametric (opposite) outcomes of variation in HPG axis development and activity, with endometriosis mediated in notable part by low prenatal and postnatal testosterone, while PCOS is mediated by high prenatal testosterone. This diametric disorder hypothesis predicts that, for characteristics shaped by the HPG axis, including hormonal profiles, reproductive physiology, life-history traits, and body morphology, women with PCOS and women with endometriosis will manifest opposite phenotypes. To evaluate these predictions, we review and synthesize existing evidence from developmental biology, endocrinology, physiology, life history, and epidemiology. The hypothesis of diametric phenotypes between endometriosis and PCOS is strongly supported across these diverse fields of research. Furthermore, the contrasts between endometriosis and PCOS in humans parallel differences among nonhuman animals in effects of low versus high prenatal testosterone on female reproductive traits. These findings suggest that PCOS and endometriosis represent maladaptive extremes of both female life-history variation and expression of sexually dimorphic female reproductive traits. The diametric disorder hypothesis for endometriosis and PCOS provides novel, unifying, proximate, and evolutionary explanations for endometriosis risk, synthesizes diverse lines of research concerning the two most common female reproductive disorders, and generates future avenues of research for improving the quality of life and health of women.
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Affiliation(s)
| | - Bernard J. Crespi
- Department of Biological SciencesSimon Fraser UniversityBurnabyBCCanada
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19
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Navarro-Lafuente F, Arense-Gonzalo JJ, Adoamnei E, Prieto-Sánchez MT, Sánchez-Ferrer ML, García-Marcos L, Morales E, Mendiola J, Torres-Cantero AM, The Nela Study Group. Is Maternal Use of Paracetamol during Pregnancy Associated with Anogenital Distance in Male Newborns? The Results from the NELA Birth Cohort. Int J Environ Res Public Health 2021; 18:6338. [PMID: 34208149 DOI: 10.3390/ijerph18126338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022]
Abstract
Paracetamol is the one of the most commonly used medications during pregnancy. However, its potential antiandrogenic effect has been suggested. The objective of this study was to evaluate associations between maternal paracetamol use during pregnancy and anogenital distance (AGD) in male newborns from a Spanish birth cohort. The study included two hundred and seventy-seven mother-male child pairs with self-reported paracetamol use and frequency during each trimester of pregnancy. AGD measurements were taken employing standardized methods. The associations between maternal paracetamol use and AGD measures were evaluated using linear regression models, adjusting for potential confounders and covariates. Overall, 61.7% of pregnant women consumed paracetamol at any time of pregnancy with an average of 9.43 (SD = 15.33) days throughout pregnancy. No associations between the maternal use of paracetamol or its frequency and AGD measures among different trimesters or during the whole pregnancy were found in the adjusted final models. A non-differential misclassification error may have occurred—the recall of paracetamol intake independent of AGD measurements—introducing bias towards the null hypothesis. Nevertheless, the current evidence suggests that paracetamol might have a potential antiandrogenic effect especially in the early stages of fetal development. Thus, it would be highly recommendable to pursue further studies to elucidate the potential effects of paracetamol in human perinatal health and its use among pregnant women.
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20
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García-Villarino M, Fernández-Iglesias R, Riaño-Galán I, Rodríguez-Dehli C, Babarro I, Fernández-Somoano A, Tardón A. Prenatal Exposure to Cigarette Smoke and Anogenital Distance at 4 Years in the INMA-Asturias Cohort. Int J Environ Res Public Health 2021; 18:4774. [PMID: 33947132 DOI: 10.3390/ijerph18094774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
Smoking by women is associated with adverse pregnancy outcomes such as spontaneous abortion, preterm delivery, low birth weight, infertility, and prolonged time to pregnancy. Anogenital distance (AGD) is a sensitive biomarker of prenatal androgen and antiandrogen exposure. We investigated the effect of smoking and passive smoke exposure during pregnancy on anogenital distance in offspring at 4 years in the INMA-Asturias cohort (Spain). Women were interviewed during pregnancy to collect information on tobacco consumption, and anogenital distance was measured in 381 children: Anoscrotal distance in boys and anofourchetal distance in girls. We also measured maternal urinary cotinine levels at 32 weeks of pregnancy. We constructed linear regression models to analyze the association between prenatal smoke exposure and anogenital distance and adjusted the models by relevant covariates. Reported prenatal smoke exposure was associated with statistically significant increased anogenital index (AGI), both at week 12 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) and at week 32 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) in male children, suggesting altered androgenic signaling.
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21
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Fisher BG, Thankamony A, Mendiola J, Petry CJ, Frederiksen H, Andersson AM, Juul A, Ong KK, Dunger DB, Hughes IA, Acerini CL. Maternal serum concentrations of bisphenol A and propyl paraben in early pregnancy are associated with male infant genital development. Hum Reprod 2021; 35:913-928. [PMID: 32325494 DOI: 10.1093/humrep/deaa045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Are maternal serum phthalate metabolite, phenol and paraben concentrations measured at 10-17 weeks of gestation associated with male infant genital developmental outcomes, specifically cryptorchidism, anogenital distance (AGD), penile length and testicular descent distance, at birth and postnatally? SUMMARY ANSWER Maternal serum bisphenol A (BPA) concentration at 10-17 weeks of gestation was positively associated with congenital or postnatally acquired cryptorchidism, and n-propyl paraben (n-PrP) concentration was associated with shorter AGD from birth to 24 months of age. WHAT IS KNOWN ALREADY Male reproductive disorders are increasing in prevalence, which may reflect environmental influences on foetal testicular development. Animal studies have implicated phthalates, BPA and parabens, to which humans are ubiquitously exposed. However, epidemiological studies have generated conflicting results and have often been limited by small sample size and/or measurement of chemical exposures outside the most relevant developmental window. STUDY DESIGN, SIZE, DURATION Case-control study of cryptorchidism nested within a prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at 10-17 postmenstrual weeks of gestation from a single UK maternity unit between 2001 and 2009 and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 330 mothers of 334 male infants (30 with congenital cryptorchidism, 25 with postnatally acquired cryptorchidism and 279 unmatched controls) were included in the present analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Maternal blood was collected at enrolment, and serum levels of 16 phthalate metabolites, 9 phenols (including BPA) and 6 parabens were measured using liquid chromatography/tandem mass spectrometry. Logistic regression was used to model the association of cryptorchidism with serum chemical concentrations, adjusting for putative confounders. Additionally, offspring AGD, penile length and testicular descent distance were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between serum chemical levels and these outcomes were tested using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE Maternal serum BPA concentration was associated with offspring all-type cryptorchidism both when considered as a continuous exposure (adjusted odds ratio per log10 μg/l: 2.90, 95% CI 1.31-6.43, P = 0.009) and as quartiles (phet = 0.002). Detection of n-PrP in maternal serum was associated with shorter AGD (by 0.242 standard deviations, 95% CI 0.051-0.433, P = 0.01) from birth to 24 months of age; this reduction was independent of body size and other putative confounders. We did not find any consistent associations with offspring outcomes for the other phenols, parabens, and phthalate metabolites measured. LIMITATIONS, REASONS FOR CAUTION We cannot discount confounding by other demographic factors or endocrine-disrupting chemicals. There may have been misclassification of chemical exposure due to use of single serum measurements. The cohort was not fully representative of pregnant women in the UK, particularly in terms of smoking prevalence and maternal ethnicity. WIDER IMPLICATIONS OF THE FINDINGS Our observational findings support experimental evidence that intrauterine exposure to BPA and n-PrP during early gestation may adversely affect male reproductive development. More evidence is required before specific public health recommendations can be made. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), Newlife the Charity for Disabled Children, the Mothercare Group Foundation, Mead Johnson Nutrition and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. Visiting Fellowship (J.M.): Regional Programme 'Jiménez de la Espada' for Research Mobility, Cooperation and Internationalization, Seneca Foundation-Science and Technology Agency for the Region of Murcia (No. 20136/EE/17). K.O. is supported by the Medical Research Council (UK) (Unit Programme number: MC_UU_12015/2). The authors declare no conflict of interest.
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Affiliation(s)
- B G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Thankamony
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Mendiola
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, IMIB-Arrixaca, Avda. Teniente Flomesta, 5, 30003 Murcia, Spain
| | - C J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - H Frederiksen
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A M Andersson
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - D B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Metabolic Research Laboratories, University of Cambridge, Box 289, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
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22
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Hsu PC, Jhong JY, Huang LP, Lee KH, Chen HP, Guo YL. Transgenerational Effects of Di(2-Ethylhexyl) Phthalate on Anogenital Distance, Sperm Functions and DNA Methylation in Rat Offspring. Int J Mol Sci 2021; 22:4131. [PMID: 33923623 DOI: 10.3390/ijms22084131] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/03/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Di(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in the manufacture of polyvinylchloride plastics and has been associated with concerns regarding male reproductive toxicity. In this study, we hypothesized that maternal exposure to DEHP induces transgenerational inheritance of adult-onset adverse reproductive outcomes through the male germline in the F1, F2, and F3 generations of male offspring. Pregnant rats were treated with 5 or 500 mg of DEHP/kg/day through gavage from gestation day 0 to birth. The offspring body weight, anogenital distance (AGD), anogenital index (AGI), sperm count, motility, and DNA fragmentation index (DFI) were measured for all generations. Methyl-CpG binding domain sequencing was performed to analyze sperm DNA methylation status in the F3. DEHP exposure at 500 mg/kg affected AGD, AGI, sperm count, mean DFI, and %DFI in the F1; AGD, sperm count, and mean DFI in the F2; and AGD, AGI, mean DFI, and %DFI in the F3. DEHP exposure at 5 mg/kg affected AGD, AGI, sperm count, and %DFI in the F1; sperm count in the F2; and AGD and AGI in F3. Compared with the control group, 15 and 45 differentially hypermethylated genes were identified in the groups administered 5 mg/kg and 500 mg/kg DEHP, respectively. Moreover, 130 and 6 differentially hypomethylated genes were observed in the groups administered 5 mg/kg and 500 mg/kg DEHP. Overall, these results demonstrated that prenatal exposure to DEHP caused transgenerational epigenetic effects, which may explain the observed phenotypic changes in the male reproductive system.
