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Barrett ES, Sharghi S, Thurston SW, Sobolewski Terry M, Loftus CT, Karr CJ, Nguyen RH, Swan SH, Sathyanarayana S. Associations of Exposure to Air Pollution during the Male Programming Window and Mini-Puberty with Anogenital Distance and Penile Width at Birth and at 1 Year of Age in the Multicenter U.S. TIDES Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:117001. [PMID: 37966231 PMCID: PMC10648757 DOI: 10.1289/ehp12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Ambient air pollution may be a developmental endocrine disruptor. In animal models, gestational and perinatal exposure to diesel exhaust and concentrated particulate matter alters anogenital distance (AGD), a marker of prenatal androgen activity, in both sexes. Little is known in humans. OBJECTIVES We examined exposure to fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) in relation to human AGD at birth and at 1 year of age, focusing on exposures during critical windows of reproductive development: the male programming window (MPW; gestational weeks 8-14) and mini-puberty (postnatal months 1-3). METHODS The Infant Development and Environment Study (TIDES) recruited first trimester pregnant women (n = 687 ) at four U.S. sites (Minneapolis, Minnesota; Rochester, New York; San Francisco, California; and Seattle, Washington) from 2010 to 2012. We measured anus to clitoris (AGD-AC) and anus to fourchette (AGD-AF) in female infants at birth; in males, we measured anus to penis (AGD-AP), anus to scrotum (AGD-AS), and penile width at birth and at 1 year of age. Using advanced spatiotemporal models, we estimated maternal exposure to PM 2.5 and NO 2 in the MPW and mini-puberty. Covariate-adjusted, sex-stratified linear regression models examined associations between PM 2.5 and NO 2 and AGD. RESULTS In males, a 1 - μ g / m 3 increase in PM 2.5 exposure during the MPW was associated with shorter AGD at birth, but a longer AGD at 1 year of age (e.g., birth AGD-AP: β = - 0.35 mm ; 95% CI: - 0.62 , - 0.07 ; AGD-AS: β = 0.37 mm ; 95% CI: 0.02, 0.73). Mini-pubertal PM 2.5 exposure was also associated with shorter male AGD-AP (β = - 0.50 mm ; 95% CI: - 0.89 , - 0.11 ) at 1 year of age. Although not associated with male AGD measures, 1 -ppb increases in NO 2 exposure during the MPW (β = - 0.07 mm ; 95% CI: - 0.02 , - 0.12 ) and mini-puberty (β = - 0.04 mm ; 95% CI: - 0.08 , 0.01) were both associated with smaller penile width at 1 year of age. Results were similar in multipollutant models, where we also observed that in females AGD-AC was inversely associated with PM 2.5 exposure, but positively associated with NO 2 exposure. DISCUSSION PM 2.5 and NO 2 exposures during critical pre- and postnatal windows may disrupt reproductive development. More work is needed to confirm these novel results and clarify mechanisms. https://doi.org/10.1289/EHP12627.
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Affiliation(s)
- Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| | - Sima Sharghi
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sally W. Thurston
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Marissa Sobolewski Terry
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christine T. Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Catherine J. Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ruby H.N. Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shanna H. Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, University of Washington, Seattle, Washington, USA
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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] [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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Dumesic DA, Abbott DH, Chazenbalk GD. An Evolutionary Model for the Ancient Origins of Polycystic Ovary Syndrome. J Clin Med 2023; 12:6120. [PMID: 37834765 PMCID: PMC10573644 DOI: 10.3390/jcm12196120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy of reproductive-aged women, characterized by hyperandrogenism, oligo-anovulation and insulin resistance and closely linked with preferential abdominal fat accumulation. As an ancestral primate trait, PCOS was likely further selected in humans when scarcity of food in hunter-gatherers of the late Pleistocene additionally programmed for enhanced fat storage to meet the metabolic demands of reproduction in later life. As an evolutionary model for PCOS, healthy normal-weight women with hyperandrogenic PCOS have subcutaneous (SC) abdominal adipose stem cells that favor fat storage through exaggerated lipid accumulation during development to adipocytes in vitro. In turn, fat storage is counterbalanced by reduced insulin sensitivity and preferential accumulation of highly lipolytic intra-abdominal fat in vivo. This metabolic adaptation in PCOS balances energy storage with glucose availability and fatty acid oxidation for optimal energy use during reproduction; its accompanying oligo-anovulation allowed PCOS women from antiquity sufficient time and strength for childrearing of fewer offspring with a greater likelihood of childhood survival. Heritable PCOS characteristics are affected by today's contemporary environment through epigenetic events that predispose women to lipotoxicity, with excess weight gain and pregnancy complications, calling for an emphasis on preventive healthcare to optimize the long-term, endocrine-metabolic health of PCOS women in today's obesogenic environment.
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Affiliation(s)
- Daniel A. Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;
| | - David H. Abbott
- Department of Obstetrics and Gynecology, Wisconsin National Primate Research Center, University of Wisconsin, 1223 Capitol Court, Madison, WI 53715, USA;
| | - Gregorio D. Chazenbalk
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;
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Halici-Ozturk F, Yucel Yetiskin FD, Gurlek B, Ocal FD, Yakut K, Engin-Ustun Y, Celen S, Sahin D. Longer anogenital distance in female fetus of diabetic and obese pregnant women. Taiwan J Obstet Gynecol 2023; 62:530-536. [PMID: 37407189 DOI: 10.1016/j.tjog.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Previous studies revealed that prenatal exposure to androgen excess such as polycystic ovary syndrome (PCOS) is associated with offspring's anogenital distance (AGD) length, and AGD is a biomarker of intrauterine androgen exposure. This study aims to investigate a possible relationship of fetal AGD with maternal diabetes and obesity, and to evaluate whether AGD predicts the fetal androgen exposure related to diabetes and obesity in female fetus. This study is the first to focus on the relationship between offspring's AGD and maternal diabetes and obesity. MATERIALS AND METHODS This is a prospective study investigating 218 pregnant women (125 in control group and 93 in study group). Fetal AGD was measured from the center of anus to the posterior convergence of the fourchette by ultrasound. Multivariate linear regression analysis was applied to assess the association of the fetal AGD length with maternal diabetes and obesity. RESULTS The control patients had significantly shorter fetal AGD (mean:10.7 mm, P < 0.001) compared to diabetic, obese and diabetic obese patients (mean: 12.6 mm, 12.8 mm and 12.9 mm, respectively). The results of regression analysis showed that both maternal diabetes and obesity were significantly correlated with longer AGD in female fetus. The results confirmed also that offspring's AGD measurement in utero by ultrasound is feasible and reliable. CONCLUSION The study findings suggest that both maternal diabetes and obesity are associated with intrauterine androgenic milieu during pregnancy, and fetal AGD may be used as a biomarker to predict this effect. This may provide important advantages in terms of early detection of reproductive system abnormalities related to prenatal androgen exposure.
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Affiliation(s)
- Filiz Halici-Ozturk
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey.
| | - Fatma Didem Yucel Yetiskin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Beril Gurlek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, 53200, Rize, Turkey
| | - Fatma Doga Ocal
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Kadriye Yakut
- Etlik Zübeyde Hanım Women Health Care Training and Research Hospital, Obstetrics and Gynecology Department, 06010, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Etlik Zübeyde Hanım Women Health Care Training and Research Hospital, Obstetrics and Gynecology Department, 06010, Ankara, Turkey
| | - Sevki Celen
- Etlik Zübeyde Hanım Women Health Care Training and Research Hospital, Obstetrics and Gynecology Department, 06010, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
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Luan M, Liang H, Chen Y, Chen D, Ji H, Chen H, Miao M, Yuan W. Prenatal exposure to organophosphate esters is associated with decreased anogenital distance in offspring. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159050. [PMID: 36174683 DOI: 10.1016/j.scitotenv.2022.159050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Evidence from in vitro and rodent studies suggests that organophosphate esters (OPEs) may disrupt sex steroid hormone homeostasis, but no human studies, to date, have examined the effects of in utero exposure to OPEs on offspring reproductive development. OBJECTIVE Anogenital distance (AGD) is a sensitive biomarker of fetal hormonal milieu and has been used to assess reproductive toxicity. We evaluated the longitudinal effects of prenatal exposure to OPEs on the AGD of offspring from birth to 4 years. METHODS Based on Shanghai-Minhang Birth Cohort Study, pregnant women provided urine samples at a gestational age of 12-16 weeks, which were analyzed for eight OPE metabolites. AGD was measured in offspring at birth and 0.5, 1, and 4 years of age. We used generalized estimating equations (GEE) and Bayesian kernel machine regression (BKMR) models to estimate the associations of prenatal exposure to individual OPE metabolites and OPE mixtures with AGD stratified by sex. RESULTS A total of 733 mother-infant pairs were analyzed. Prenatal exposure to diphenyl phosphate and bis-(2-ethylhexyl) phosphate was associated with decreased AGD in boys in GEE models. Bis-(1-chloro-2-propyl) phosphate (BCIPP) showed a similar but marginally significant effect. Prenatal exposure to most OPE metabolites was associated with decreased AGD in girls, with the most profound association observed for bis (2-butoxyethyl) phosphate (BBOEP) and alkyl-OPEs. The OPE mixture was also inversely associated with AGD in both sexes. The single-exposure effects of BKMR models were largely consistent with those observed in the GEE models. In addition, alkyl-OPEs, particularly BBOEP, contributed the most to the decreased AGD in girls, while BCIPP contributed the most to the decreased AGD in boys. CONCLUSIONS This study provides the first human evidence that prenatal exposure to OPEs is associated with decreased AGD in offspring. The magnitude of these effects may vary depending on the structure of OPEs.
