Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Fertil Steril. 2018 Nov;110(6):1137-1144.e1. doi: 10.1016/j.fertnstert.2018.06.045.
To evaluate whether urinary concentrations of organophosphate flame retardant (PFR) metabolites are associated with pregnancy loss among women conceiving with assisted reproductive technology (ART).
Prospective preconception cohort of subfertile women.
Academic hospital fertility center in Boston, Massachusetts.
PATIENT(S): A total of 155 women conceiving 179 pregnancies with ART.
INTERVENTION(S): None. Mean exposure to each of five PFR metabolites was estimated by averaging the specific-gravity adjusted natural log concentrations from two urine samples collected during the ART cycle of conception.
MAIN OUTCOME MEASURE(S): Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical and total pregnancy loss (all losses <20 weeks' gestation) by quartiles of PFR metabolite concentrations were estimated using a repeated measures log-binomial model, accounting for multiple pregnancies per woman.
RESULT(S): Of the 179 pregnancies, 31% ended in pregnancy loss (12% in biochemical loss). Among the three metabolites with high detection frequency [bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), diphenyl phosphate (DPHP), and isopropylphenyl phenyl phosphate (ip-PPP)], an increased risk of biochemical loss was observed for women with DPHP concentrations in the fourth vs. first quartile (RR 1.64; 95% CI 0.61-4.39). Also found was an elevated risk of biochemical pregnancy loss among women in the highest quartile of the molar sum of urinary PFR metabolites compared with the lowest (RR 1.89; 95% CI 0.64-5.58). Urinary concentrations of ip-PPP and BDCIPP were not associated with either outcome.
CONCLUSION(S): Among subfertile women, urinary DPHP metabolite concentrations measured during the ART cycle of conception may be associated with early pregnancy loss. Although this study is uniquely designed to investigate early markers of pregnancy success and maintenance, the small sample size likely contributed to imprecision. Given their increasing use as replacement chemicals for traditional flame retardants, exposure to PFRs may increase, and more studies will be needed to investigate their potential to impact pregnancy and reproduction.
评估在接受辅助生殖技术（ART）受孕的女性中，有机磷阻燃剂（PFR）代谢物的尿浓度是否与妊娠丢失有关。
患有不孕症的女性进行的前瞻性受孕前队列研究。
马萨诸塞州波士顿学术医院生育中心。
共有 155 名女性在接受 ART 时怀孕了 179 次。
无。通过对两次 ART 周期中收集的尿液样本进行比重调整自然对数浓度的平均，估计了五种 PFR 代谢物中每种代谢物的平均暴露量。
使用重复测量对数二项式模型，根据 PFR 代谢物浓度的四分位数，估计生化和总妊娠丢失（<20 周妊娠的所有丢失）的调整后风险比（RR）和 95%置信区间（CI），该模型考虑了每位女性的多次妊娠。
在 179 次妊娠中，31%以妊娠丢失告终（12%为生化丢失）。在高检测频率的三种代谢物[双（1,3-二氯-2-丙基）磷酸酯（BDCIPP）、磷酸二苯酯（DPHP）和异丙基苯基苯基磷酸酯（ip-PPP）]中，与 DPHP 浓度处于第一四分位数的女性相比，浓度处于第四四分位数的女性生化丢失的风险增加（RR 1.64；95%CI 0.61-4.39）。还发现与最低四分位相比，尿液中 PFR 代谢物摩尔总和最高的女性生化妊娠丢失的风险升高（RR 1.89；95%CI 0.64-5.58）。尿液中 ip-PPP 和 BDCIPP 与任何结果均无关。
在患有不孕症的女性中，在接受 ART 的周期中测量的尿液 DPHP 代谢物浓度可能与早期妊娠丢失有关。尽管这项研究是专门设计来研究妊娠成功和维持的早期标志物，但由于样本量小，可能存在不准确性。考虑到它们作为传统阻燃剂的替代品的使用日益增加，PFR 的暴露可能会增加，需要进行更多的研究来调查它们对妊娠和生殖的潜在影响。