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Crestani A, Abdel Wahab C, Arfi A, Ploteau S, Kolanska K, Breban M, Bendifallah S, Ferrier C, Darai E. A short anogenital distance on MRI is a marker of endometriosis. Hum Reprod Open 2021; 2021:hoab003. [PMID: 33623831 PMCID: PMC7887775 DOI: 10.1093/hropen/hoab003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Could the anogenital distance (AGD) as assessed by MRI (MRI-AGD) be a diagnostic tool for endometriosis? SUMMARY ANSWER A short MRI-AGD is a strong diagnostic marker of endometriosis. WHAT IS KNOWN ALREADY A short clinically assessed AGD (C-AGD) is associated with the presence of endometriosis. STUDY DESIGN SIZE DURATION This study is a re-analysis of previously published data from a case-control study. PARTICIPANTS/MATERIALS SETTING METHODS Women undergoing pelvic surgery from January 2018 to June 2019 and who had a preoperative pelvic MRI were included. C-AGD was measured at the beginning of the surgery by a different operator who was unaware of the endometriosis status. MRI-AGD was measured retrospectively by a senior radiologist who was blinded to the final diagnosis. Two measurements were made: from the posterior wall of the clitoris to the anterior edge of the anal canal (MRI-AGD-AC), and from the posterior wall of the vagina to the anterior edge of the anal canal (MRI-AGD-AF). MAIN RESULTS AND THE ROLE OF CHANCE The study compared MRI-AGD of 67 women with endometriosis to 31 without endometriosis (controls). Average MRI-AGD-AF measurements were 13.3 mm (±3.9) and 21.2 mm (±5.4) in the endometriosis and non-endometriosis groups, respectively (P < 10-5). Average MRI-AGD-AC measurements were 40.4 mm (±7.3) and 51.1 mm (±8.6) for the endometriosis and non-endometriosis groups, respectively (P < 10-5). There was no difference of MRI-AGD in women with and without endometrioma (P = 0.21), or digestive involvement (P = 0.26). Moreover, MRI-AGD values were independent of the revised score of the American Society of Reproductive Medicine and the Enzian score. The diagnosis of endometriosis was negatively associated with both the MRI-AGD-AF (β = -7.79, 95% CI (-9.88; -5.71), P < 0.001) and MRI-AGD-AC (β = -9.51 mm, 95% CI (-12.7; 6.24), P < 0.001) in multivariable analysis. Age (β = +0.31 mm, 95% CI (0.09; 0.53), P = 0.006) and BMI (β = +0.44 mm, 95% CI (0.17; 0.72), P = 0.001) were positively associated with the MRI-AGD-AC measurements in multivariable analysis. MRI-AGD-AF had an AUC of 0.869 (95% CI (0.79; 0.95)) and outperformed C-AGD. Using an optimal cut-off of 20 mm for MRI-AGD-AF, a sensitivity of 97.01% and a specificity of 70.97% were noted. LIMITATIONS REASONS FOR CAUTION This was a retrospective analysis and no adolescents had been included. WIDER IMPLICATIONS OF THE FINDINGS This study is consistent with previous works associating a short C-AGD with endometriosis and the absence of correlation with the disease phenotype. MRI-AGD is more accurate than C-AGD in this setting and could be evaluated in the MRI examination of patients with suspected endometriosis. STUDY FUNDING/COMPETING INTERESTS N/A. TRIAL REGISTRATION NUMBER The protocol was approved by the 'Groupe Nantais d'Ethique dans le Domaine de la Santé' and registered under reference 02651077.
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Affiliation(s)
- A Crestani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - C Abdel Wahab
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - A Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - S Ploteau
- Service de Gynécologie-Obstétrique, CIC FEA, Hôpital Mère Enfant, CHU Hôtel Dieu, Nantes, France
| | - K Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - M Breban
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris, France
- INSERM UMR_S_707, ‘Epidemiology, Information Systems, Modeling’, University Pierre and Marie Curie, Paris, France
| | - C Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - E Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
- UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris, France
- INSERM UMR_S_707, ‘Epidemiology, Information Systems, Modeling’, University Pierre and Marie Curie, Paris, France
- Groupe de recherche clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, hôpital Tenon, Sorbonne Université, Paris, France
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Kızılay DÖ, Aydın C, Aygün AP, Tuhan HÜ, Olukman Ö. Prenatal smoke exposure is associated with increased anogenital distance in female infants: a prospective case-control study. J Pediatr Endocrinol Metab 2021; 34:79-88. [PMID: 33035191 DOI: 10.1515/jpem-2020-0363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the effects of maternal smoking during pregnancy on newborn infants' anogenital distance (AGD). METHODS Fifty-six female and sixty-four male newborn infants from mothers who smoked during pregnancy were included in this study. A control group for each sex was selected from infants whose mothers had no active or passive (in either the household or the workplace) smoke exposure before or during pregnancy. Questionnaire data on maternal demographic characteristics and information about cigarette use were collected. We assessed genital anthropometry which included AGD for both male and female neonates, and stretched penile length (SPL), penile girth for males within the first 48 h after birth. AGD measurements were also normalized according to birth weight (AGD/weight in grams), length (AGD/height in millimeters), and ponderal index [AGD/(weight in grams/height in cubic centimeters)]. Anogenital index (AGI) was calculated by dividing the AGD by cube root of birth weight. RESULTS In female infants, prenatal smoke exposure was associated with significantly increased weight-adjusted AGD (p=0.03). There was also a significant correlation between mothers' daily smoking rates and weight-adjusted AGD (r=0.27/p=0.03). In male infants, fetal smoke exposure was not associated with any AGD measurements, SPL and penile girth. CONCLUSIONS A significant increase in weight-adjusted AGD in female infants exposed to maternal smoking may be an indicator of antenatal androgen exposure and may pose a risk for short and long-term endocrine, metabolic and behavioral problems.
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Affiliation(s)
- Deniz Özalp Kızılay
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Cansever Aydın
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Ayşe Pakel Aygün
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Hale Ünver Tuhan
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Özgür Olukman
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Izmir, Turkey
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25
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Abstract
Male reproductive health has declined as indicated by increasing rates of cryptorchidism, i.e., undescended testis, poor semen quality, low serum testosterone level, and testicular cancer. Exposure to endocrine disrupting chemicals (EDCs) has been proposed to have a role in this finding. In utero exposure to antiandrogenic EDCs, particularly at a sensitive period of fetal testicular development, the so-called 'masculinization programming window (MPW)', can disturb testicular development and function. Low androgen effect during the MPW can cause both short- and long-term reproductive disorders. A concurrent exposure to EDCs may also affect testicular function or damage testicular cells. Evidence from animal studies supports the role of endocrine disrupting chemicals in development of male reproductive disorders. However, evidence from epidemiological studies is relatively mixed. In this article, we review the current literature that evaluated relationship between prenatal EDC exposures and anogenital distance, cryptorchidism, and congenital penile abnormality called hypospadias. We review also studies on the association between early life and postnatal EDC exposure and semen quality, hypothalamic-pituitary-gonadal axis hormone levels and testicular cancer.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- *Correspondence: Helena E. Virtanen,
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Pan Z, Zhu F, Zhou K. A Systematic Review of Anogenital Distance and Gynecological Disorders: Endometriosis and Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:696879. [PMID: 34367069 PMCID: PMC8339921 DOI: 10.3389/fendo.2021.696879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Anogenital distance (AGD) can serve as a life-long indicator of androgen action in gestational weeks 8-14. AGD has been used as an important tool to investigate the exposure to endocrine-disrupting compounds in newborns and in individuals with male reproductive disorder. Endometriosis and polycystic ovary syndrome (PCOS) are two common gynecological disorders and both are related to prenatal androgen levels. Therefore, we performed a systematic review to evaluate the relationships of AGD with these gynecological disorders. METHODS PubMed, Web of Science, and Embase were searched for published studies up to January 25, 2021. No language restriction was implemented. RESULTS Ten studies were included in this review. Five focused on women with endometriosis, and six investigated women with PCOS. According to these studies, PCOS patients had longer AGD than controls, while endometriosis patients had shorter AGD than controls. In conclusion, this study provides a detailed and accurate review of the associations of AGD with endometriosis and PCOS. CONCLUSION The current findings indicate the longer AGD was related to PCOS and shorter AGD was related to endometriosis. However, further well-designed studies are needed to corroborate the current findings.
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Affiliation(s)
| | | | - Kai Zhou
- *Correspondence: Fangfang Zhu, ; Kai Zhou,
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27
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Luan M, Liang H, Fang G, Wang Z, Su X, Chen A, Miao M, Yuan W. Association Between Neonatal Thyroid Function and Anogenital Distance from Birth to 48 Months of Age. Front Endocrinol (Lausanne) 2021; 12:736505. [PMID: 34566898 PMCID: PMC8456038 DOI: 10.3389/fendo.2021.736505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence from animal studies has indicated that neonatal thyroid function is vital for the reproductive development. Anogenital distance (AGD), a sensitive biomarker of the fetal hormonal milieu, can be used to predict adult reproductive disorders. However, few human studies have examined the association between neonatal thyroid function and AGD. We aimed to explore their associations in a birth cohort study. METHODS Concentrations of thyroid stimulating hormone (TSH) and thyroid hormones (THs), including total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and free thyroxine (FT4) were measured in cord plasma in the Shanghai-Minhang Birth Cohort. The offspring AGD (AGDAP [anus-penis] and AGDAS [anus-scrotum] for boys and AGDAC [anus-clitoris] and AGDAF [anus-fourchette] for girls), body weight and anogenital index (AGI = AGD/weight [mm/kg]) were obtained at each follow-up visit. In total, 344 children (194 boys and 150 girls) with cord plasma concentrations of THs and TSH and at least one AGD measurement at birth and at 6, 12, and 48 months of age were included. Multiple linear regression and generalized estimating equation (GEE) models were used to examine the associations of cord plasma concentrations of THs and TSH with AGI. RESULTS Multiple linear regression models showed inverse associations of TT4, FT3, and FT4 with female AGI, although statistical significance was only reached at birth, 6 and 48 months of age. These associations were also found in GEE models: higher TT4 and FT4 concentrations were associated with lower AGIAC (TT4: β = -0.27, 95% CI: -0.50, -0.03 for middle vs. lowest tertile; FT4: β = -0.38, 95% CI: -0.61, -0.16 for middle and β = -0.30, 95% CI: -0.55, -0.04 for highest vs. lowest tertile). Besides, girls with the highest tertile of FT3 concentrations had lower AGIAF than those with the lowest tertile (the highest vs. lowest tertile: β = -0.22, 95% CI: -0.36, -0.08). Positive associations between TSH and AGI at birth and at 12 months of age were observed in boys. CONCLUSIONS This study provides further evidence on the effects of neonatal thyroid function on reproductive development at an early life stage.