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Affiliation(s)
- Min Luan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China
| | - Yafei Chen
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China
| | - Da Chen
- School of Environment and Guangdong Key Laboratory of Environment Pollution and Health, Jinan University, Guangzhou, China
| | - Honglei Ji
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China
| | - Hexia Chen
- School of Environment and Guangdong Key Laboratory of Environment Pollution and Health, Jinan University, Guangzhou, China
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China.
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Shanghai, China
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Dapas M, Dunaif A. Deconstructing a Syndrome: Genomic Insights Into PCOS Causal Mechanisms and Classification. Endocr Rev 2022; 43:927-965. [PMID: 35026001 PMCID: PMC9695127 DOI: 10.1210/endrev/bnac001] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 01/16/2023]
Abstract
Polycystic ovary syndrome (PCOS) is among the most common disorders in women of reproductive age, affecting up to 15% worldwide, depending on the diagnostic criteria. PCOS is characterized by a constellation of interrelated reproductive abnormalities, including disordered gonadotropin secretion, increased androgen production, chronic anovulation, and polycystic ovarian morphology. It is frequently associated with insulin resistance and obesity. These reproductive and metabolic derangements cause major morbidities across the lifespan, including anovulatory infertility and type 2 diabetes (T2D). Despite decades of investigative effort, the etiology of PCOS remains unknown. Familial clustering of PCOS cases has indicated a genetic contribution to PCOS. There are rare Mendelian forms of PCOS associated with extreme phenotypes, but PCOS typically follows a non-Mendelian pattern of inheritance consistent with a complex genetic architecture, analogous to T2D and obesity, that reflects the interaction of susceptibility genes and environmental factors. Genomic studies of PCOS have provided important insights into disease pathways and have indicated that current diagnostic criteria do not capture underlying differences in biology associated with different forms of PCOS. We provide a state-of-the-science review of genetic analyses of PCOS, including an overview of genomic methodologies aimed at a general audience of non-geneticists and clinicians. Applications in PCOS will be discussed, including strengths and limitations of each study. The contributions of environmental factors, including developmental origins, will be reviewed. Insights into the pathogenesis and genetic architecture of PCOS will be summarized. Future directions for PCOS genetic studies will be outlined.
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Affiliation(s)
- Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Andrea Dunaif
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Harada M. Pathophysiology of polycystic ovary syndrome revisited: Current understanding and perspectives regarding future research. Reprod Med Biol 2022; 21:e12487. [PMID: 36310656 PMCID: PMC9601867 DOI: 10.1002/rmb2.12487] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive‐age women and has lifelong effects on health. Methods In this review, I discuss the pathophysiology of PCOS. First, I summarize our current understanding of the etiology and pathology of PCOS, then, discuss details of two representative environmental factors involved in the pathogenesis of PCOS. Finally, I present perspectives regarding the directions of future research. Main findings The pathophysiology of PCOS is heterogeneous and shaped by the interaction of reproductive dysfunction and metabolic disorders. Hyperandrogenism and insulin resistance exacerbate one another during the development of PCOS, which is also affected by dysfunction of the hypothalamus‐pituitary‐ovarian axis. PCOS is a highly heritable disorder, and exposure to certain environmental factors causes individuals with predisposing genetic factors to develop PCOS. The environmental factors that drive the development of PCOS pathophysiology make a larger contribution than the genetic factors, and may include the intrauterine environment during the prenatal period, the follicular microenvironment, and lifestyle after birth. Conclusion On the basis of this current understanding, three areas are proposed to be subjects for future research, with the ultimate goals of developing therapeutic and preventive strategies and providing appropriate lifelong management, including preconception care.
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Affiliation(s)
- Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of MedicineThe University of TokyoTokyoJapan
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McCartney CR, Campbell RE, Marshall JC, Moenter SM. The role of gonadotropin-releasing hormone neurons in polycystic ovary syndrome. J Neuroendocrinol 2022; 34:e13093. [PMID: 35083794 PMCID: PMC9232905 DOI: 10.1111/jne.13093] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 01/28/2023]
Abstract
Given the critical central role of gonadotropin-releasing hormone (GnRH) neurons in fertility, it is not surprising that the GnRH neural network is implicated in the pathology of polycystic ovary syndrome (PCOS), the most common cause of anovulatory infertility. Although many symptoms of PCOS relate most proximately to ovarian dysfunction, the central reproductive neuroendocrine system ultimately drives ovarian function through its regulation of anterior pituitary gonadotropin release. The typical cyclical changes in frequency of GnRH release are often absent in women with PCOS, resulting in a persistent high-frequency drive promoting gonadotropin changes (i.e., relatively high luteinizing hormone and relatively low follicle-stimulating hormone concentrations) that contribute to ovarian hyperandrogenemia and ovulatory dysfunction. However, the specific mechanisms underpinning GnRH neuron dysfunction in PCOS remain unclear. Here, we summarize several preclinical and clinical studies that explore the causes of aberrant GnRH secretion in PCOS and the role of disordered GnRH secretion in PCOS pathophysiology.
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Affiliation(s)
- Christopher R. McCartney
- Center for Research in Reproduction and Department of MedicineUniversity of Virginia School of MedicineCharlottesvilleVAUSA
| | - Rebecca E. Campbell
- Centre for Neuroendocrinology and Department of PhysiologySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - John C. Marshall
- Center for Research in Reproduction and Department of MedicineUniversity of Virginia School of MedicineCharlottesvilleVAUSA
| | - Suzanne M. Moenter
- Departments of Molecular & Integrative PhysiologyInternal MedicineObstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
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Li Z, Xu MJ, Jin Y, Zhu BG. Premenstrual dysphoric disorder is associated with the longer length from clitoris to urethra. BMC WOMENS HEALTH 2021; 21:266. [PMID: 34225734 PMCID: PMC8259395 DOI: 10.1186/s12905-021-01403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
Background Premenstrual dysphoric disorder (PMDD) is a common, recently recognized, psychiatric condition among reproductive women, reflecting abnormal responsivity to ovarian steroids. Moreover, the potential organizational effect of prenatal sex hormones during PMDD has got attentions, but there have been considerably less of researches on this topic. The aim of this research was to investigate the possible role of prenatal androgen in the PMDD. Methods Anogenital distance (AGD), the distance between a woman’s clitoris and her urethral meatus (CUMD), left and right 2D:4D ratios were measured in 77 subjects (25 patients with PMDD), as these anthropometric indicators are considered to indirectly reflect prenatal androgen exposures in utero. Results Patients with PMDD had a longer CUMD than controls (25.03 ± 4.73 vs. 22.07 ± 4.30, P = 0.008), while there were no significant difference between PMDD group and control group in the AGD and right and left 2D:4D ratios. Conclusion Atypical high prenatal androgen exposure might predispose individuals to be susceptible to PMDD. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01403-4.
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Affiliation(s)
- Zheng Li
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, 200124, China.,Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Meng-Jiao Xu
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Ying Jin
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, 200124, China
| | - Bing-Gen Zhu
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, 200124, China. .,Department of Psychiatry, Tenth Peoples' Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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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: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [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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Padmanabhan V, Moeller J, Puttabyatappa M. Impact of gestational exposure to endocrine disrupting chemicals on pregnancy and birth outcomes. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 92:279-346. [PMID: 34452689 DOI: 10.1016/bs.apha.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the advent of industrialization, humans are exposed to a wide range of environmental chemicals, many with endocrine disrupting potential. As successful maintenance of pregnancy and fetal development are under tight hormonal control, the gestational exposure to environmental endocrine disrupting chemicals (EDC) have the potential to adversely affect the maternal milieu and support to the fetus, fetal developmental trajectory and birth outcomes. This chapter summarizes the impact of exposure to EDCs both individually and as mixtures during pregnancy, the immediate and long-term consequences of such exposures on the mother and fetus, the direct and indirect mechanisms through which they elicit their effects, factors that modify their action, and the research directions to focus future investigations.
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Affiliation(s)
| | - Jacob Moeller
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Sánchez-Ferrer ML, De La Cruz-Sánchez E, Arense-Gonzalo JJ, Prieto-Sánchez MT, Bernabeu-González I, Carmona-Barnosi A, Mendiola J, Torres-Cantero AM. Body Composition and Characterization of Skinfold Thicknesses from Polycystic Ovary Syndrome Phenotypes. A Preliminar Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2977. [PMID: 33799425 PMCID: PMC8002058 DOI: 10.3390/ijerph18062977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
To describe whether polycystic ovary syndrome (PCOS) phenotypes vary in their body composition and skinfold (SKF) thicknesses and if they differ from women without PCOS, a preiminar case-control study was performed. A total of 117 cases were diagnosed using the Rotterdam criteria. Gynecological examinations and transvaginal ultrasound were performed in all women (266 women). Anthropometric measurements including SKF thickness were taken according to the restricted profile protocol of the international standards for the anthropometric evaluation according to the International Society of the Advancement of Kinanthropometry (ISAK). Women with PCOS had higher body mass index and percentage of fat mass with respect to controls. The endomorphy component was also significantly higher in women with PCOS than in controls. Each PCOS phenotype displayed a different representation in the somatochart respect to the others phenotypes and also compared to controls. Women with PCOS had significantly higher ∑7 SKF (p = 0.013), ∑appendicular SKF (p = 0.017) and ∑arm SKF (p = 0.019) than controls. H-O-POM phenotype had higher 7∑ SKF (p = 0.003), ∑appendicular SKF (p = 0.01), ∑arm SKF (0.005), ∑leg SKF, and ∑trunk SKF (0.008) and also a higher fast mass percentage than controls (p = 0.011). In conclusion, body composition evaluated by ISAK protocol is different in women with PCOS, especially in the complete phenotype (H-O-POM). This could have relevant implications in terms of clinical evaluation and follow-up of these women, although more researches in this field are needed.
