Elsevier

Annals of Epidemiology

Volume 11, Issue 7, October 2001, Pages 491-496
Annals of Epidemiology

Original report
Association of DDT with Spontaneous Abortion: A Case-Control Study

https://doi.org/10.1016/S1047-2797(01)00239-3Get rights and content

Abstract

PURPOSE: Spontaneous abortion (SAB), the most common adverse pregnancy outcome, affects ∼15% of clinically recognized pregnancies. Except for advanced maternal age and smoking, there are not well-established risk factors for SAB. Animal models associate increased fetal resorption or abortion with exposure to the pesticide dichlorodiphenyl trichloroethane (DDT), but epidemiologic investigations of DDT and SAB are inconsistent. We undertook a pilot investigation of the hypothesized association of DDT with SAB.

METHODS: Participants in this case-control study were selected from a longitudinal study of reproductive effects of rotating shifts among female Chinese textile workers who were married, ages 22–34, nulliparous without history of SAB or infertility, and planning pregnancy. From 412 pregnancies, 42 of which ended in SAB, 15 SAB cases and 15 full-term controls were randomly selected and phlebotomized. Serum was analyzed for p,p′-DDT, o,p′-DDT, their metabolites (DDE and DDD), and other organochlorines including polychlorinated biphenyls.

RESULTS: Cases and controls were nonsmokers and did not differ in age (mean 25 years), body mass index (BMI), passive smoke exposure, or workplace exposures. Cases had significantly (p < 0.05) higher serum levels of p,p′-DDE (22 vs.12 ng/g) and o,p′-DDE (0.09 vs. 0.05 ng/g) than controls. After adjustment for age and BMI, each ng/g serum increase in p,p′-DDE was associated with a 1.13 (CI, 1.02–1.26) increased odds of SAB. With adjustment of serum DDE levels for excretion via breastfeeding, DDE-associated increased odds of SAB remained significant with up to 7% declines in maternal serum DDE levels for each month of breastfeeding.

CONCLUSIONS: A potential increased risk of SAB is associated with maternal serum DDE levels.

Section snippets

Selected Abbreviations and Acronyms

DDT = dichlorodiphenyl trichloroethane

DDE = dichlorodiphenyl dichloroethene

DDD = dichlorodiphenyl dichloroethane

HCB = hexachlorobenzene

PCBs = polychlorinated biphenyls

BMI = body mass index

CI =95% confidence interval

SAB = spontaneous abortion

SD = standard deviation

Study Population

Participants in this case-control study were recruited from a prospective cohort study begun in 1996 to assess the reproductive effects of rotating shift work among women working in the Yifang Textile Mill in Anqing, China. Women who are married, ages 22–34 years, nulliparous without history of SAB or infertility, and planning to have a child, are eligible for the parent study. In China, each married couple is permitted to have one child and must receive state permission to do so. Potential

Study Population

The 15 case and 15 control women assessed in this analysis did not differ significantly with regard to demographic characteristics, BMI, or workplace exposures from the 27 women with SAB and 210 with live births not included in the study. Consistent with population characteristics reported for this region of China (18), both case and control women were lean (Table 1). Except for greater breastfeeding and a shorter time between their index event (SAB or birth) and phlebotomy among controls

Discussion

Results of this study support findings in animal models suggesting that exposure to DDT and its metabolites is a potential source of increased risk for SAB 12, 13, 19. Although the mechanism of these associations is unknown, DDT's potential for endocrine activity is hypothesized to explain some of its reproductive toxicities. For example, DDT and DDE are structurally similar to various hormones, including estrogens, and o,p′-DDT and DDE isomers act analogously to estradiol (20). P,p-isomers of

Acknowledgements

This research was supported by grants from the National Institute of Child Health and Human Development (NICHD HD32505) and National Institute of Environmental Health Sciences (NIEHS ES00002, ES05947) with funding for the latter provided by the U.S. Environmental Protection Agency (EPA). Dr. Korrick was additionally supported by NIEHS grant ES08074 and a Harvard Medical School Edward and Amalie Kass 50th Anniversary Scholars in Medicine Fellowship. This manuscript's contents are the sole

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