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Affiliation(s)
- Min Luan
- National Health Commission (NHC) Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Public Health, Fudan University, Shanghai, China
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Guanghong Fang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Ziliang Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- *Correspondence: Maohua Miao,
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
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Barrett E, Thurston SW, Harrington D, Bush NR, Sathyanarayana S, Nguyen R, Zavez A, Wang C, Swan S. Digit ratio, a proposed marker of the prenatal hormone environment, is not associated with prenatal sex steroids, anogenital distance, or gender-typed play behavior in preschool age children. J Dev Orig Health Dis 2020;:1-10. [PMID: 33336644 DOI: 10.1017/S2040174420001270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Prenatal hormones have been proposed as key factors impacting child development as well as long-term health and disease. Digit ratio (the ratio of the lengths of the second to fourth digits; 2D:4D) has been proposed as a sexually dimorphic, noninvasive marker of prenatal androgen exposure that can be reliably measured in children and adults. To date, few longitudinal pregnancy cohort studies have examined childhood digit ratio in relation to other relevant measures including prenatal hormones and androgen-sensitive outcomes. To augment the current literature on this topic, we measured right-hand digit ratio in 4-year-old children participating in The Infant Development and the Environment Study, a multicenter longitudinal cohort study that has been following mother-child dyads since the first trimester of pregnancy (n = 321). We assessed sex differences in digit ratio and fit multivariable linear regression models to examine digit ratio in relation to: (1) child sex; (2) maternal sex steroid hormone concentrations in early pregnancy; (3) newborn anogenital distance, another proposed measure of sensitivity to prenatal androgens; and (4) gender-typical play behavior as measured by the Preschool Activities Inventory (PSAI) at age 4. We observed no sex difference in digit ratio; the mean 2D:4D was 0.97 ± 0.05 mm in both sexes. Furthermore, digit ratio was not associated with maternal sex steroid concentrations in early pregnancy, anogenital distance in either sex, or PSAI scores in either sex in covariate-adjusted models. In conclusion, we observed no evidence that early childhood digit ratio was associated with child sex or hormone-sensitive measures in this cohort.
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García-Peñarrubia P, Ruiz-Alcaraz AJ, Martínez-Esparza M, Marín P, Machado-Linde F. Hypothetical roadmap towards endometriosis: prenatal endocrine-disrupting chemical pollutant exposure, anogenital distance, gut-genital microbiota and subclinical infections. Hum Reprod Update 2020; 26:214-246. [PMID: 32108227 DOI: 10.1093/humupd/dmz044] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endometriosis is a gynaecological hormone-dependent disorder that is defined by histological lesions generated by the growth of endometrial-like tissue out of the uterus cavity, most commonly engrafted within the peritoneal cavity, although these lesions can also be located in distant organs. Endometriosis affects ~10% of women of reproductive age, frequently producing severe and, sometimes, incapacitating symptoms, including chronic pelvic pain, dysmenorrhea and dyspareunia, among others. Furthermore, endometriosis causes infertility in ~30% of affected women. Despite intense research on the mechanisms involved in the initial development and later progression of endometriosis, many questions remain unanswered and its aetiology remains unknown. Recent studies have demonstrated the critical role played by the relationship between the microbiome and mucosal immunology in preventing sexually transmitted diseases (HIV), infertility and several gynaecologic diseases. OBJECTIVE AND RATIONALE In this review, we sought to respond to the main research question related to the aetiology of endometriosis. We provide a model pointing out several risk factors that could explain the development of endometriosis. The hypothesis arises from bringing together current findings from large distinct areas, linking high prenatal exposure to environmental endocrine-disrupting chemicals with a short anogenital distance, female genital tract contamination with the faecal microbiota and the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. SEARCH METHODS We performed a search of the scientific literature published until 2019 in the PubMed database. The search strategy included the following keywords in various combinations: endometriosis, anogenital distance, chemical pollutants, endocrine-disrupting chemicals, prenatal exposure to endocrine-disrupting chemicals, the microbiome of the female reproductive tract, microbiota and genital tract, bacterial vaginosis, endometritis, oestrogens and microbiota and microbiota-immune system interactions. OUTCOMES On searching the corresponding bibliography, we found frequent associations between environmental endocrine-disrupting chemicals and endometriosis risk. Likewise, recent evidence and hypotheses have suggested the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. Hence, we can envisage a direct relationship between higher prenatal exposure to oestrogens or estrogenic endocrine-disrupting compounds (phthalates, bisphenols, organochlorine pesticides and others) and a shorter anogenital distance, which could favour frequent postnatal episodes of faecal microbiota contamination of the vulva and vagina, producing cervicovaginal microbiota dysbiosis. This relationship would disrupt local antimicrobial defences, subverting the homeostasis state and inducing a subclinical inflammatory response that could evolve into a sustained immune dysregulation, closing the vicious cycle responsible for the development of endometriosis. WIDER IMPLICATIONS Determining the aetiology of endometriosis is a challenging issue. Posing a new hypothesis on this subject provides the initial tool necessary to design future experimental, clinical and epidemiological research that could allow for a better understanding of the origin of this disease. Furthermore, advances in the understanding of its aetiology would allow the identification of new therapeutics and preventive actions.
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Affiliation(s)
- Pilar García-Peñarrubia
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - Antonio J Ruiz-Alcaraz
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - María Martínez-Esparza
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - Pilar Marín
- Servicio de Ginecología y Obstetricia, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Francisco Machado-Linde
- Servicio de Ginecología y Obstetricia, Hospital Clínico Universitario Reina Sofía, CARM, Murcia, Spain
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Peters HE, Laeven CHC, Trimbos CJMA, van de Ven PM, Verhoeven MO, Schats R, Mijatovic V, Lambalk CB. Anthropometric biomarkers for abnormal prenatal reproductive hormone exposure in women with Mayer-Rokitanksy-Küster-Hauser syndrome, polycystic ovary syndrome, and endometriosis. Fertil Steril 2020; 114:1297-1305. [PMID: 33036791 DOI: 10.1016/j.fertnstert.2020.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study whether markers of prenatal exposure to reproductive hormones are related to Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, polycystic ovary syndrome (PCOS), and endometriosis. DESIGN Case-control study. Comparison of sex hormone-related external genital and digital characteristics in cases and controls. SETTING University hospital. PATIENT(S) We enrolled 172 women in four groups-women with MKRH, women with PCOS, women with endometriosis, and controls (43 in each group). INTERVENTION(S) Measurement of two anthropometric biomarkers: anogenital distance and digit ratio. MAIN OUTCOME MEASURE(S) Anogenital distance was measured from the anus to the anterior clitoral surface (AGDac) and from the anus to the posterior fourchette (AGDaf). For the digit ratio we used a direct, as well as a computer-assisted graphic measurement to measure the length of the second and fourth digit. RESULT(S) After adjustment for body mass index and age, AGDac was the shortest in endometriosis and the longest in PCOS groups, with a mean difference of 10 mm (95% confidence interval 3.1-16.8). AGDaf but not AGDac measures were found to be significantly larger in the MRKH group, with a mean difference compared with controls of 2.6 mm (95% confidence interval 0.1-5.2). The digit ratio was not significantly different between the groups. CONCLUSION(S) In this study we did find limited evidence for androgen exposure during the development of MRKH. This is compatible with the hypothesis that the uterovaginal agenesis may have been the result of temporary prenatal exposure to altered gonadal hormone concentrations. For endometriosis and PCOS we confirm previously observed associations for anogenital distance reflecting possible estrogen-based and androgen-based intrauterine origins, respectively. DUTCH TRIAL REGISTRATION NUMBER NTR7492.
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Affiliation(s)
- Henrike E Peters
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands.