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Affiliation(s)
- María L. Sánchez-Ferrer
- Department of Obstetrics & Gynecology, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar, Spain; (M.L.S.-F.); (M.T.P.-S.); (I.B.-G.); (A.C.-B.)
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Spain;
| | - Ernesto De La Cruz-Sánchez
- Division of Preventive Medicine and Public Health, Department of Physical Activity, Faculty of Sport Sciences, University of Murcia, C/Santa Alicia, s/n, 30720 Santiago de la Ribera, Spain;
| | - Julián J. Arense-Gonzalo
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Spain;
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100 Espinardo, Spain;
| | - María T. Prieto-Sánchez
- Department of Obstetrics & Gynecology, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar, Spain; (M.L.S.-F.); (M.T.P.-S.); (I.B.-G.); (A.C.-B.)
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Spain;
| | - Itziar Bernabeu-González
- Department of Obstetrics & Gynecology, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar, Spain; (M.L.S.-F.); (M.T.P.-S.); (I.B.-G.); (A.C.-B.)
| | - Ana Carmona-Barnosi
- Department of Obstetrics & Gynecology, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar, Spain; (M.L.S.-F.); (M.T.P.-S.); (I.B.-G.); (A.C.-B.)
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100 Espinardo, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alberto M. Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar, Spain;
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100 Espinardo, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar, Spain
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Assessment of Optimism in Women with Polycystic Ovary Syndrome: A Case Control-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052352. [PMID: 33670871 PMCID: PMC7957798 DOI: 10.3390/ijerph18052352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy characterized by hyperandrogenism and anovulation that may pervade psychological dimensions such as dispositional optimism. Considering how PCOS influences mental health and the lack of studies on this matter, this research was aimed at assessing optimism and associated factors in PCOS. A case–control study of 156 patients with PCOS and 117 controls was conducted. All woman filled out the Life Orientation Test-Revised (LOT-R), a self-report questionnaire for measuring dispositional optimism. Medication, pain severity, gynecological, and sociodemographic information was also collected. Lower optimism was found in patients with PCOS compared to controls, even after covariate adjustment (LOT-R global scores: 14.1 vs. 15.9, p = 0.020). Our study provides evidence that a personality characteristic with important implications in illness prognosis may be affected in PCOS. We propose to assess dispositional optimism with the LOT-R scale in the gynecological appointment and tailor medical attention accordingly as a way to improve the comprehensive care of these patients within a multidisciplinary team.
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14
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Luan M, Ji H, Miao M, Liang H, Wang Z, Chen Y, Chen A, Cao W, Yuan W. Association between prenatal exposure to polybrominated diphenyl ethers and anogenital distance in girls at ages 0-4 years. Int J Hyg Environ Health 2021; 233:113706. [PMID: 33582604 DOI: 10.1016/j.ijheh.2021.113706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
Anogenital distance (AGD) is a sensitive marker for the effect of in utero hormonal disturbance. However, studies on the associations between prenatal exposure to polybrominated diphenyl ethers (PBDEs), a group of endocrine disruptors, and AGD are limited. We examined the associations between prenatal PBDE exposure and AGD in girls at ages 0-4 years in the Shanghai-Minhang Birth Cohort Study. We measured PBDE in cord plasma collected from 148 girls at birth. Of them, two AGD metrics (AGDAC: from the anterior surface of the clitoral hood to the center of the anus; AGDAF: from the posterior end of the fourchette to the center of the anus) were measured in 142, 114, 104 and 120 of girls at birth, 6, 12, and 48 months of age, respectively. Linear regression models and linear mixed models were used to evaluate the associations between PBDE exposure and AGD at ages 0-4 years. We found positive associations of PBDE exposure with AGDAF and AGDAC in linear regression models, although some associations only reached significance at 6 and 48 months of age. For AGDAF, the associations were statistically significant for BDE-47, -99, and -100 at 6 months of age (β = 2.34, 95% CI (0.21, 4.48) for BDE-47; β = 2.21, 95% CI (0.05, 4.36) for BDE-99; β = 2.12, 95% CI (0.01, 4.23) for BDE-100), and for BDE-99 and -100 at 48 months of age (β = 4.49, 95% CI (1.27, 7.71) for BDE-99; β = 5.04, 95% CI (1.87, 8.22) for BDE-100), while statistically significant associations with AGDAC were only observed for BDE-99, -100, -153, and ∑5PBDEs at 48 months of age (β = 7.62, 95% CI (2.59, 12.64) for BDE-99; β = 7.04, 95% CI (2.01, 12.07) for BDE-100; β = 5.41, 95% CI (0.45, 10.38) for BDE-153; β = 5.05 mm, 95% CI (0.09, 10.01 for ∑5PBDEs). A consistent pattern of positive associations between prenatal exposure to PBDEs and AGD was also observed in linear mixed models. The finding provided further insights into the adverse effects of PBDEs on reproductive development at low dose exposure.
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Affiliation(s)
- Min Luan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China
| | - Honglei Ji
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Ziliang Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Yafei Chen
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - 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, Wuhan, China
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China.
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Are Dietary Indices Associated with Polycystic Ovary Syndrome and Its Phenotypes? A Preliminary Study. Nutrients 2021; 13:nu13020313. [PMID: 33499268 PMCID: PMC7911683 DOI: 10.3390/nu13020313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder which impairs ovarian function. The adherence to healthy dietary patterns and physical exercise are the first line of recommended treatment for PCOS patients, but it is yet unclear what type of diet is more adequate. In this case-control study, we explored associations between adherence to five dietary quality indices and the presence of PCOS. We enrolled 126 cases of PCOS and 159 controls living in Murcia (Spain). Diagnostic of PCOS and its phenotypes were established following the Rotterdam criteria (hyperandrogenism (H), oligoanovulation (O), polycystic ovaries morphology (POM)). We used a validated food frequency questionnaires to calculate the scores of five dietary indices: alternate Healthy Eating index (AHEI), AHEI-2010, relative Mediterranean Dietary Score (rMED), alternate Mediterranean Dietary Score (aMED) and Dietary Approaches to Stop Hypertension (DASH). We used multivariable logistic regression to estimate adjusted odds ratios and confidence intervals. In the multivariable analysis, AHEI-2010 index was inversely associated with Hyperandrogenism + Oligoanovulation PCOS phenotype (ORQ3 vs. Q1 = 0.1; 95% CI: (0.0; 0.9); Pfor trend = 0.02). We did not find any statistical significant association between dietary indices and total anovulatory or ovulatory PCOS. However, further studies with higher sample sizes exploring these associations among the diverse phenotypes of PCOS are highly warranted.
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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] [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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Hong X, Qin P, Yin J, Shi Y, Xuan Y, Chen Z, Zhou X, Yu H, Peng D, Wang B. Clinical Manifestations of Polycystic Ovary Syndrome and Associations With the Vaginal Microbiome: A Cross-Sectional Based Exploratory Study. Front Endocrinol (Lausanne) 2021; 12:662725. [PMID: 33967963 PMCID: PMC8104084 DOI: 10.3389/fendo.2021.662725] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies suggest that the vaginal microbiome is associated with polycystic ovary syndrome (PCOS). However, the clinical manifestations of PCOS are heterogeneous. Whether the vaginal microbiome is related with different clinical symptoms was unknown. MATERIALS AND METHODS In this cross-sectional study, 89 female patients with PCOS admitted to Zhongda Hospital (Nanjing, China) were included. Basic demographic information, health-related behaviors, clinical manifestations and sex hormone levels were comprehensively recorded for all patients. Vaginal swabs were acquired for microbiota sequencing of the V3-V4 region of the 16S rRNA gene. RESULTS The prevalence of bacterial vaginitis and vulvovaginal candidiasis was 15.7% and 13.5%, respectively, within the PCOS patients, which were the most important factors affecting the vaginal microbiome (permutational multivariate analysis of variance test, R2 = 0.108, P = 0.001). The vaginal microbiome was associated with specific clinical manifestations of PCOS, including acanthosis nigricans, intermenstrual bleeding, pregnancy history, testosterone level and anti-müllerian hormone level, with P values < 0.05. The abundance of Lactobacillus crispatus was higher (P = 0.010) while that of Lactobacillus iners was lower (P = 0.036) among PCOS patients with elevated testosterone levels. Other potential bacterial biomarkers were not statistically significant after adjusting for confounding factors. No evidence of associations of other common manifestations of PCOS, such as obesity and acne, with the vaginal microbiome was obtained. CONCLUSION Vaginal bacterial species among PCOS patients with variable clinical manifestations, especially differences in testosterone levels, are distinct. Further studies are essential to investigate the microbiota and molecular mechanisms underpinning this disease.
