Environmental Phthalates Exposure and Measures of Uterine Fibroid Size among a Racially Diverse Population of Premenopausal Women

摘要

Background. Etiology of uterine leiomyoma (fibroids) is poorly understood. Endocrine disruptors, such as phthalates, may contribute to fibroid pathobiology because ovarian hormones are critical to fibroid growth. Objectives. We examined the association between phthalates exposure and two measures of fibroid size: diameter of largest fibroid and uterine volume. Study Design. We conducted a cross-sectional study of 61 premenopausal women undergoing surgery for their fibroids between 2014-2017 in an urban academic hospital in Washington DC. Spot urine samples were collected during a pre-operative clinical visit and analyzed for 14 phthalate metabolites and two non-phthalate plasticizer metabolites using mass spectrometry. Information on fibroid and uterine characteristics was obtained from MRI and/or ultrasound imaging. We examined associations with individual biomarkers, metabolite sums by parent compounds, and a potency-weighted sum of antiandrogenic phthalates (Zandrogen-disruptor). Size of the largest fibroid and uterine volume were modeled as dichotomous outcomes (divided at the median) using logistic regression adjusting for age, race/ethnicity, BMI, and time since diagnosis. Results. The majority of the sample was African American (63.9%), overweight or obese (75.1%), and had completed college or graduate school (68.3%). In multivariate models, women with higher concentrations of di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DiNP) metabolites, and Zandrogen-disruptors had significantly greater uterine volumes compared to women with lower concentrations. ZDEHP metabolites and ZDINP metabolites were associated with 3.05 (95% CI 1.08-8.63) and 1.87 (95% CI 1.07, 3.29) increased odds of greater uterine volume, respectively. Conclusions. In this preliminary study, exposure to some phthalates was associated with larger uterine volume, a marker of disease severity and fibroid growth. Larger, prospective studies are needed to confirm these relationships.