| | - Claire H C Laeven
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Constantia J M A Trimbos
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marieke O Verhoeven
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Roel Schats
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Velja Mijatovic
- Endometriosis Center, Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
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Glintborg D, Jensen RC, Schmedes AV, Brandslund I, Kyhl HB, Jensen TK, Andersen MS. Anogenital distance in children born of mothers with polycystic ovary syndrome: the Odense Child Cohort. Hum Reprod 2020; 34:2061-2070. [PMID: 31560039 DOI: 10.1093/humrep/dez122] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/18/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Are higher testosterone levels during pregnancy in women with polycystic ovary syndrome (PCOS) associated with longer offspring anogenital distance (AGD)? SUMMARY ANSWER AGD was similar in 3-month-old children born of mothers with PCOS compared to controls. WHAT IS KNOWN ALREADY AGD is considered a marker of prenatal androgenization. STUDY DESIGN, SIZE, DURATION Maternal testosterone levels were measured by mass spectrometry at Gestational Week 28 in 1127 women. Maternal diagnosis of PCOS before pregnancy was defined according to Rotterdam criteria. Offspring measures included AGD from anus to posterior fourchette (AGDaf) and clitoris (AGDac) in girls and to scrotum (AGDas) and penis (AGDap) and penile width in boys and body composition (weight and BMI SD scores) at age 3 months. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was part of the prospective study, Odense Child Cohort (OCC), and included mothers with PCOS (n = 139) and controls (n = 1422). The control population included women with regular menstrual cycles (<35 days) before conception and no signs of androgen excess (hirsutism and/or acne). MAIN RESULTS AND THE ROLE OF CHANCE AGD measures were comparable in offspring of women with PCOS compared to controls (all P > 0.2) despite significantly higher maternal levels of total testosterone (mean: 2.4 versus 2.0 nmol/l) and free testosterone (mean: 0.005 versus 0.004 nmol/l) in women with PCOS versus controls (both P < 0.001). In women with PCOS, maternal testosterone was an independent positive predictor of offspring AGDas and AGDap in boys. Maternal testosterone levels did not predict AGD in girls born of mothers with PCOS or in boys or girls born of women in the control group. LIMITATIONS, REASONS FOR CAUTION The diagnosis of PCOS was based on retrospective information and questionnaires during pregnancy. Women participating in OCC were more ethnically homogenous, leaner, more educated and less likely to smoke compared to the background population. Our study findings, therefore, need to be reproduced in prospective study cohorts with PCOS, in more obese study populations and in women of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS Our finding of the same AGD in girls born of mothers with PCOS compared to controls expands previous results of studies reporting longer AGD in adult women with PCOS. Our results suggest that longer AGD in adult women with PCOS could be the result of increased testosterone levels in puberty, perhaps in combination with weight gain. STUDY FUNDING/COMPETING INTEREST(S) Financial grants for the study were provided by the Danish Foundation for Scientific Innovation and Technology (09-067180), Ronald McDonald Children Foundation, Odense University Hospital, the Region of Southern Denmark, the Municipality of Odense, the Mental Health Service of the Region of Southern Denmark, The Danish Council for Strategic Research, Program Commission on Health, Food and Welfare (2101-08-0058), Odense Patient data Explorative Network, Novo Nordisk Foundation (grant no. NNF15OC00017734), the Danish Council for Independent Research and the Foundation for research collaboration between Rigshospitalet and Odense University Hospital and the Health Foundation (Helsefonden). There is no conflict of interest of any author that could be perceived as prejudicing the impartiality of the research reported.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University, Odense, Denmark
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism, Odense University, Odense, Denmark.,Department of Environmental Medicine, Odense University Hospital, Odense, Denmark
| | | | - Ivan Brandslund
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, SDU, Odense, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Tina Kold Jensen
- Department of Environmental Medicine, Odense University Hospital, Odense, Denmark.,Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Fischer MB, Ljubicic ML, Hagen CP, Thankamony A, Ong K, Hughes I, Jensen TK, Main KM, Petersen JH, Busch AS, Upners EN, Sathyanarayana S, Swan SH, Juul A. Anogenital Distance in Healthy Infants: Method-, Age- and Sex-related Reference Ranges. J Clin Endocrinol Metab 2020; 105:5861574. [PMID: 32574349 PMCID: PMC7368455 DOI: 10.1210/clinem/dgaa393] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/19/2020] [Indexed: 02/01/2023]
Abstract
CONTEXT The use of anogenital distance (AGD) in clinical and epidemiological settings is increasing; however, sex-specific reference data on AGD and data on longitudinal changes in AGD in children is scarce. OBJECTIVE To create age-, sex-, and method-related reference ranges of AGD in healthy boys and girls aged 0-24 months, to assess the age-related changes in AGD and to evaluate the 2 predominantly used methods of AGD measurement. DESIGN The International AGD consortium comprising 4 centers compiled data from 1 cross-sectional and 3 longitudinal cohort studies (clinicaltrials.gov [NCT02497209]). SETTING All data were collected from population-based studies, recruiting from 4 maternity or obstetric centers (United States, Cambridge [United Kingdom], Odense, and Copenhagen [Denmark]). SUBJECTS This study included a total of 3705 healthy, mainly Caucasian children aged 0-24 months on whom 7295 measurements were recorded. MAIN OUTCOME MEASURES AGDAS (ano-scrotal), AGDAF (ano-fourchette), AGDAP (ano-penile), AGDAC (ano-clitoral), AGD body size indices (weight, body mass index [BMI], body surface area, and length), and intra- and interobserver biases. RESULTS We created age-specific reference ranges by centers. We found that AGD increased from birth to 6 months of age and thereafter reached a plateau. Changes in AGD/BMI during the first year of life were minor (0-6% and 0-11% in boys and girls, respectively). CONCLUSIONS Reference ranges for AGD can be used in future epidemiological research and may be utilized clinically to evaluate prenatal androgen action in differences-in-sex-development patients. The increase in AGD during the first year of life was age-related, while AGD/BMI was fairly stable. The TIDES and Cambridge methods were equally reproducible.
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Affiliation(s)
- Margit Bistrup Fischer
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Correspondence and Reprint Requests: Margit Bistrup Fischer, MD, Department of Growth and Reproduction, GR, 5064,Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø,Denmark. E-mail:
| | - Marie Lindhardt Ljubicic
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Casper P Hagen
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ken Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ieuan Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Tina Kold Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, dense, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Katharina M Main
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Alexander S Busch
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emmie N Upners
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sheela Sathyanarayana
- Department of Pediatrics/Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Research Institute, Seattle, Washington
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anders Juul
- Deptartment of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Tian Y, Liang H, Miao M, Yang F, Ji H, Cao W, Liu X, Zhang X, Chen A, Xiao H, Hu H, Yuan W. Maternal plasma concentrations of perfluoroalkyl and polyfluoroalkyl substances during pregnancy and anogenital distance in male infants. Hum Reprod 2020; 34:1356-1368. [PMID: 31242507 DOI: 10.1093/humrep/dez058] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/08/2019] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION Are maternal plasma concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFASs) during pregnancy associated with anogenital distance (AGD) in male infants at birth, 6, and 12 months of age? SUMMARY ANSWER Higher maternal plasma concentrations of some PFASs were associated with shorter AGD in male infants at birth and 6 months of age. WHAT IS KNOWN ALREADY Two animal studies have found that exposure to PFASs was associated with shorter AGD in male rat fetuses and wild male minks. There is only one human study on the topic that did not identify consistent patterns between maternal serum concentrations of PFASs during pregnancy and AGD in male infants. STUDY DESIGN, SIZE, DURATION In the prospective cohort study, a total of 1292 eligible pregnant women were recruited at 12-16 weeks of gestation between April and December 2012 at the Maternal and Child Health Hospital of Minhang district in Shanghai, China. At delivery, 667 male singletons were born. They were then followed up at birth (n = 439) and at 6 (n = 411) and 12 months (n = 376) of age when anopenile distance (AGDAP) and anoscrotal distance (AGDAS) were measured. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 500 male infants who had both maternal plasma concentrations of PFASs and at least one AGD measurement of at three time points were included in the present study. Multiple linear regression models were used to evaluate the potential linear associations between maternal concentrations of PFASs and AGD. MAIN RESULTS AND THE ROLE OF CHANCE Maternal plasma concentrations (ln-transformed) of perfluorooctane sulfonate (PFOS), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUdA) were inversely associated with AGDAS or AGDAP at birth (AGDAS: per ln unit increase in PFAS concentrations: β (95% CI): -0.65 (-1.27 to -0.02) mm for PFOS; -0.58 (-1.11 to -0.06) mm for PFDA; and -0.57 (-1.09 to -0.06) mm for PFUdA; AGDAP: per ln unit increase in PFAS concentrations: β (95% CI): -0.63 (-1.24 to -0.01) mm for PFDA and - 0.76 (-1.36 to -0.16) mm for PFUdA). At 6 months of age, per unit increase in maternal ln concentrations of PFOS and perfluorotridecanoic acid (PFTrDA), AGDAS decreased on average by -2.21 (95% CI: -4.28 to -0.14) and -1.11 (95% CI: -2.17 to -0.06) mm, respectively. Additionally, ln-transformed perfluorooctanoic acid (PFOA) showed nonsignificant but inverse associations with both AGDAS and AGDAP at 6 months of age. We found no significant associations between ln-transformed maternal concentrations of PFASs and either AGDAS or AGDAP at 12 months of age. However, significantly inverse association of ln-transformed PFOA with AGDAP was observed in male infants who never or shortly breastfed (<3 months) at 12 months of age. LIMITATIONS, REASONS FOR CAUTION AGD measurements were performed by different examiners at each follow-up visit, and the intra-examiner variation was not assessed, which might cause intra-rater and inter-rater measurement errors. Additionally, our study may have selection bias since a considerable number of participants withdrew from the cohort although the differences in demographic characteristics were not statistically significant between included mother-infant pairs and those excluded. No statistical correction was made for multiple comparisons. WIDER IMPLICATIONS OF THE FINDINGS Our findings may have important implications for the early development of genital health in male infants since PFASs can be detected in almost all pregnant women and infants worldwide. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the National Key Research and Development program of China (2018YFC1002801 and 2016YFC1000505), the Science and Technology Commission of Shanghai Municipality (16ZR1430100), the National Natural Science Foundation of China (81428011), and the Innovation-Oriented Science and Technology Grant from National Health Commission Key Laboratory of Reproduction Regulation (CX2017-06). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Youping Tian
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
| | - Hong Liang
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
| | - Maohua Miao
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
| | - Fen Yang
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
| | - Honglei Ji
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
| | - Wencheng Cao
- National Reference Laboratory of Dioxin, Institute of Health Inspection and Detection, Hubei Provincial Academy of Preventive Medicine, Hubei Provincial Center for Disease Control and Prevention, #6 Zhuo Daoquan North Road, Wuhan, China
| | - Xiaofang Liu
- National Reference Laboratory of Dioxin, Institute of Health Inspection and Detection, Hubei Provincial Academy of Preventive Medicine, Hubei Provincial Center for Disease Control and Prevention, #6 Zhuo Daoquan North Road, Wuhan, China
| | - Xiaotian Zhang
- National Reference Laboratory of Dioxin, Institute of Health Inspection and Detection, Hubei Provincial Academy of Preventive Medicine, Hubei Provincial Center for Disease Control and Prevention, #6 Zhuo Daoquan North Road, Wuhan, China
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH, USA