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Affiliation(s)
- Xiang Hong
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pengfei Qin
- Department of Obstetrics and Gynecology, Medical School, Southeast University, Nanjing, China
| | - Jiechen Yin
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yong Shi
- Department of Obstetrics and Gynecology, Zhong Da Hospital, Southeast University, Nanjing, China
| | - Yan Xuan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Zhengqi Chen
- Department of Obstetrics and Gynecology, Medical School, Southeast University, Nanjing, China
| | - Xu Zhou
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Medical School, Southeast University, Nanjing, China
- Department of Obstetrics and Gynecology, Zhong Da Hospital, Southeast University, Nanjing, China
| | - Danhong Peng
- Department of Obstetrics and Gynecology, Medical School, Southeast University, Nanjing, China
- Department of Obstetrics and Gynecology, Zhong Da Hospital, Southeast University, Nanjing, China
- *Correspondence: Bei Wang, ; Danhong Peng,
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- *Correspondence: Bei Wang, ; Danhong Peng,
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Dumesic DA, Hoyos LR, Chazenbalk GD, Naik R, Padmanabhan V, Abbott DH. Mechanisms of intergenerational transmission of polycystic ovary syndrome. Reproduction 2020; 159:R1-R13. [PMID: 31376813 DOI: 10.1530/rep-19-0197] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022]
Abstract
Developmental origins of adult disease (DoHAD) refers to critical gestational ages during human fetal development and beyond when the endocrine metabolic status of the mother can permanently program the physiology and/or morphology of the fetus, modifying its susceptibility to disease after birth. The aim of this review is to address how DoHAD plays an important role in the phenotypic expression of polycystic ovary syndrome (PCOS), the most common endocrinopathy of women characterized by hyperandrogenism, oligo-anovulation and polycystic ovarian morphology. Clinical studies of PCOS women are integrated with findings from relevant animal models to show how intergenerational transmission of these central components of PCOS are programmed through an altered maternal endocrine-metabolic environment that adversely affects the female fetus and long-term offspring health. Prenatal testosterone treatment in monkeys and sheep have been particularly crucial in our understanding of developmental programming of PCOS because organ system differentiation in these species, as in humans, occurs during fetal life. These animal models, along with altricial rodents, produce permanent PCOS-like phenotypes variably characterized by LH hypersecretion from reduced steroid-negative feedback, hyperandrogenism, ovulatory dysfunction, increased adiposity, impaired glucose-insulin homeostasis and other metabolic abnormalities. The review concludes that DoHAD underlies the phenotypic expression of PCOS through an altered maternal endocrine-metabolic environment that can induce epigenetic modifications of fetal genetic susceptibility to PCOS after birth. It calls for improved maternal endocrine-metabolic health of PCOS women to lower their risks of pregnancy-related complications and to potentially reduce intergenerational susceptibility to PCOS and its metabolic derangements in offspring.
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Affiliation(s)
- Daniel A Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Luis R Hoyos
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gregorio D Chazenbalk
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rajanigandha Naik
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - David H Abbott
- Department of Obstetrics and Gynecology and Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin, USA
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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] [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] [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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Foetal Sonographic Anogenital Distance Is Longer in Polycystic Ovary Syndrome Mothers. J Clin Med 2020; 9:jcm9092863. [PMID: 32899698 PMCID: PMC7563834 DOI: 10.3390/jcm9092863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Anogenital distance (AGD) is a biomarker for the prenatal hormonal environment. Androgen excess is a key element in polycystic ovary syndrome (PCOS). The aim of this study was to assess the sonographic foetal AGD in a population of PCOS mothers in comparison to the general population. Foetal AGD was measured prospectively by 2D ultrasound in PCOS mothers and compared to prenatal AGD nomograms. The results were interpreted regarding maternal and foetal characteristics. The mean sonographic foetal AGD centile measurement in PCOS mothers was significantly longer in comparison to the general population (86.04% ± 18.22; p < 0.001). Estimated foetal weight and birthweight were appropriate for gestational age and did not correlate with AGD. Sonographic foetal AGD was significantly longer in PCOS diabetic mothers and in those who conceived following assisted reproduction treatments when compared to the general population (p < 0.001). Our results support the role of AGD as a biomarker of the prenatal hormonal environment and provide evidence for the hyperandrogenic effect in PCOS pregnancies on foetal androgenic status and genitalia development.
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22
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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] [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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Prieto-Sánchez MT, Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, Torres-Cantero AM. Anogenital distance and anti-Müllerian hormone combined improves the diagnosis of polycystic ovary syndrome. HUM FERTIL 2020; 25:274-282. [PMID: 32713212 DOI: 10.1080/14647273.2020.1795574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to assess the accuracy of the combination of anogenital distance (AGD) and anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). The study included women diagnosed with PCOS and a control group who attended the Clinical University Hospital 'Virgen de la Arrixaca' in Murcia (Spain). Serum concentrations of AMH were measured and two AGD measurements were obtained: (i) from the anterior clitoral surface to the upper verge of the anus (AGDAC); and (ii) from the posterior fourchette to the upper verge of the anus (AGDAF). Data were assessed by receiver operator characteristic (ROC) curves. Women with PCOS (n = 126) had significantly larger AGDAC (80.5 ± 11.3 versus 76.0 ± 10.4 mm; p < 0.001) and higher AMH (7.2 ± 4.7 versus 3.1 ± 2.2; p < 0.001) compared to control women (n = 159). Women with serum AMH above 3.8 ng/mL (clinical cut-off used in PCOS) were 9.1 times more likely to have PCOS (95% CI: 5.1-16.2). The area under the ROC curve of combined model of AMH and AGDAC was 0.87 (95% CI: 0.83-0.91). The combined model for predicting PCOS based on AMH and AGDAC has better diagnostic accuracy than that of AMH or AGDAC alone. This model could be useful for clinicians and improve diagnosis and clinical management of these women.
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Affiliation(s)
- María T Prieto-Sánchez
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, Murcia, Spain.,Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Ana I Hernández-Peñalver
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, Murcia, Spain
| | - María L Sánchez-Ferrer
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, Murcia, Spain.,Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain.,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Murcia, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain.,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Murcia, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine, "Virgen de la Arrixaca" University Clinical Hospital, Murcia, Spain
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24
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Sánchez-Ferrer ML, Adoamnei E, Prieto-Sánchez MT, Mendiola J, Corbalán-Biyang S, Moñino-García M, Palomar-Rodríguez JA, Torres-Cantero AM. Health-related quality of life in women with polycystic ovary syndrome attending to a tertiary hospital in Southeastern Spain: a case-control study. Health Qual Life Outcomes 2020; 18:232. [PMID: 32677953 PMCID: PMC7364602 DOI: 10.1186/s12955-020-01484-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a chronic condition with symptoms affecting many women at reproductive age and evaluating their health-related quality of Life (HRQoL) is an important issue. Moreover, differences in the HRQoL between women with different PCOS phenotypes have never been analyzed. Therefore, the aim of our study was to compare the HRQoL between women with PCOS -and its phenotypes- and controls attending to a tertiary hospital. METHODS A group of 117 women with PCOS and 153 controls were studied between 2014 and 2016. Controls were women without PCOS attending the gynecological outpatient clinic for routine examinations. Cases were women attending the same setting and diagnosed with PCOS. PCOS diagnose was performed following the Rotterdam Criteria and women were further classified by anovulatory or ovulatory phenotypic subtype. Women underwent physical and gynecological exams and completed health questionnaires including the Short Form-12v2. Eight scales and two component summary scores [Physical (PCS) and Mental (MCS), respectively] were calculated. Bivariate and multivariate analyses were performed to assess differences in HRQoL between women with PCOS and controls. RESULTS All women with PCOS and anovulatory PCOS presented lower score in PCS compared to controls [mean (95%CI): 53.7 (52.5-54.9) and 52.9 (51.5-54.4) vs. 55.8 (54.8-56.8); p-values< 0.01], as well as lower scores for five out of the eight scales (p-values < 0.05) after adjusting by age, body mass index, infertility, educational level and current occupation. No significant differences were observed for the MCS between women with or without PCOS or its phenotypic subtypes. CONCLUSIONS HRQoL was significantly decreased in adult women with PCOS and its anovulatory phenotype compared to controls attending the outpatient clinic of a tertiary hospital. These results may have implications for the clinical practice and suggest the need for specific interventions in women with PCOS.
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Affiliation(s)
- María L Sánchez-Ferrer
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, 30120, El Palmar (Murcia), Spain.,Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain
| | - Evdochia Adoamnei
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain. .,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100, Espinardo (Murcia), Spain.
| | - María T Prieto-Sánchez
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, 30120, El Palmar (Murcia), Spain.,Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain.,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100, Espinardo (Murcia), Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
| | - Shiana Corbalán-Biyang
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca" University Clinical Hospital, 30120, El Palmar (Murcia), Spain
| | - Miriam Moñino-García
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain.,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100, Espinardo (Murcia), Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación y Financiación Sanitaria, Consejería de Salud, Región de Murcia, 30001, Murcia, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar (Murcia), Spain.,Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, 30100, Espinardo (Murcia), Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain.,Department of Preventive Medicine, "Virgen de la Arrixaca" University Clinical Hospital, 30120, El Palmar (Murcia), Spain
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25
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Sánchez-Ferrer ML, Arense-Gonzalo JJ, Prieto-Sánchez MT, Alfosea-Marhuenda E, Gómez-Carrascosa I, Iniesta MA, Mendiola J, Torres-Cantero AM. Does the anogenital distance change across pregnancy? Reprod Biomed Online 2020; 41:527-533. [PMID: 32586732 DOI: 10.1016/j.rbmo.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 01/03/2023]
Abstract
RESEARCH QUESTION Does the length of the anogenital distance (AGD), an anthropometric biomarker of fetal androgen exposure, change across pregnancy? It has been suggested that AGD remains stable during adulthood with no changes across the menstrual cycle. No studies, however, have been carried out during pregnancy, during which women are exposed to important hormonal and anthropometric variations. DESIGN A cohort study of 186 singleton pregnant women recruited in the first trimester of pregnancy. 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) and body mass index (BMI) were obtained in each trimester. Generalized linear model for repeated measures was carried out to assess differences in AGDs and BMI across the three trimesters of the pregnancy. RESULTS In crude analyses, AGDAC was progressively and significantly longer as the pregnancy developed (first trimester: 87.69 ± 13.14mm; second trimester: 89.69 ± 13.47mm; third trimester: 91.95 ± 13.25 mm; P < 0.001), whereas AGDAF did not significantly change throughout pregnancy (first trimester: 28.37 ± 6.94 mm; second trimester: 28.09 ± 7.66 mm; third trimester: 28.94 ± 6.7 mm). In the multivariable mixed-effect models for fixed effect (trimester) and time-covariate (BMI), AGDs did not show significant associations with trimesters of pregnancy when BMI was included in the model. CONCLUSIONS Our results suggest that AGDAF and AGDAC, when adjusted by BMI, do not change throughout gestation despite maternal anthropometric variations during pregnancy. AGDAF may be a meaningful measurement at any time during pregnancy without considering BMI. Therefore, maternal AGDAF may be used as a prenatal biomarker of the mother's in-uteru hormonal exposure even during pregnancy.
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Affiliation(s)
- María L Sánchez-Ferrer
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain
| | - Julian J Arense-Gonzalo
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - María T Prieto-Sánchez
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain.
| | - Emilia Alfosea-Marhuenda
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Inmaculada Gómez-Carrascosa
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Miguel A Iniesta
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Department of Preventive Medicine, 'Virgen de la Arrixaca' University Clinical l Hospital, Murcia Murcia 30003, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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26
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Ercin S, Ertas S, Dundar O, Oktem O, Yakin K. Anogenital distance in newborn infants conceived by assisted reproduction and natural conception. Reprod Biomed Online 2020; 41:474-482. [PMID: 32576490 DOI: 10.1016/j.rbmo.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/09/2022]
Abstract
RESEARCH QUESTION Does anogenital distance (AGD) differ in newborn infants conceived through assisted reproduction technology (ART) compared with those conceived naturally? DESIGN This case-control study looked at anthropometric and anogenital measurements in 247 male and 200 female newborns born after ART (n = 121) or natural conception (n = 326), within 24 h of birth. Anogenital measurements included distance from the centre of the anus to the anterior clitoris (AGDAC) and to the posterior fourchette (AGDAF) in female infants, and from the centre of the anus to the posterior base of the scrotum (AGDAS) and to the anterior base of the penis (AGDAP) in male infants. RESULTS ART mothers were older, more likely to be nulliparous and delivered by Caesarean section at an earlier gestational week. AGDAS of male infants was approximately twice the AGDAF of female infants (17.6 ± 5.0 versus 9.1 ± 3.6 mm). AGDAF in female infants conceived by ART compared with those conceived naturally was not significantly different (8.8 ± 3.6 versus 9.3 ± 3.6 mm; P = 0.404). AGDAC were also comparable for both groups (27.4 ± 6.3 versus 27.7 ± 7.1 mm; P = 0.770). In male infants, no significant difference was seen between ART and natural conception groups in terms of AGDAS (17.4 ± 4.6 versus 17.7 ± 5.2 mm, P = 0.742) and AGDAP (37.5 ± 6.6 versus 38.0 ± 6.7 mm, P = 0.589). When adjusted for gestational age, weight, length and head circumference, mode of conception was not associated with differences in any of the anogenital measurements. CONCLUSIONS AGD measurements in infants conceived by ART are no different from those of infants conceived naturally.
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Affiliation(s)
- Secil Ercin
- American Hospital, Women's Health Center Istanbul, Turkey
| | - Sinem Ertas
- American Hospital, Women's Health Center Istanbul, Turkey
| | - Oznur Dundar
- American Hospital, Women's Health Center Istanbul, Turkey
| | - Ozgur Oktem
- Department of Obstetrics and Gynecology, Koc University School of Medicine Istanbul, Turkey
| | - Kayhan Yakin
- American Hospital, Women's Health Center Istanbul, Turkey; Department of Obstetrics and Gynecology, Koc University School of Medicine Istanbul, Turkey.
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Abstract
Although the fundamental symptoms of polycystic ovary syndrome (PCOS) relate most directly to ovarian dysfunction, central neuroendocrine systems play a prominent role in its pathophysiology. Gonadotropin-releasing hormone (GnRH) pulse generator resistance to negative feedback contributes to rapid GnRH pulse secretion, which promotes gonadotropin abnormalities that foster ovarian hyperandrogenemia and ovulatory dysfunction. The causes of GnRH neuron dysfunction, however, have remained enigmatic. In this review, we highlight a number of recent preclinical and clinical studies pertinent to the neuroendocrine abnormalities of PCOS, including those that have provided important insights into the relevance of animal models with PCOS-like features, the potential roles of kisspeptin and γ-aminobutyric acid (GABA)-ergic neurons, and the potential role of anti-Müllerian hormone.
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Abstract
Polycystic ovary syndrome (PCOS), characterized by hormonal imbalance and ovarian dysfunction, often starts during adolescence. Inconsistent diagnostic criteria, variable provider knowledge, and lack of consensus pose specific challenges for the care of women with PCOS. These factors encourage inaccurate diagnosis with both under and overdiagnosis. This unfavorable diagnostic experience exasperates affected women and limits timely opportunities for intervention to minimize associated comorbidities, especially during the transition from pediatric to adult care. Recognition of these issues in the care of adolescents and women with PCOS inspired the development of the International Evidence-Based PCOS Guidelines, which emphasize the prevention, screening, and treatment of PCOS across the reproductive lifespan. The Guidelines and accompanying meta-analyses focus on three major categories of associated comorbidities: (1) reproductive; (2) metabolic; and (3) psychological. With the exception of infertility, this article considers common manifestations and comorbidities associated with PCOS throughout the lifecycle. Healthy lifestyle interventions with prevention of excess weight gain comprise the primary intervention for all comorbidities. Hence, early identification of girls "at risk" for PCOS and those with PCOS is a priority. Extensive guidelines for provider and patient education aim to decrease the medical, psychosocial, and economic burdens attributable to PCOS and its associated comorbidities.
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Siemienowicz KJ, Filis P, Shaw S, Douglas A, Thomas J, Mulroy S, Howie F, Fowler PA, Duncan WC, Rae MT. Fetal androgen exposure is a determinant of adult male metabolic health. Sci Rep 2019; 9:20195. [PMID: 31882954 PMCID: PMC6934666 DOI: 10.1038/s41598-019-56790-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Androgen signalling is a critical driver of male development. Fetal steroid signalling can be dysregulated by a range of environmental insults and clinical conditions. We hypothesised that poor adult male health was partially attributable to aberrant androgen exposure during development. Testosterone was directly administered to developing male ovine fetuses to model excess prenatal androgenic overexposure associated with conditions such as polycystic ovary syndrome (PCOS). Such in utero androgen excess recreated the dyslipidaemia and hormonal profile observed in sons of PCOS patients. 1,084 of 15,134 and 408 of 2,766 quantifiable genes and proteins respectively, were altered in the liver during adolescence, attributable to fetal androgen excess. Furthermore, prenatal androgen excess predisposed to adolescent development of an intrahepatic cholestasis-like condition with attendant hypercholesterolaemia and an emergent pro-fibrotic, pro-oxidative stress gene and protein expression profile evident in both liver and circulation. We conclude that prenatal androgen excess is a previously unrecognised determinant of lifelong male metabolic health.
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Affiliation(s)
| | - Panagiotis Filis
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Sophie Shaw
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alex Douglas
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer Thomas
- School of Applied Science, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Sally Mulroy
- School of Applied Science, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Forbes Howie
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Paul A Fowler
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - W Colin Duncan
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Mick T Rae
- School of Applied Science, Edinburgh Napier University, Edinburgh, EH11 4BN, UK.
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Abbott DH, Rogers J, Dumesic DA, Levine JE. Naturally Occurring and Experimentally Induced Rhesus Macaque Models for Polycystic Ovary Syndrome: Translational Gateways to Clinical Application. Med Sci (Basel) 2019; 7:medsci7120107. [PMID: 31783681 PMCID: PMC6950671 DOI: 10.3390/medsci7120107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/16/2019] [Accepted: 11/16/2019] [Indexed: 12/19/2022] Open
Abstract
Indian rhesus macaque nonhuman primate models for polycystic ovary syndrome (PCOS) implicate both female hyperandrogenism and developmental molecular origins as core components of PCOS etiopathogenesis. Establishing and exploiting macaque models for translational impact into the clinic, however, has required multi-year, integrated basic-clinical science collaborations. Paradigm shifting insight has accrued from such concerted investment, leading to novel mechanistic understanding of PCOS, including hyperandrogenic fetal and peripubertal origins, epigenetic programming, altered neural function, defective oocytes and embryos, adipogenic constraint enhancing progression to insulin resistance, pancreatic decompensation and type 2 diabetes, together with placental compromise, all contributing to transgenerational transmission of traits likely to manifest in adult PCOS phenotypes. Our recent demonstration of PCOS-related traits in naturally hyperandrogenic (High T) female macaques additionally creates opportunities to employ whole genome sequencing to enable exploration of gene variants within human PCOS candidate genes contributing to PCOS-related traits in macaque models. This review will therefore consider Indian macaque model contributions to various aspects of PCOS-related pathophysiology, as well as the benefits of using macaque models with compellingly close homologies to the human genome, phenotype, development and aging.