| | - Hong Xiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, USA
| | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, USA
| | - Wei Yuan
- National Health Commission Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai, China
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Crestani A, Arfi A, Ploteau S, Breban M, Boudy AS, Bendifallah S, Ferrier C, Darai E. Anogenital distance in adult women is a strong marker of endometriosis: results of a prospective study with laparoscopic and histological findings. Hum Reprod Open 2020; 2020:hoaa023. [PMID: 32529050 PMCID: PMC7275635 DOI: 10.1093/hropen/hoaa023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/08/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Could anogenital distance (AGD) be a non-invasive marker of endometriosis and correlated to the American Society for Reproductive Medicine revised score (r-ASRM) and ENZIAN classifications? SUMMARY ANSWER Surgically and histologically proven endometriosis is associated with a short AGD in women of reproductive age but not correlated either to the severity or to the location of the disease. WHAT IS KNOWN ALREADY AGD is a marker of intrauterine androgen exposure and exposure to oestrogen-like chemicals such as phthalates. Moreover, exposure to endocrine disruptors, such as organochlorine chemicals, is associated with endometriosis. It has been suggested that a short AGD in women is associated with an increased risk of endometriosis based on clinical and ultrasound exams. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted from January 2018 to June 2019 in a tertiary-care centre including 168 adult women undergoing pelvic surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 168 women included, 98 patients had endometriosis (endometriosis group) and 70 did not (non-endometriosis group). An operator (not the surgeon) measured the distance from the clitoral surface to the anus (AGD-AC) and from the posterior fourchette to the anus (AGD-AF) before surgery using a millimetre accuracy ruler. Endometriosis was diagnosed on exploration of the abdominopelvic cavity, and the r-ASRM and ENZIAN scores were calculated. All removed tissues underwent pathological examination. MAIN RESULTS AND THE ROLE OF CHANCE Mean (±SD) AGD-AF measurements were 21.5 mm (±6.4) and 32.3 mm (±8.1), and average AGD-AC measurements were 100.9 mm (±20.6) and 83.8 mm (±12.9) in the endometriosis and non-endometriosis groups (P < 0.001), respectively. Mean AGD-AF and AGD-AC measurements were not related to r-ASRM stage (P = 0.73 and 0.80, respectively) or ENZIAN score (P = 0.62 and 0.21, respectively). AGD-AF had a better predictive value than AGD-AC for discriminating the presence of endometriosis (AUC = 0.840 (95% CI 0.782–0.898) and 0.756 (95% CI 0.684–0.828)), respectively. For AGD-AF, an optimal cut-off of 20 mm had a specificity of 0.986 (95% CI 0.923–0.999), sensitivity of 0.306 (95% CI 26.1–31.6) and positive predictive value of 0.969 (95% CI 0.826–0.998). In multivariable analysis, the diagnosis of endometriosis was the only variable independently associated with the AGD-AF (β = −9.66 mm 95% CI −12.20–−7.12), P < 0.001). LIMITATIONS, REASONS FOR CAUTION The sample size was relatively small with a high proportion of patients with colorectal endometriosis reflecting the activity of an expert centre. Furthermore, we did not include adolescents and the AGD-AF measurement could be particularly relevant in this population. WIDER IMPLICATIONS OF THE FINDINGS The measurement of AGD could be a useful non-invasive tool to predict endometriosis. This could be especially relevant for adolescents and virgin women to avoid diagnostic laparoscopy and empiric treatment. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- A Crestani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France
| | - A Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France
| | - S Ploteau
- Department of Gynaecology and Obstetrics, CIC FEA, Hôpital Mère Enfant, CHU Hôtel Dieu, Nantes, 44093, France
| | - M Breban
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France
| | - A-S Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France.,INSERM UMR_S_707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris, France
| | - C Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France
| | - E Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) University Pierre and Marie Curie, Paris 75020, France.,Centre de Recherche Saint Antoine (UMRS 938), Faculté de Médecine Sorbonne Université, Paris 75012, France.,INSERM UMR_S_707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris, France.,Groupe de recherche clinique (GRC-6); Centre Expert En Endométriose (C3E), Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
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Kareem AJ, Owa JA, Elusiyan JBE. Estimations of total serum testosterone levels in Nigerian term neonates at birth using anogenital distance measurements. J Pediatr Endocrinol Metab 2020; 33:631-638. [PMID: 32229671 DOI: 10.1515/jpem-2019-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/25/2020] [Indexed: 11/15/2022]
Abstract
Background In genital anomalies, measurement of total testosterone is required but is expensive and technically difficult to assay. Therefore, the measurement of anogenital distance, which is non-invasive and cheap, could be used to estimate total serum testosterone in neonates. The objective if this study is to determine the relationship between total serum testosterone and anogenital distance and estimate total serum testosterone levels in term neonates using measurements of anogenital distance. Methods This was a prospective cross-sectional study. Consecutive healthy term neonates were recruited in the first 72 h of postnatal life. Anogenital distance was measured with a digital vernier calliper. Total serum testosterone was determined using enzyme linked immunoassay. Results A total of 240 term neonates comprising 124 (51.7%) males and 116 (48.3%) females were studied. The overall mean anogenital distance was 19.7 (7.7) mm and 26.5 (3.7) mm for males which was more than twice 12.4 (2.3) mm for females (t = 35.3, p < 0.001, 95% confidence interval [CI], 13-14). The overall mean total serum testosterone level was 267.1 (204.8) ng/dL; and 357.4 (241.7) ng/dL in males which was more than twice of 170.6 (80.7) ng/dL for females (t = 7.9, p < 0.001, 95% CI, 144-221). There was positive correlation between total serum testosterone and anogenital distance (r = 0.425, p < 0.001). The correlation was stronger in males than in females. The linear regression equation was as follows: total serum testosterone (ng/dL) = 44.3 + 11.3*AGD (mm) with 95% CI, 8-14. Conclusions The known value of anogenital distance could be used to estimate total serum testosterone levels in term neonates.
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Affiliation(s)
- Abiodun John Kareem
- Endocrinology and Metabolism Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Neonatology Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, Phone: +2348034319940
| | - Joshua Aderinsola Owa
- Neonatology Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Jerome Boluwaji Elutayo Elusiyan
- Endocrinology and Metabolism Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Schwartz CL, Vinggaard AM, Christiansen S, Darde TA, Chalmel F, Svingen T. Distinct Transcriptional Profiles of the Female, Male, and Finasteride-Induced Feminized Male Anogenital Region in Rat Fetuses. Toxicol Sci 2020; 169:303-311. [PMID: 30768126 DOI: 10.1093/toxsci/kfz046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A short anogenital distance (AGD) in males is a marker for incomplete masculinization and a predictor of adverse effects on male reproductive health. For this reason, AGD is used to assess the endocrine disrupting potential of chemicals for risk assessment purposes. The molecular mechanisms underpinning this chemically induced shortening of the AGD, however, remains unclear. Although it is clear that androgen receptor-mediated signaling is essential, evidence also suggest the involvement of other signaling pathways. This study presents the first global transcriptional profile of the anogenital tissue in male rat fetuses with chemically induced short AGD, also including comparison to normal male and female control animals. The antiandrogenic drug finasteride (10 mg/kg bw/day) was used to induce short AGD by exposing time-mated Sprague Dawley rats at gestation days 7-21. The AGD was 37% shorter in exposed male fetuses compared with control males at gestation day 21. Transcriptomics analysis on anogenital tissues revealed a sexually dimorphic transcriptional profile. More than 350 genes were found to be differentially expressed between the 3 groups. The expression pattern of 4 genes of particular interest (Esr1, Padi2, Wnt2, and Sfrp4) was also tested by RT-qPCR analyses, indicating that estrogen and Wnt2 signaling play a role in the sexually dimorphic development of the anogenital region. Our transcriptomics profiles provide a stepping-stone for future studies aimed at characterizing the molecular events governing development of the anogenital tissues, as well as describing the detailed Adverse Outcome Pathways for short AGD; an accepted biomarker of endocrine effects for chemical risk assessment.
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Affiliation(s)
- Camilla Lindgren Schwartz
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Marie Vinggaard
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Sofie Christiansen
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Thomas Alain Darde
- INSERM, Université de Rennes, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S1085, Rennes, France
| | - Frederic Chalmel
- INSERM, Université de Rennes, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S1085, Rennes, France
| | - Terje Svingen
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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Kutluhan MA, Şahin A, Ürkmez A, Toprak T, Akgül K, Topaktaş R, Sertkaya Z, Verit A. The relationship between anogenital distance and benign prostate hyperplasia-related lower urinary tract symptoms. Andrologia 2020; 52:e13589. [PMID: 32271471 DOI: 10.1111/and.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022] Open
Abstract
Anogenital distance (AGD) is the length between the genitals and anus which shows an androgenic activity in the evolution of the reproductive system in the uterine life. For prostatic evolution and development during the embryological stage, androgen exposure is required. In this study, we aimed to investigate the relationship between AGD and benign prostate hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). A total of 70 patients who were admitted to our urology clinics with LUTS due to BPH (LUTS group) and 70 patients without LUTS (control group) were included. All patients were administered an International Prostate Symptom Score form. Data including height, weight, body mass index, total prostate-specific antigen, prostate volume and uroflowmetry Qmax values of all patients were evaluated. The AGD of the LUTS and control groups was measured. The mean AGDAS values of the LUTS group were significantly lower than the control group (p = .013). There was no statistically significant difference between the two groups in terms of the mean adjusted AGDAP values (p = .241). However, the mean adjusted AGDAS values were significantly lower in the LUTS group than the control group (p = .002). Our study results suggest that AGD may be a useful marker in BPH-related LUTS.
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Affiliation(s)
- Musab Ali Kutluhan
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Aytaç Şahin
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Korhan Akgül
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Ramazan Topaktaş
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
| | - Zülfü Sertkaya
- Department of Urology, Memorial Hospital, Diyarbakır, Turkey
| | - Ayhan Verit
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Sağlık Bilimleri University, Istanbul, Turkey
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Sertkaya Z, Ertaş K, Tokuç E. The relationship between premature ejaculation and anogenital distance. Andrologia 2020; 52:e13571. [PMID: 32201974 DOI: 10.1111/and.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Premature ejaculation is a common male sexual disease in andrology practice. The goal of essay is to investigate the relation of anogenital distance that predicts prenatal testosterone exposure with premature ejaculation. Between January and May 2019, 150 men were participated in the study. The patients were evaluated with anamnesis and physical examination; age, smoking, alcohol consumption, intravaginal ejaculation latency time, body mass index, premature ejaculation diagnostic tool, distance from anal point to scrotum and distance from anal point to penis were recorded. According to premature ejaculation diagnostic tool score, the patients were classified as premature ejaculation group (score ≥11) and control group (score <11). The mean of the male age was 30.73 ± 4.40 years. The mean intravaginal ejaculation latency time score was 3.42 ± 2.71 min. Two groups were compared using the distance from anal point to scrotum distance from anal point to penis. In the premature ejaculation group, the distances were found lower (77.46 ± 2.31 and 54.78 ± 2.56 mm) than the control group (81.32 ± 3.11 and 58.16 ± 3.48 mm). There were statistical differences between two groups (p < .001). It was concluded that it is likely to have a negative relationship between anogenital distance and premature ejaculation diagnostic tool score.