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Affiliation(s)
- David H. Abbott
- Department of Obstetrics and Gynecology, Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI 53715, USA
- Correspondence: ; Tel.: +1-608-698-1953
| | - Jeffrey Rogers
- Department of Molecular and Human Genetics and Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Daniel A. Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Jon E. Levine
- Department of Neuroscience, Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI 53715, USA;
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Simsir C, Pekcan MK, Aksoy RT, Ecemis T, Coskun B, Kilic SH, Tokmak A. The ratio of anterior anogenital distance to posterior anogenital distance: A novel-biomarker for polycystic ovary syndrome. J Chin Med Assoc 2019; 82:782-786. [PMID: 31356564 DOI: 10.1097/jcma.0000000000000150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. The etiopathogenesis of the disease remains uncertain. Additionally, a full consensus has not been reached regarding PCOS diagnostic criteria. Several attempts have been made to diagnose PCOS with a simple clinical biomarker, but most of them failed. This study aims to investigate the possible association between PCOS and anogenital distance (AGD), which is an important sign of intrauterine androgen exposure. METHODS A prospective cohort study was conducted on 130 women. The study group contained 65 women with PCOS whereas 65 healthy women were recruited for the control group, all between 18 and 40 years in age. The groups were compared in terms of demographics and clinical and laboratory parameters. Both anterior and posterior AGDs and associated ratios were recorded for each woman. RESULTS The mean ratio of anterior AGD to posterior AGD for the PCOS and control group were 4.4 ± 1.0 and 4.9 ± 1.0, respectively (p = 0.003). Regression analysis demonstrated that this ratio significantly and positively correlated with the waist to hip ratio and negatively correlated with the free androgen index. CONCLUSION AGD was initially used to define sexual differentiation of animals. Subsequent human studies showed that boys have longer AGDs than girls. Recent studies supporting the hypothesis that extreme prenatal androgen exposure contributes to PCOS found that AGD in adult PCOS patients was longer than control PCOS patients. However, a novel biomarker other than AGD needs to be identified to standardize these measurements. This work represents the first study to evaluate the ratio of anterior AGD to posterior AGD in PCOS patients. In this study, AGD anterior and posterior measurements were longer in PCOS patients than in controls. However, the strongest predictor of PCOS is the ratio of anterior to posterior AGD.
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Affiliation(s)
- Coskun Simsir
- Department of Obstetrics and Gynecology, Liv Hospital, Ankara, Turkey
| | - Meryem Kuru Pekcan
- Division of Gynecological Endocrinology, Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, University of Health Sciences, Ankara, Turkey
| | - Rifat Taner Aksoy
- Division of Gynecological Endocrinology, Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, University of Health Sciences, Ankara, Turkey
| | - Tolga Ecemis
- Department of Obstetrics and Gynecology, Liv Hospital, Ankara, Turkey
| | - Bugra Coskun
- Department of Obstetrics and Gynecology, Liv Hospital, Ankara, Turkey
| | | | - Aytekin Tokmak
- Division of Gynecological Endocrinology, Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, University of Health Sciences, Ankara, Turkey
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Fabregues F, González-Foruria I, Peñarrubia J, Carmona F. Ovarian response is associated with anogenital distance in patients undergoing controlled ovarian stimulation for IVF. Hum Reprod 2019; 33:1696-1704. [PMID: 30016431 DOI: 10.1093/humrep/dey244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/19/2018] [Indexed: 01/18/2023] Open
Abstract
STUDY QUESTION Is the length of the anogenital distance (AGD) a biomarker of ovarian reserve and response to controlled ovarian stimulation (COS)? SUMMARY ANSWER Shorter AGD is associated with presence of poor ovarian response. WHAT IS KNOWN ALREADY Organ development during prenatal life is influenced by the prevailing intrauterine environment, and it has been suggested that nutritional, environmental and toxic factors could affect ovarian reserve set prenatally. AGD is a biomarker of prenatal-hormonal environment and observational studies have shown an association between its length and reproductive parameters in both sexes. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study of 437 women treated with IVF/ICSI conducted in a tertiary-care university hospital between January and December 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS All women underwent their first COS for IVF/ICSI and reached criteria for oocyte retrieval. Based on the number of oocytes obtained, patients were divided into three groups: poor responders (≤3 oocytes) (n = 50), normoresponders (4-15 oocytes) (n = 332) and high responders (>15 oocytes) (n = 55). Before retrieval, the following patient data were recorded: age, body mass index (BMI), ovarian reserve markers (anti-Müllerian hormone [AMH], antral follicle count [AFC] and follicular stimulation hormone [FSH]), cause of infertility, total doses of gonadotropins used and ovarian sensitivity index (OSI). Patients with previous pregnancies, polycystic ovary syndrome (PCOS), endometriosis and previous ovarian or genital surgery were excluded. Anthropometric biomarkers of AGDAC (anus-clitoris) and AGDAF (anus-fourchette) were measured in all patients under sedation on the day of retrieval and before proceeding to oocyte pick-up. Multiple linear regression analyses were used to examine the association between both AGD and ovarian reserve markers, the total units of gonadotropins used, the number of oocytes obtained and the OSI. Logistic regression was used to predict poor response in COS for IVF/ICSI, while accounting for confounders such as age and BMI. MAIN RESULTS AND THE ROLE OF CHANCE Baseline FSH, AMH, AFC and age were significantly different among the three groups of ovarian response, as were the units of gonadotropin used, and the ovarian sensitivity index (OSI) (P < 0.001). Both AGDAC and AGDAF measurements were positively correlated with AMH levels (r = 0.38 and r = 0.21; P < 0.05), AFC (r = 0.41 and r = 0.20; P < 0.05), the OSI (r = 0.24 and r = 0.19; P < 0.05) and the number of oocytes retrieved (r = 0.29 and r = 0.28, respectively; P < 0.05). Conversely, there was a negative correlation between both AGD measurements and the doses of gonadotropins used (r= -0.19 and r= -0.15; P < 0.05). The area under the curve (AUC) for prediction of poor response of AGDAC was 0.70 (95% CI 0.66, 0.75), which was comparable to the classic ovarian reserve markers, such as AFC and AMH. AGDAF showed a significantly worse predictive capacity for poor ovarian response (AUC 0.60 [95% CI 0.55, 0.60]) than AMH and AFC. LIMITATIONS, REASONS FOR CAUTION The population used for the study was a highly selected group of infertile women who underwent COS for IVF, so the findings of this research may not be applicable for general population. Besides, measurement or selection biases might have been possible and must be considered. WIDER IMPLICATIONS OF THE FINDINGS The findings of this study suggest that in utero exposure to certain hormonal environments could affect the ovarian reserve set prenatally. STUDY FUNDING/COMPETING INTEREST(S) None. The authors have no competing interests to declare.
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Affiliation(s)
- F Fabregues
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Spain
| | - I González-Foruria
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Spain
| | - J Peñarrubia
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Spain
| | - F Carmona
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Spain
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Jain VG, Goyal V, Chowdhary V, Swarup N, Singh RJ, Singal A, Shekhawat P. Anogenital distance is determined during early gestation in humans. Hum Reprod 2019; 33:1619-1627. [PMID: 30124868 DOI: 10.1093/humrep/dey265] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/30/2018] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION Does cord blood androgen level obtained at birth affect the AGD in human newborns? SUMMARY ANSWER In human newborns, though males have a significantly longer AGD compared to females (as early as 22 weeks of gestation) the AGD is not affected by androgen levels at birth in both the sexes. WHAT IS KNOWN ALREADY Animal studies have reported a critical time period in early fetal life, termed the masculinization programming window (MPW) during which AGD is fixed by in utero androgen action and is unaffected by testosterone levels later during gestation. Thus, AGD may serve as a lifelong biomarker of androgen exposure during this window. This MPW is hypothesized to occur in humans at 8-14 weeks of gestation during which AGD is fixed. The effect of androgens (testosterone) on AGD after the MPW in humans is not known. Furthermore, altered AGD has been associated with various human reproductive health disorders in both males and females. STUDY DESIGN, SIZE, DURATION A prospective descriptive cohort study was performed using data from randomly selected neonates (n = 205) born at a single center over a period of 1 year (August 2015 to August 2016). PARTICIPANTS/MATERIALS, SETTING, METHODS AGDs in male (n = 117) and female infants (n = 88) together with penile width, glans girth and stretched penile length were measured by trained caregivers. Gestation ranged from 22 to 41 weeks and infants were examined within 24 h of birth (within 48-72 h in very sick preterm infants after clinical stabilization). AGD-1 was measured from the center of the anus to the posterior base of scrotum in males or to the posterior fourchette in females. AGD-2 was measured from the center of the anus to the anterior base of the penis in males or to the clitoris in females. Sex steroid hormones (testosterone, 17-OH progesterone (17-OHP) and androstenedione) were measured in serum prepared from umbilical cord blood samples taken at birth, using liquid chromatography-tandem mass spectrometry. MAIN RESULTS AND THE ROLE OF CHANCE Males had a significantly lower gestational age (mean ± SD; 34.6 ± 4.9 versus 36.1 ± 4.1 weeks, P = 0.04), and a significantly longer AGD-1 (mean ± SD; 21.6 ± 6.0 versus 12.7 ± 3.8 mm, P < 0.001) and AGD-2 (41.9 ± 8.7 versus 33.9 ± 7.1 mm, P = 0.004) compared to female infants, respectively. The cord serum testosterone levels were significantly higher for male than female infants [median, interquartile range; 13.0 (7.3, 20.5) versus 4.1 (2.5, 5.9), ng/dl, P < 0.001]. There was no difference in levels of 17-OHP (P = 0.697) or androstenedione (P = 0.601) between the two sexes. On multiple regression analysis after adjusting for potential confounders, none of the AGD's in both males and females correlated with any sex steroid hormonal levels. We also provide normative charts for penile length, penile width and glans girth in preterm and term infants. LIMITATIONS, REASONS FOR CAUTION No data were collected on family history of genital malformation, infertility or hormonal disorders, parental endocrine-disrupting chemical exposure or diet pattern, any of which might have influenced the AGD and/or sex steroid hormone levels in the offspring. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that AGD in humans, like animals, is fixed in early gestation (likely during the hypothesized MPW) and is unaffected by androgen levels thereafter. Thus, AGD can serve as a biomarker of in utero androgen action during early gestation (likely 8-14 weeks) in humans. As such, causes of human newborn and adult reproductive health disorders, such as endocrine disruptors, should be explored during early gestation. However, further larger studies are needed to help corroborate these findings. STUDY FUNDING/COMPETING INTERESTS No specific funding was obtained for this study, and all authors have no conflict of interest to declare.
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Affiliation(s)
- Viral G Jain
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, USA.,Division of Neonatology, MetroHealth Medical Centre (Case Western Reserve University), 2500 MetroHealth Dr, Cleveland, OH, USA
| | - Vaibhav Goyal
- Division of Neonatology, MetroHealth Medical Centre (Case Western Reserve University), 2500 MetroHealth Dr, Cleveland, OH, USA
| | - Vikas Chowdhary
- Division of Neonatology, MetroHealth Medical Centre (Case Western Reserve University), 2500 MetroHealth Dr, Cleveland, OH, USA
| | - Namita Swarup
- Division of Neonatology, MetroHealth Medical Centre (Case Western Reserve University), 2500 MetroHealth Dr, Cleveland, OH, USA
| | - Ravinder J Singh
- Department of Laboratory Medicine & Pathology, Mayo Clinic and Foundation, 200 First St. SW Rochester, MN, USA
| | - Arbinder Singal
- Hypospadias Foundation & MITR Hospital, Plot:37, Eden Garden, Sector-5, Kharghar, Navi Mumbai, India
| | - Prem Shekhawat
- Division of Neonatology, MetroHealth Medical Centre (Case Western Reserve University), 2500 MetroHealth Dr, Cleveland, OH, USA
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Kshetrimayum C, Sharma A, Mishra VV, Kumar S. Polycystic ovarian syndrome: Environmental/occupational, lifestyle factors; an overview. J Turk Ger Gynecol Assoc 2019; 20:255-263. [PMID: 30821135 PMCID: PMC6883751 DOI: 10.4274/jtgga.galenos.2019.2018.0142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multifaceted disease of women with infertility that has diverse etiologic factors. Some women may have only a few PCOS-linked symptoms or mild symptoms, whereas others will have severe or all PCOS-linked symptoms. Therefore, PCOS symptoms can differ among women. PCOS is a state of hormonal imbalance, excess terminal hair (hirsutism), hair loss (alopecia), menstruation impairments, metabolic disorders, and cystic appearance on the ovaries. The cysts hamper ovulation, thus reducing the ability of women to become pregnant and result in infertility. The available data suggest that PCOS might originate in utero and the phenotypic appearance of PCOS symptoms may be developed in later life, which could be linked with host factors (endogenous) and exogenous factors like lifestyle, and dietary, environmental or occupational factors. Based upon the available information, it can be postulated that prenatal exposure to excessive androgens might be responsible for androgenization of the fetus, which in turn may alter the program of differentiating target tissues and the phenotypic characteristics of PCOS can be persuaded by exposure of female offspring to various endogenous and exogenous factors at later life. Genetic/host and environmental/lifestyle factors might be related to the pathophysiology of PCOS after prenatal exposure to androgen. Additional studies are necessary to understand the exact mechanism responsible for the manifestation of PCOS because it is a very important issue in female reproduction.
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Affiliation(s)
- Chaoba Kshetrimayum
- Department of Reproductive and Cytotoxicology, ICMR-National Institute of Occupational Health, Ahmedabad, India,PhD Scholar, Life Science, Gujarat University, Ahmedabad, India
| | - Anupama Sharma
- Department of Reproductive and Cytotoxicology, ICMR-National Institute of Occupational Health, Ahmedabad, India
| | | | - Sunil Kumar
- Former, Scientist G & Director-in-Charge NIOH (ICMR), Ahmedabad, India
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Abbott DH, Dumesic DA, Levine JE. Hyperandrogenic origins of polycystic ovary syndrome - implications for pathophysiology and therapy. Expert Rev Endocrinol Metab 2019; 14:131-143. [PMID: 30767580 PMCID: PMC6992448 DOI: 10.1080/17446651.2019.1576522] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) diagnosis comprises combinations of female hyperandrogenism, menstrual irregularity and polycystic ovaries. While it is a familial and highly prevalent endocrine disorder, progress towards a cure is hindered by absence of a definitive pathogenic mechanism and lack of an animal model of naturally occurring PCOS. AREAS COVERED These include an overview of PCOS and its potential etiology, and an examination of insights gained into its pathogenic origins. Animal models derived from experimentally-induced hyperandrogenism during gestation, or from naturally-occurring PCOS-like traits, most reliably demonstrate reproductive, neuroendocrine and metabolic pathogenesis. EXPERT OPINION Genetic studies, while identifying at least 17 PCOS risk genes, account for <10% of women with PCOS. A number of PCOS risk genes involve regulation of gonadotropin secretion or action, suggesting a reproductive neuroendocrine basis for PCOS pathogenesis. Consistent with this notion, a number of animal models employing fetal androgen excess demonstrate epigenetic induction of PCOS-like traits, including reproductive neuroendocrine and metabolic dysfunction. Monkey models are most comprehensive, while mouse models provide molecular insight, including identifying the androgen receptor, particularly in neurons, as mediating androgen-induced PCOS-like programming. Naturally-occurring female hyperandrogenism is also demonstrated in monkeys. Animal models are poised to delineate molecular gateways to PCOS pathogenesis.
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Affiliation(s)
- David H Abbott
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
- Department of Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, USA
| | - Daniel A Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jon E Levine
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
- Department of Neuroscience, University of Wisconsin, Madison, WI, USA
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Sánchez-Ferrer ML, Prieto-Sánchez MT, Corbalán-Biyang S, Mendiola J, Adoamnei E, Hernández-Peñalver AI, Carmona-Barnosi A, Salido-Fiérrez EJ, Torres-Cantero AM. Are there differences in basal thrombophilias and C-reactive protein between women with or without PCOS? Reprod Biomed Online 2019; 38:1018-1026. [PMID: 31023609 DOI: 10.1016/j.rbmo.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/11/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION Polycystic ovary syndrome (PCOS) women have increased cardiovascular risks, although it is unclear whether the haemostatic system and coagulation contribute to that increased risk. DESIGN Women attending the Gynecology Unit of the 'Virgen de la Arrixaca' University Hospital (Murcia, Spain) for routine gynaecological examinations between September 2014 and May 2016 were assessed for PCOS using the Rotterdam criteria (hyperandrogenism [H], oligo/amenorrhoea [O] and polycystic ovarian morphology [POM]) and were classified into four phenotypic. In total, 126 cases were identified and 159 control women were selected. All women underwent physical and gynaecological examinations, and blood tests between the second and fifth day of the menstrual cycle. Differences in hormonal, basal thrombophilia and metabolic parameters, and C-reactive protein (CRP) between PCOS and controls were analysed. RESULTS After adjusting by BMI and age, PCOS women had higher LH (P < 0.001), testosterone (P < 0.001), free testosterone (P = 0.01) and anti-Müllerian hormone (P < 0.001) and lower FSH (P = 0.03) compared with controls, whereas sex hormone-binding globulin was no different. Cases showed significantly higher protein S, glucose, insulin and insulin resistance (HOMA-IR) compared with controls (P < 0.05). There were no differences in protein C levels, antithrombin III, prothrombin time, homocysteine, D-dimer, factor V Leyden, prothrombin G20210A polymorphism or CRP. The H+O phenotype showed the poorest results for insulin and HOMA-IR (P = 0.04 and 0.05). CONCLUSIONS The results suggest that there are no differences in the basal thrombophilias between women with and without PCOS. However, PCOS with H+O shows the poorest metabolic profile.
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Affiliation(s)
- María L Sánchez-Ferrer
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain
| | - María T Prieto-Sánchez
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain.
| | - Shiana Corbalán-Biyang
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Evdochia Adoamnei
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - Ana I Hernández-Peñalver
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Ana Carmona-Barnosi
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Eduardo J Salido-Fiérrez
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Department of Hematology and Hemotherapy, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain; Department of Preventive Medicine, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
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Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, Adoamnei E, Prieto-Sánchez MT, Corbalán-Biyang S, Carmona-Barnosi A, Nieto A, Torres-Cantero AM. Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome. Reprod Biomed Online 2018; 37:741-749. [PMID: 30361047 DOI: 10.1016/j.rbmo.2018.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022]
Abstract
RESEARCH QUESTION Is anogenital distance (AGD) a useful clinical tool for predicting polycystic ovarian syndrome (PCOS) and its main National Institutes of Health (NIH) phenotypes? DESIGN Case-control study conducted between September 2014 and May 2016 at the Department of Obstetrics and Gynecology of the University Clinical Hospital 'Virgen de la Arrixaca' in the Murcia region (south-eastern Spain). One hundred and twenty-six cases of PCOS and 159 controls without PCOS were included. AGD measurements were taken 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). Parametric and non-parametric tests and receiver operating characteristic (ROC) curves were used to assess associations between AGD and the presence of PCOS and its phenotypes. RESULTS AGDAC, but not AGDAF, was associated with PCOS and all its phenotypes (P-values < 0.001 to 0.048). The highest area under the curve (0.62; 95% confidence interval 0.55 to 0.71) was obtained for all PCOS with AGDAC with a sensitivity and specificity of 50.0% and 73.0%, and positive and negative predictive value of 59.0% and 64.4%, respectively. CONCLUSIONS AGDAC could moderately discriminate the presence of PCOS and may be a useful clinical tool.