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Affiliation(s)
- Zülfü Sertkaya
- Department of Urology, Memorial Hospital, Diyarbakır, Turkey
| | - Kemal Ertaş
- Department of Urology, Memorial Hospital, Diyarbakır, Turkey
| | - Emre Tokuç
- Sultanbeyli State Hospital, İstanbul, Turkey
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Toprak T, Şahin A, Akgul K, Kutluhan MA, Ramazanoglu MA, Yilmaz M, Sahan A, Verit A. The relationship between anogenital distance and lifelong premature ejaculation. Andrology 2019; 8:353-357. [PMID: 31536679 DOI: 10.1111/andr.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure. OBJECTIVES The aim of this study was to investigate the association between lifelong premature ejaculation and anogenital distance. MATERIALS AND METHODS The study included 140 participants: 70 with lifelong premature ejaculation (group 1) and 70 without any ejaculatory complaints (group 2). Premature Ejaculation Diagnostic Tool and stopwatch intravaginal ejaculatory latency time were recorded from all participants in order to evaluate ejaculatory function. Two variants of anogenital distance were measured: anogenital distance (from anus to the posterior base of the scrotum) from anus to the posterior base of the scrotum and anogenital distance (from anus to the cephalad insertion of the penis) to the cephalad insertion of the penis. We compared differences between groups and correlations between anogenital distance variants and patients' characteristics. RESULTS The groups were similar in terms of age, BMI, and total testosterone levels. The mean anogenital distance (from anus to the posterior base of the scrotum) scores were 59.45 ± 10.76 vs. 55.02 ± 10.13 (p = 0.01), and anogenital distance (from anus to the cephalad insertion of the penis) scores were 128.37 ± 22.2 vs. 126.78 ± 16.21 (p = 0.63) in groups 1 and 2, respectively. Significant correlation was observed between anogenital distance (from anus to the posterior base of the scrotum) and Premature Ejaculation Diagnostic Tool scores (r = 0.199, p = 0.019) and intravaginal ejaculatory latency time (r = -0.185, p = 0.028). There were no statistically significant differences between anogenital distance (from anus to the posterior base of the scrotum) scores and total testosterone levels and between anogenital distance (from anus to the cephalad insertion of the penis) and Premature Ejaculation Diagnostic Tool scores or intravaginal ejaculatory latency time. CONCLUSIONS These results suggest that longer anogenital distance is associated with higher possibility of lifelong premature ejaculation. However, further studies are needed to confirm our results.
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Affiliation(s)
- T Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - A Şahin
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - K Akgul
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - M A Kutluhan
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - M Yilmaz
- Urology, Ankara City Hospital, Ankara, Turkey
| | - A Sahan
- Department of Urology, Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - A Verit
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Priskorn L, Bang AK, Nordkap L, Krause M, Mendiola J, Jensen TK, Juul A, Skakkebaek NE, Swan SH, Jørgensen N. Anogenital distance is associated with semen quality but not reproductive hormones in 1106 young men from the general population. Hum Reprod 2019; 34:12-24. [PMID: 30452659 PMCID: PMC6295959 DOI: 10.1093/humrep/dey326] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is anogenital distance (AGD) associated with semen quality and reproductive hormones in men from the general population? SUMMARY ANSWER Short AGD measured from the anus to the base of scrotum (AGDAS) was associated with reduced sperm counts and morphology but not with sperm motility or reproductive hormones. WHAT IS KNOWN ALREADY AGD is longer in males than in females. In rodents, AGD is a well-established and sensitive marker of disruption during the masculinization programming window in utero and it has been suggested to be so in humans as well. Therefore, the average AGD would be expected to be shorter in men with poor semen quality, which some studies have confirmed while others have not. STUDY DESIGN, SIZE, DURATION This cross-sectional population-based study was of 1106 men included between 2012 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Men from the general Danish population (median age 19 years), unselected with regard to fertility status and semen quality, delivered a semen sample, had a blood sample drawn, which was analyzed for concentrations of reproductive hormones, and answered a comprehensive questionnaire. They also had a physical examination performed including determination of AGD measured as the distance between anus and scrotum (AGDAS) and penis (AGDAP). Odds ratios (OR) and 95% CI were estimated for a man having abnormal semen parameters according to the World Health Organization's reference values or a low/high concentration of reproductive hormones (defined as the lowest or highest 10%) depending on AGD. AGD was categorized in four strata: ≤10th percentile, 10th-30th percentile, 30th-50th percentile and >50th percentile. MAIN RESULTS AND THE ROLE OF CHANCE Men with the 10% shortest AGDAS had a more than doubled risk (OR: 2.19, 95% CI: 1.40-3.42) of being in the subfertile range for either sperm concentration (<15 million/mL) or sperm morphology (<4%) compared to men with AGDAS above the median (reference). Men in the 10th-30th percentile also had an increased OR of 1.48 (95% CI: 1.06-2.08) but not men in the 30th-50th percentile (OR: 1.14, 95% CI: 0.81-1.62). AGDAP was only weakly related to semen quality. AGD was not associated with testicular volume or any of the reproductive hormones. LIMITATIONS, REASONS FOR CAUTION Limitations include the potential non-differential misclassification of reproductive outcomes based on a single semen and blood sample and some between-examiner differences in AGD measurements which introduces noise and may result in an underestimation of observed associations. WIDER IMPLICATIONS OF THE FINDINGS Our study of men from the general population confirmed associations between AGD and semen quality, supporting the hypothesis that AGD in humans could be a marker of fetal testicular development. This suggests that the low semen quality in Danish men may partly be explained by prenatal factors. STUDY FUNDING/COMPETING INTEREST(S) The study has received financial support from the ReproUnion (L.P.); the Research fund of Rigshospitalet, Copenhagen University Hospital (N.J.); Grants R01ES016863-04 and R01ES016863-02S4; National Institute of Environmental Health Sciences (NIEHS) and National Institute of Environmental Health Sciences grant (P30ES023515) (S.S.); the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); the Danish Ministry of Health; the Danish Environmental Protection Agency; A.P. Møller and wife Chastine McKinney Møllers foundation; and Svend Andersens Foundation. None of the funders had any role in the study design, collection, analysis or interpretation of data, writing of the paper or publication decisions. The authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Priskorn
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A K Bang
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Nordkap
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Krause
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca), Espinardo, Murcia, Spain
| | - T K Jensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - A Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N E Skakkebaek
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hua XG, Hu R, Hu CY, Li FL, Jiang W, Zhang XJ. Associations between hypospadias, cryptorchidism and anogenital distance: Systematic review and meta-analysis. Andrologia 2018; 50:e13152. [PMID: 30251425 DOI: 10.1111/and.13152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/27/2018] [Accepted: 08/10/2018] [Indexed: 01/22/2023] Open
Abstract
Hypospadias and cryptorchidism are potential manifestations of testicular dysgenesis syndrome (TDS) at birth. Anogenital distance (AGD) has been presumed as an indicator related to endocrine disruptors proposed as one of the pathogenetic mechanisms underlying male reproductive disorders. In humans, recent studies have correlated AGD in boys to testicular anomalies. However, the associations between hypospadias, cryptorchidism and AGD remain inconsistent and have not been combined. Hence, we conducted a meta-analysis to assess gradations in the severity of the endocrine disruption in cryptorchidism or hypospadias by using AGD. A total of 2,119 boys from five birth cohort studies and two cross-sectional studies were subjected to meta-analysis. Random-effect model was used to calculate the standardised mean difference (SMD) of AGD. Our results reveal that boys with hypospadias or cryptorchidism have shorter AGD ([SMD, -2.63; 95% CI, -4.65 to -0.62] and [SMD, -0.69; 95% CI, -1.36 to -0.02]) respectively. There was no indication of a publication bias either from the result of Egger's test or Begg's test for hypospadias and cryptorchidism.
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Affiliation(s)
- Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Rui Hu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Feng-Li Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Freire C, Ocón-Hernández O, Dávila-Arias C, Pérez-Lobato R, Calvente I, Ramos R, Olea N, Fernández MF. Anogenital distance and reproductive outcomes in 9- to 11-year-old boys: the INMA-Granada cohort study. Andrology 2018; 6:874-881. [PMID: 30113141 DOI: 10.1111/andr.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/26/2018] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies examining the association of anogenital distance (AGD), a biomarker of prenatal androgen exposure, with sexual development in children are lacking. OBJECTIVE To assess the association between AGD measures and reproductive outcomes, including puberty onset, testicular volume, reproductive hormone levels, and urogenital malformations in boys aged 9-11 years. MATERIALS AND METHODS A cross-sectional study was conducted among children belonging to the Spanish Environment and Childhood (INMA) Project, a population-based birth cohort study. The present sample included 279 boys for whom data were available on AGD, pubertal stage, testicular volume, and relevant covariates. Out of the boys with AGD data, 187 provided a blood sample for hormone analysis. AGD was measured from the center of the anus to the base of the scrotum. Pubertal development was assessed according to Tanner stage of genital development (G1-G5), and testicular volume was measured with an orchidometer. RESULTS After adjusting for potential confounders, logistic regression analysis showed that AGD was positively associated with testicular volume but not with Tanner stage (>G1 vs. G1), serum hormone levels, or undescended testis. Regardless of their age, body mass index, and Tanner stage (G1 or >G1), boys with longer AGD showed increased odds of a testicular volume >3 mL (OR = 1.06, 95%CI = 1.00-1.19 per 10% increment in AGD; and OR = 3.14, 95%CI = 0.99-9.94 for AGD >42 mm vs. <33 mm). DISCUSSION Longer AGD was associated with testicular growth, an indicator of gonadarche, but not with other reproductive outcomes. CONCLUSIONS Although AGD was positively associated with testicular volume, it remains unclear whether AGD predicts testis size at puberty or is related to puberty onset.