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Affiliation(s)
- Ana I Hernández-Peñalver
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Maria L Sánchez-Ferrer
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain.
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain
| | - Evdochia Adoamnei
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - Maria T Prieto-Sánchez
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain
| | - Shiana Corbalán-Biyang
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Ana Carmona-Barnosi
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Aníbal Nieto
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Murcia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain; Department of Preventive Medicine, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
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Sánchez-Ferrer ML, Prieto-Sánchez MT, Moya-Jiménez C, Mendiola J, García-Hernández CM, Carmona-Barnosi A, Nieto A, Torres-Cantero AM. Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse (POP) Quantification System. J Vis Exp 2018. [PMID: 30295651 DOI: 10.3791/57912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Anogenital distance (AGD) is a sexually dimorphic attribute, twice longer in males than in females, and a marker of intrauterine hormonal environment. Interest in AGD measurements is increasing due to mounting evidence on their potential clinical implications. A parallel set of perineal measurements, the Pelvic Organ Prolapse Quantification System (POP-Q), include similar, but not exactly the same, landmarks: the perineal body (PB) and the genital hiatus (GH) lengths. However, clinical reproducibility of both perineal measurements and their usefulness to describe perineal anthropometry needs to be elucidated. To our knowledge, there is no publication in video format showing the methodology of these measurements. The main objective of this work is to show how to properly perform perineal anthropometry, including measurements of the AGD in its two variants [anoclitoral (AGDAC) and anofourchette (AGDAF)], genital hiatus (GH) and perineal body (PB). Moreover, we explored if there were differences in these measurements in women with and without Pelvic Organ Prolapse (POP). We research whether the anthropometric characteristics of the perineum, such as AGD (which is determined prenatally), may be altered in these women and be an independent etiological factor for pelvic floor dysfunction. We show two different ways of measuring perineal lengths, as they might be quite comparable. Our suggestion is that unifying perineal measurements could be useful for clinical and biomedical investigation. More studies are needed in order to compare GH and PB measurements and its AGD counterparts to analyze which procedures are more reproducible with less intra and interobserver variability.
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Affiliation(s)
- María Luisa Sánchez-Ferrer
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca", University Clinical Hospital; Institute for Biomedical Research of Murcia, IMIB-Arrixaca
| | - María Teresa Prieto-Sánchez
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca", University Clinical Hospital; Institute for Biomedical Research of Murcia, IMIB-Arrixaca;
| | - Carlos Moya-Jiménez
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca", University Clinical Hospital
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP)
| | | | - Ana Carmona-Barnosi
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca", University Clinical Hospital
| | - Anibal Nieto
- Department of Obstetrics & Gynecology, "Virgen de la Arrixaca", University Clinical Hospital; Institute for Biomedical Research of Murcia, IMIB-Arrixaca
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP); Department of Preventive Medicine, "Virgen de la Arrixaca", University Clinical Hospital
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39
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Sánchez-Ferrer ML, Prieto-Sánchez MT, Moya-Jiménez LC, Adoamnei E, Mendiola J, Torres-Cantero AM. Comparability between adult female anogenital distance and perineal measurements standardized by POP-Q system (GH and PB). Neurourol Urodyn 2018; 37:2847-2853. [DOI: 10.1002/nau.23798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/09/2018] [Indexed: 01/24/2023]
Affiliation(s)
- María L. Sánchez-Ferrer
- Departmentof Obstetrics and Gynecology; “Virgen de la Arrixaca” University Clinical Hospital and Institute for Biomedical Research of Murcia; El Palmar Murcia Spain
| | - María T. Prieto-Sánchez
- Departmentof Obstetrics and Gynecology; “Virgen de la Arrixaca” University Clinical Hospital and Institute for Biomedical Research of Murcia; El Palmar Murcia Spain
| | - Luis C. Moya-Jiménez
- Department of Obstetrics and Gynecology; University General Hospital Santa Lucía; Cartagena Murcia Spain
| | - Evdochia Adoamnei
- Division of Preventive Medicine and Public Health; Department of Public Health Sciences; University of Murcia School of Medicine; Espinardo Murcia Spain
- Institute for Biomedical Research of Murcia; El Palmar Murcia Spain
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health; Department of Public Health Sciences; University of Murcia School of Medicine; Espinardo Murcia Spain
- Institute for Biomedical Research of Murcia; 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; Espinardo Murcia Spain
- Institute for Biomedical Research of Murcia; El Palmar Murcia Spain
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40
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Barrett ES, Hoeger KM, Sathyanarayana S, Abbott DH, Redmon JB, Nguyen RHN, Swan SH. Anogenital distance in newborn daughters of women with polycystic ovary syndrome indicates fetal testosterone exposure. J Dev Orig Health Dis 2018; 9:307-314. [PMID: 29310733 PMCID: PMC5997496 DOI: 10.1017/s2040174417001118] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects ~7% of reproductive age women. Although its etiology is unknown, in animals, excess prenatal testosterone (T) exposure induces PCOS-like phenotypes. While measuring fetal T in humans is infeasible, demonstrating in utero androgen exposure using a reliable newborn biomarker, anogenital distance (AGD), would provide evidence for a fetal origin of PCOS and potentially identify girls at risk. Using data from a pregnancy cohort (The Infant Development and Environment Study), we tested the novel hypothesis that infant girls born to women with PCOS have longer AGD, suggesting higher fetal T exposure, than girls born to women without PCOS. During pregnancy, women reported whether they ever had a PCOS diagnosis. After birth, infant girls underwent two AGD measurements: anofourchette distance (AGD-AF) and anoclitoral distance (AGD-AC). We fit adjusted linear regression models to examine the association between maternal PCOS and girls' AGD. In total, 300 mother-daughter dyads had complete data and 23 mothers reported PCOS. AGD was longer in the daughters of women with a PCOS diagnosis compared with daughters of women with no diagnosis (AGD-AF: β=1.21, P=0.05; AGD-AC: β=1.05, P=0.18). Results were stronger in analyses limited to term births (AGD-AF: β=1.65, P=0.02; AGD-AC: β=1.43, P=0.09). Our study is the first to examine AGD in offspring of women with PCOS. Our results are consistent with findings that women with PCOS have longer AGD and suggest that during PCOS pregnancies, daughters may experience elevated T exposure. Identifying the underlying causes of PCOS may facilitate early identification and intervention for those at risk.
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Affiliation(s)
- Emily S. Barrett
- Division of Epidemiology and Biostatistics, Environmental and Occupational Health Sciences Institute and Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Kathleen M. Hoeger
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98121; Seattle Children’s Research Institute, Seattle, WA
| | - David H. Abbott
- Departments of Obstetrics and Gynecology and Neuroscience, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53703; Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI 53715
| | - J. Bruce Redmon
- Department of Medicine, University of Minnesota, Minneapolis, MN 55454
| | - Ruby H. N. Nguyen
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454
| | - Shanna H. Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
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41
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Sipahi M, Tokgöz VY, Alanya Tosun Ş. An appropriate way to predict fetal gender at first trimester: anogenital distance. J Matern Fetal Neonatal Med 2018; 32:2012-2016. [PMID: 29298531 DOI: 10.1080/14767058.2018.1424131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Using anogenital distance to determine fetal sex is a new method. There is only one study in the literature. We predict that it will pass through the literature as a new method that can be used in determining fetal sex especially in first trimester. INTRODUCTION Determination of fetal gender before birth has been a matter of curiosity for both the family and the clinician. In the presence of gender-linked genetic disease, it becomes an obligation instead of an interest. The aim of this study was to determine the fetal gender accurately at first trimester with anogenital distance (AGD) and to investigate the correlations of nuchal translucency (NT), fetal heart rate (FHR), and crown-rump length (CRL) with AGD. MATERIALS AND METHODS In this prospective cross-sectional study, AGD measurement was performed in 111 patients with singleton pregnancy from 11 to 13 weeks and 6 days (CRL 45-84 mm). Measurements of AGD ≥4.8 mm were identified for males, and AGD <4.8 mm for females. RESULTS Genders were demonstrated accurately for males as 76.7% and for females as 97.1%. The mean value of AGD was 3.6 mm for females and 5.1 mm for males. There were no relations between fetal gender and FHR and also NT. CONCLUSIONS Gender can be detected with great accuracy in gestations between 11 to 13 weeks and 6 days by using AGD. CRL and gestational week (GW) were determined as nonsignificant predictors of fetal gender by AGD measurement. In order to obtain more accurate results with AGD, consideration of further studies with larger series in different races is recommended.
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Affiliation(s)
- Mehmet Sipahi
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
| | - Vehbi Yavuz Tokgöz
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
| | - Şebnem Alanya Tosun
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
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