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Affiliation(s)
- C Freire
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - O Ocón-Hernández
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Obstetrics and Gynecology Service, San Cecilio University Hospital, Granada, Spain
| | - C Dávila-Arias
- Radiology Unit, Health Science Technological Park University Hospital, Granada, Spain
| | - R Pérez-Lobato
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Psychology Clinic ISEP, Granada, Spain
| | - I Calvente
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain
| | - R Ramos
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain
| | - N Olea
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain.,Department of Radiology, School of Medicine, Center for Biomedical Research, University of Granada, Granada, Spain
| | - M F Fernández
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain.,Department of Radiology, School of Medicine, Center for Biomedical Research, University of Granada, Granada, Spain
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Dorman DC, Chiu W, Hales BF, Hauser R, Johnson KJ, Mantus E, Martel S, Robinson KA, Rooney AA, Rudel R, Sathyanarayana S, Schantz SL, Waters KM. Systematic reviews and meta-analyses of human and animal evidence of prenatal diethylhexyl phthalate exposure and changes in male anogenital distance. J Toxicol Environ Health B Crit Rev 2018; 21:207-226. [PMID: 30199328 DOI: 10.1080/10937404.2018.1505354.systematic] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Male reproductive alterations found in animals and humans following in utero phthalate exposure include decreased anogenital distance (AGD) and other reproductive-tract malformations. The aim of this investigation was to conduct systematic reviews of human and animal evidence of the effect of in utero exposure to diethylhexyl phthalate (DEHP) on anogenital distance (AGD) in males. PubMed, Embase, and Toxline were searched for relevant human and experimental animal studies on August 15, 2016. Search results were screened for relevance, and studies that met the inclusion criteria were evaluated for quality and data extracted for analysis. Confidence in the human and animal bodies of evidence was assessed and hazard conclusions reached by integrating evidence streams. The search yielded 6 relevant human studies and 19 animal studies. Meta-analysis of 5 human observational prospective cohort studies showed that increased maternal urinary concentrations of DEHP metabolites were associated with decreased AGD in boys (-4.07 [CI, -6.49 to -1.66] % decrease per log10 rise in DEHP metabolites). Meta-analysis and meta-regression of the 19 experimental animal studies found reduced AGD with DEHP treatment, with a dose-response gradient, and with heterogeneity explained by species and strain. There is a moderate level of evidence from human investigations and a high level of data from animal studies that in utero exposure to DEHP decreases AGD. Based upon the available human and animal evidence, and consideration of mechanistic data, DEHP is presumed to be a reproductive hazard to humans on the basis of effects on AGD.
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Affiliation(s)
- David C Dorman
- a Department of Molecular and Biomedical Sciences, College of Veterinary Medicine , North Carolina State University , Raleigh , NC , USA
| | - Weihsueh Chiu
- b Department of Veterinary Integrative Biosciences, College of Veterinary Medicine , Texas A&M University , College Station , TX , USA
| | - Barbara F Hales
- c Department of Pharmacology and Therapeutics , McGill University , Montreal , Quebec , Canada
| | - Russ Hauser
- d Department of Environmental Health and Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Kamin J Johnson
- e Predictive Safety Center , The Dow Chemical Company , Midland , MI , USA
| | - Ellen Mantus
- f Board on Environmental Studies and Toxicology at the National Academies of Sciences , Engineering, and Medicine , Washington , DC , USA
| | - Susan Martel
- f Board on Environmental Studies and Toxicology at the National Academies of Sciences , Engineering, and Medicine , Washington , DC , USA
| | - Karen A Robinson
- g Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Andrew A Rooney
- h Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services , Research Triangle Park , NC , USA
| | | | - Sheela Sathyanarayana
- j Department of Pediatrics , University of Washington, Seattle Children's Research Institute , Seattle , WA , USA
| | - Susan L Schantz
- k Department of Comparative Biosciences, College of Veterinary Medicine and Beckman Institute for Advanced Science and Technology , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - Katrina M Waters
- l Biological Sciences Division , Pacific Northwest National Laboratory , Richland , WA , USA
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Dorman DC, Chiu W, Hales BF, Hauser R, Johnson KJ, Mantus E, Martel S, Robinson KA, Rooney AA, Rudel R, Sathyanarayana S, Schantz SL, Waters KM. Systematic reviews and meta-analyses of human and animal evidence of prenatal diethylhexyl phthalate exposure and changes in male anogenital distance. J Toxicol Environ Health B Crit Rev 2018; 21:207-226. [PMID: 30199328 PMCID: PMC6786271 DOI: 10.1080/10937404.2018.1505354] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Male reproductive alterations found in animals and humans following in utero phthalate exposure include decreased anogenital distance (AGD) and other reproductive-tract malformations. The aim of this investigation was to conduct systematic reviews of human and animal evidence of the effect of in utero exposure to diethylhexyl phthalate (DEHP) on anogenital distance (AGD) in males. PubMed, Embase, and Toxline were searched for relevant human and experimental animal studies on August 15, 2016. Search results were screened for relevance, and studies that met the inclusion criteria were evaluated for quality and data extracted for analysis. Confidence in the human and animal bodies of evidence was assessed and hazard conclusions reached by integrating evidence streams. The search yielded 6 relevant human studies and 19 animal studies. Meta-analysis of 5 human observational prospective cohort studies showed that increased maternal urinary concentrations of DEHP metabolites were associated with decreased AGD in boys (-4.07 [CI, -6.49 to -1.66] % decrease per log10 rise in DEHP metabolites). Meta-analysis and meta-regression of the 19 experimental animal studies found reduced AGD with DEHP treatment, with a dose-response gradient, and with heterogeneity explained by species and strain. There is a moderate level of evidence from human investigations and a high level of data from animal studies that in utero exposure to DEHP decreases AGD. Based upon the available human and animal evidence, and consideration of mechanistic data, DEHP is presumed to be a reproductive hazard to humans on the basis of effects on AGD.
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Affiliation(s)
- David C. Dorman
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Weihsueh Chiu
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine, Texas A&M University, College Station, TX, USA
| | - Barbara F. Hales
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Russ Hauser
- Department of Environmental Health and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kamin J. Johnson
- Predictive Safety Center, The Dow Chemical Company, Midland, MI, USA
| | - Ellen Mantus
- Board on Environmental Studies and Toxicology at the National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Susan Martel
- Board on Environmental Studies and Toxicology at the National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Karen A. Robinson
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew A. Rooney
- Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Susan L. Schantz
- Department of Comparative Biosciences, College of Veterinary Medicine and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Katrina M. Waters
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
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Maldonado-Cárceles AB, Sánchez-Rodríguez C, Vera-Porras EM, Árense-Gonzalo JJ, Oñate-Celdrán J, Samper-Mateo P, García-Escudero D, Torres-Roca M, Martínez-Díaz F, Mendiola J, Torres-Cantero AM. Anogenital Distance, a Biomarker of Prenatal Androgen Exposure Is Associated With Prostate Cancer Severity. Prostate 2017; 77:406-411. [PMID: 27862129 DOI: 10.1002/pros.23279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity. MATERIALS We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP ). We compared differences in groups to evaluate the association between AGD measurements and severity of the preoperative biopsy and clinical scores. RESULTS Longer AGDAS was significantly associated with the highest Gleason score (P = 0.015) and D'Amico nomogram (P = 0.048). In contrast, no statistical differences were found in the AGDAP and severity of the preoperative biopsy. CONCLUSIONS These findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ana B Maldonado-Cárceles
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Espinardo (Murcia), IMIB-Arrixaca, Spain
- Department of Preventive Medicine, "Reina Sofia", University General Hospital, Murcia, Spain
| | | | - Eva M Vera-Porras
- Department of Preventive Medicine, "Reina Sofia", University General Hospital, Murcia, Spain
| | - Julián J Árense-Gonzalo
- Department of Preventive Medicine, "Reina Sofia", University General Hospital, Murcia, Spain
| | - Julián Oñate-Celdrán
- Department of Urology, "Reina Sofia", University General Hospital, Murcia, Spain
| | - Paula Samper-Mateo
- Department of Urology, "Reina Sofia", University General Hospital, Murcia, Spain
| | | | - Marcos Torres-Roca
- Department of Urology, "Reina Sofia", University General Hospital, Murcia, Spain
| | - Francisco Martínez-Díaz
- Department of Anatomical Pathology, "Reina Sofia", University General Hospital, Murcia, Spain
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Espinardo (Murcia), IMIB-Arrixaca, Spain
| | - Alberto M Torres-Cantero
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Espinardo (Murcia), IMIB-Arrixaca, Spain
- Department of Preventive Medicine, "Reina Sofia", University General Hospital, Murcia, Spain
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Gilboa Y, Perlman S, Kivilevitch Z, Messing B, Achiron R. Prenatal Anogenital Distance Is Shorter in Fetuses With Hypospadias. J Ultrasound Med 2017; 36:175-182. [PMID: 27925677 DOI: 10.7863/ultra.16.01006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Recent research provides evidence that anogenital distance may serve as a novel metric to assess reproductive potential in men. In children, a shorter anogenital distance was linked with cryptorchidism, hypospadias, and micropenis. Scarce data exist in the literature regarding anogenital distance measurement in the fetus. The aim of our study was to assess whether intrauterine measurement of fetal anogenital distance could assist in the differential diagnosis of male genital anomalies. METHODS Anogenital distance was prospectively measured in all cases referred for suspected isolated abnormal male genitalia. Final diagnoses, confirmed by a pediatric urologist, were compared with anogenital distance prenatal measurements. RESULTS Fifty-two cases were referred for evaluation because of suspected male external genital malformation during a 12-month period. Cases with normal-appearing genitalia, associated major malformations, and early severe fetal growth restriction were excluded from the study. Postnatal examination revealed 14 cases of hypospadias in varying severity and 8 cases of a buried penis. All fetuses with hypospadias had an anogenital distance measurement below the fifth percentile. Statistical analysis revealed a significant difference between the normal mean anogenital distance for gestational age versus those with hypospadias (mean ± SD, 16.90 ± 4.08 and 11.68 ± 3.31 mm, respectively; P = .001). No significant difference was found between the normal mean anogenital distance for gestational age versus those with a buried penis (18.85 ± 2.76 and 19.46 ± 3.41 mm; P = .700). CONCLUSIONS Fetuses with hypospadias have a statistically significant shorter anogenital distance compared with the general population. Therefore, anogenital distance may serve as a complementary objective sonographic parameter in the prenatal assessment and counseling of male external genital anomalies.
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Affiliation(s)
- Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Baruch Messing
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Haim Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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47
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Fisher BG, Thankamony A, Hughes IA, Ong KK, Dunger DB, Acerini CL. Prenatal paracetamol exposure is associated with shorter anogenital distance in male infants. Hum Reprod 2016; 31:2642-2650. [PMID: 27609981 PMCID: PMC5088633 DOI: 10.1093/humrep/dew196] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/18/2016] [Accepted: 07/15/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the relationship between maternal paracetamol intake during the masculinisation programming window (MPW, 8-14 weeks of gestation) and male infant anogenital distance (AGD), a biomarker for androgen action during the MPW? SUMMARY ANSWER Intrauterine paracetamol exposure during 8-14 weeks of gestation is associated with shorter AGD from birth to 24 months of age. WHAT IS ALREADY KNOWN The increasing prevalence of male reproductive disorders may reflect environmental influences on foetal testicular development during the MPW. Animal and human xenograft studies have demonstrated that paracetamol reduces foetal testicular testosterone production, consistent with reported epidemiological associations between prenatal paracetamol exposure and cryptorchidism. STUDY DESIGN, SIZE, DURATION Prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at ~12 post-menstrual weeks of gestation from a single UK maternity unit between 2001 and 2009, and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 676 delivered male infants and completed a medicine consumption questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHOD Mothers self-reported medicine consumption during pregnancy by a questionnaire administered during the perinatal period. Infant AGD (measured from 2006 onwards), penile length and testicular descent were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between paracetamol intake during three gestational periods (<8 weeks, 8-14 weeks and >14 weeks) and these outcomes were tested by linear mixed models. Two hundred and twenty-five (33%) of six hundred and eighty-one male infants were exposed to paracetamol during pregnancy, of whom sixty-eight were reported to be exposed during 8-14 weeks. AGD measurements were available for 434 male infants. MAIN RESULTS AND THE ROLE OF CHANCE Paracetamol exposure during 8-14 weeks of gestation, but not any other period, was associated with shorter AGD (by 0.27 SD, 95% CI 0.06-0.48, P = 0.014) from birth to 24 months of age. This reduction was independent of body size. Paracetamol exposure was not related to penile length or testicular descent. LIMITATIONS, REASONS FOR CAUTION Confounding by other drugs or endocrine-disrupting chemicals cannot be discounted. The cohort was not fully representative of pregnant women in the UK, particularly in terms of maternal ethnicity and smoking prevalence. There is likely to have been misclassification of paracetamol exposure due to recall error. WIDER IMPLICATIONS OF THE FINDINGS Our observational findings support experimental evidence that intrauterine paracetamol exposure during the MPW may adversely affect male reproductive development. STUDY FUNDING/COMPETING INTERESTS This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), the Newlife Foundation for Disabled Children, the Evelyn Trust, the Mothercare Group Foundation, Mead Johnson Nutrition, and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. The authors declare no conflict of interest.
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Affiliation(s)
- B G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - A Thankamony
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - D B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Lind DV, Priskorn L, Lassen TH, Nielsen F, Kyhl HB, Kristensen DM, Christesen HT, Steener J, Grandjean P, Jensen TK. Prenatal exposure to perfluoroalkyl substances and anogenital distance at 3 months of age as marker of endocrine disruption. Reprod Toxicol 2016:S0890-6238(16)30265-9. [PMID: 27421581 DOI: 10.1016/j.reprotox.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/13/2016] [Accepted: 07/09/2016] [Indexed: 11/22/2022]
Abstract
In the Odense child cohort, serum concentrations of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were measured in 649 pregnant women at approximately 12 weeks of gestation. Birth weight, head and abdominal circumferences were measured, and gestational age determined. Anogenital distance (AGD), i.e., the distance from the anus to the genital organs, penile width and body weight were measured 3 months after the expected date of birth in 511 children. PFOS, PFHxS, PFNA and PFDA were associated with a decreased AGD in girls (p-trend<0.05) after adjusting for age and weight-for-age standard deviation score. Specifically, PFOS in the highest quartile was associated with a 2.8mm (95% confidence intervals -4.5;-1.1) reduction in AGD in girls. No such tendencies were seen in boys. However, a tendency toward increased birth weight in girls and reduced in boys suggests that sex-dimorphic effects may occur from endocrine disrupting effects of these substances.
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Affiliation(s)
- Dorte Vesterholm Lind
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lærke Priskorn
- Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tina Harmer Lassen
- Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Flemming Nielsen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henriette Boye Kyhl
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense Patient data Exploratory Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - David Møbjerg Kristensen
- Laboratory of Genomic and Molecular Biomedicine, Department of Biology, University of Copenhagen, Universitetsparken 13, DK-2100 Copenhagen, Denmark
| | - Henrik Thybo Christesen
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense University Hospital, Institute for Clinical Research, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Jan Steener
- Odense University Hospital, Department of Obstetrics and Gynaecology, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense University Hospital, Institute for Clinical Research, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Philippe Grandjean
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA 02215, USA
| | - Tina Kold Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Hans Christian Andersen Children's Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense Patient data Exploratory Network (OPEN), University of Southern Denmark, Odense, Denmark.
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49
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Thankamony A, Pasterski V, Ong KK, Acerini CL, Hughes IA. Anogenital distance as a marker of androgen exposure in humans. Andrology 2016; 4:616-25. [PMID: 26846869 PMCID: PMC6225986 DOI: 10.1111/andr.12156] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 12/20/2022]
Abstract
Abnormal foetal testis development has been proposed to underlie common disorders of the male reproductive system such as cryptorchidism, hypospadias, reduced semen quality and testicular germ cell tumour, which are regarded as components of a 'testicular dysgenesis syndrome'. The increasing trends and geographical variation in their incidence have been suggested to result from in utero exposure to environmental chemicals acting as endocrine disruptors. In rodents, the anogenital distance (AGD), measured from the anus to the base of genital tubercle, is a sensitive biomarker of androgen exposure during a critical embryonic window of testis development. In humans, several epidemiological studies have shown alterations in AGD associated with prenatal exposure to several chemicals with potential endocrine disrupting activity. However, the link between AGD and androgen exposure in humans is not well-defined. This review focuses on the current evidence for such a relationship. As in rodents, a clear gender difference is detected during foetal development of the AGD in humans which is maintained thereafter. Reduced AGD in association with clinically relevant outcomes of potential environmental exposures, such as cryptorchidism or hypospadias, is in keeping with AGD as a marker of foetal testicular function. Furthermore, AGD may reflect variations in prenatal androgen exposure in healthy children as shorter AGD at birth is associated with reduced masculine play behaviour in preschool boys. Several studies provide evidence linking shorter AGD with lower fertility, semen quality and testosterone levels in selected groups of adults attending andrology clinics. Overall, the observational data in humans are consistent with experimental studies in animals and support the use of AGD as a biomarker of foetal androgen exposure. Future studies evaluating AGD in relation to reproductive hormones in both infants and adults, and to gene polymorphisms, will help to further delineate the effect of prenatal and postnatal androgen exposures on AGD.
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Affiliation(s)
- Ajay Thankamony
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Vickie Pasterski
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Psychology, University of Cambridge, Cambridge, CB2 3RQ, UK
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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50
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Mendiola J, Sánchez-Ferrer ML, Jiménez-Velázquez R, Cánovas-López L, Hernández-Peñalver AI, Corbalán-Biyang S, Carmona-Barnosi A, Prieto-Sánchez MT, Nieto A, Torres-Cantero AM. Endometriomas and deep infiltrating endometriosis in adulthood are strongly associated with anogenital distance, a biomarker for prenatal hormonal environment. Hum Reprod 2016; 31:2377-83. [PMID: 27357299 PMCID: PMC5027925 DOI: 10.1093/humrep/dew163] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/03/2016] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Is the length of the anogenital distance (AGD), a biomarker of the in-utero prenatal hormonal environment, associated with the presence of endometriomas and deep infiltrating endometriosis (DIE)? SUMMARY ANSWER Shorter AGD is associated with presence of endometriomas and DIE. WHAT IS KNOWN ALREADY It is debated whether hormonal exposure to estrogens in utero may be a risk factor for endometriosis in adulthood. AGD is a biomarker of prenatal hormonal environment and observational studies have shown an association between AGD and reproductive parameters in both sexes. STUDY DESIGN, SIZE, DURATION This case–control study of 114 women with endometriosis (endometriomas and/or DIE) and 105 controls was conducted between September 2014 and May 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Cases were attending the Endometriosis Unit of the Hospital. Prevalent as well as incident cases, diagnosed by transvaginal ultrasound (TVUS), were included. Controls were women without endometriosis attending the gynecological outpatient clinic for routine gynecological exams. Participants completed health questionnaires, followed physical and gynecological examinations, including TVUS. Measurements from the anterior clitoral surface to the upper verge of the anus (AGDAC), and from the posterior fourchette to the upper verge of the anus (AGDAF) were obtained in all subjects. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of endometriomas and/or DIE while accounting for important confounders and covariates, including age, body mass index, vaginal delivery or episiotomy. MAIN RESULTS AND THE ROLE OF CHANCE AGDAF was related to presence of endometriomas and/or DIE. For all cases of endometriosis (endometriomas and DIE), women in the lowest tertile of the AGDAF distribution, compared with the upper tertile, were 7.6-times (95% CI 2.8–21.0; P-trend < 0.001) more likely to have endometriosis. With regard to DIE, women with AGDAF below the median, compared with those with AGDAF above the median, were 41.6-times (95% CI 3.9–438; P-value = 0.002) more likely to have endometriosis. LIMITATIONS, REASONS FOR CAUTION In case–control studies, information and selection bias has to be ruled out. Physicians conducting the measurement were blind to the status of the patients. Controls came from the same population as the cases. We adjusted for known and suspected confounders and covariates, but the possibility of residual confounding or chance findings should always be considered. As with all observational studies, causal inference is limited. WIDER IMPLICATIONS OF THE FINDINGS This study suggests that endometriosis, especially the DIE, might have a prenatal origin that may be traced back to the hormonal milieu in which the fetus develops. STUDY FUNDING/COMPETING INTEREST This work was supported by the Ministry of Economy and Competitiveness, ISCIII (AES), grant no. PI13/01237 and the Seneca Foundation, Murcia Regional Agency of Science and Technology, grant no. 19443/PI/14. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Jaime Mendiola
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100 Espinardo, Murcia, Spain Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain
| | - María L Sánchez-Ferrer
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Raquel Jiménez-Velázquez
- Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Laura Cánovas-López
- Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Ana I Hernández-Peñalver
- Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Shiana Corbalán-Biyang
- Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Ana Carmona-Barnosi
- Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - María T Prieto-Sánchez
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Aníbal Nieto
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain Department of Obstetrics & Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 El Palmar, Murcia, Spain
| | - Alberto M Torres-Cantero
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100 Espinardo, Murcia, Spain Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain Department of Preventive Medicine, 'Reina Sofia' University General Hospital, 30003 Murcia, Murcia, Spain
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