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Vacca M, Calabrese FM, Loperfido F, Maccarini B, Cerbo RM, Sommella E, Salviati E, Voto L, De Angelis M, Ceccarelli G, Di Napoli I, Raspini B, Porri D, Civardi E, Garofoli F, Campiglia P, Cena H, De Giuseppe R. Maternal Exposure to Endocrine-Disrupting Chemicals: Analysis of Their Impact on Infant Gut Microbiota Composition. Biomedicines 2024; 12:234. [PMID: 38275405 PMCID: PMC10813257 DOI: 10.3390/biomedicines12010234] [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: 12/17/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Endocrine disruptors (EDCs) are chemicals that interfere with the endocrine system. EDC exposure may contribute to the development of obesity, type 2 diabetes, and cardiovascular diseases by impacting the composition of an infant's gut microbiota during the first 1000 days of life. To explore the relationship between maternal urinary levels of Bisphenol-A and phthalates (UHPLC-MS/MS), and the composition of the infant gut microbiota (16S rDNA) at age 12 months (T3) and, retrospectively, at birth (T0), 1 month (T1), and 6 months (T2), stool samples from 20 infants breastfed at least once a day were analyzed. Metataxonomic bacteria relative abundances were correlated with EDC values. Based on median Bisphenol-A levels, infants were assigned to the over-exposed group (O, n = 8) and the low-exposed group (B, n = 12). The B-group exhibited higher gut colonization of the Ruminococcus torques group genus and the O-group showed higher abundances of Erysipelatoclostridium and Bifidobacterium breve. Additionally, infants were stratified as high-risk (HR, n = 12) or low-risk (LR, n = 8) exposure to phthalates, based on the presence of at least three phthalates with concentrations exceeding the cohort median values; no differences were observed in gut microbiota composition. A retrospective analysis of gut microbiota (T0-T2) revealed a disparity in β-diversity between the O-group and the B-group. Considering T0-T3, the Linear Discriminant Effect Size indicated differences in certain microbes between the O-group vs. the B-group and the HR-group vs. the LR-group. Our findings support the potential role of microbial communities as biomarkers for high EDC exposure levels. Nevertheless, further investigations are required to deeply investigate this issue.
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Affiliation(s)
- Mirco Vacca
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, 70126 Bari, Italy; (M.V.); (F.M.C.); (M.D.A.)
| | - Francesco Maria Calabrese
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, 70126 Bari, Italy; (M.V.); (F.M.C.); (M.D.A.)
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Beatrice Maccarini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.M.C.); (E.C.); (F.G.)
| | - Eduardo Sommella
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (E.S.); (E.S.); (P.C.)
| | - Emanuela Salviati
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (E.S.); (E.S.); (P.C.)
| | - Luana Voto
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Maria De Angelis
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, 70126 Bari, Italy; (M.V.); (F.M.C.); (M.D.A.)
| | - Gabriele Ceccarelli
- Human Anatomy Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Ilaria Di Napoli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Benedetta Raspini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
| | - Elisa Civardi
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.M.C.); (E.C.); (F.G.)
| | - Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.M.C.); (E.C.); (F.G.)
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (E.S.); (E.S.); (P.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
- Clinical Nutrition Unit, General Medicine, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (B.M.); (L.V.); (I.D.N.); (B.R.); (D.P.); (H.C.); (R.D.G.)
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Hallberg I, Björvang RD, Hadziosmanovic N, Koekkoekk J, Pikki A, van Duursen M, Lenters V, Sjunnesson Y, Holte J, Berglund L, Persson S, Olovsson M, Damdimopoulou P. Associations between lifestyle factors and levels of per- and polyfluoroalkyl substances (PFASs), phthalates and parabens in follicular fluid in women undergoing fertility treatment. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:699-709. [PMID: 37481638 PMCID: PMC10541317 DOI: 10.1038/s41370-023-00579-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Concerns have been raised whether exposure to endocrine-disrupting chemicals (EDCs) can alter reproductive functions and play a role in the aetiology of infertility in women. With increasing evidence of adverse effects, information on factors associated with exposure is necessary to form firm recommendations aiming at reducing exposure. OBJECTIVE Our aim was to identify associations between lifestyle factors including the home environment, use of personal care products (PCP), and dietary habits and concentrations of EDCs in ovarian follicular fluid. METHODS April-June 2016, 185 women undergoing ovum pick-up for in vitro fertilisation in Sweden were recruited. Correlation analyses were performed between self-reported lifestyle factors and concentration of EDCs analysed in follicular fluid. Habits related to cleaning, PCPs, and diet were assessed together with concentration of six per- and polyfluoroalkyl substances (PFASs) [PFHxS, PFOA, PFOS, PFNA, PFDA and PFUnDA], methyl paraben and eight phthalate metabolites [MECPP, MEHPP, MEOHP, MEHP, cxMinCH, cxMiNP, ohMiNP, MEP, MOHiBP]. Spearman's partial correlations were adjusted for age, parity and BMI. RESULTS Significant associations were discovered between multiple lifestyle factors and concentrations of EDCs in ovarian follicular fluid. After correcting p values for multiple testing, frequent use of perfume was associated with MEP (correlation ρ = 0.41 (confidence interval 0.21-0.47), p < 0.001); hens' egg consumption was positively associated with PFOS (ρ = 0.30 (0.15-0.43), p = 0.007) and PFUnDA (ρ = 0.27 (0.12-0.40), p = 0.036). White fish consumption was positively associated with PFUnDA (ρ = 0.34 (0.20-0.47), p < 0.001) and PFDA (ρ = 0.27 (0.13-0.41), p = 0.028). More correlations were discovered when considering the raw uncorrected p values. Altogether, our results suggest that multiple lifestyle variables affect chemical contamination of follicular fluid. IMPACT STATEMENT This study shows how lifestyle factors correlate with the level of contamination in the ovary by both persistent and semi-persistent chemicals in women of reproductive age. Subsequently, these data can be used to form recommendations regarding lifestyle to mitigate possible negative health outcomes and fertility problems associated with chemical exposure, and to inform chemical policy decision making. Our study can also help form the basis for the design of larger observational and intervention studies to examine possible effects of lifestyle changes on exposure levels, and to unravel the complex interactions between biological factors, lifestyle and chemical exposures in more detail.
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Affiliation(s)
- Ida Hallberg
- Department of Women´s and Children´s Health, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Richelle D Björvang
- Department of Women´s and Children´s Health, Uppsala University, SE-751 85, Uppsala, Sweden
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | | | - Jacco Koekkoekk
- Environment and Health, Amsterdam Institute for Life and Environment, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Anne Pikki
- Carl von Linnékliniken, SE-751 83, Uppsala, Sweden
| | - Majorie van Duursen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CG, Utrecht, the Netherlands
| | - Virissa Lenters
- Environment and Health, Amsterdam Institute for Life and Environment, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CG, Utrecht, the Netherlands
| | - Ylva Sjunnesson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, SE-750 07, Uppsala, Sweden
| | - Jan Holte
- Department of Women´s and Children´s Health, Uppsala University, SE-751 85, Uppsala, Sweden
- Carl von Linnékliniken, SE-751 83, Uppsala, Sweden
| | - Lars Berglund
- School of Health and Welfare, Dalarna University, SE-791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22, Uppsala, Sweden
| | - Sara Persson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, SE-750 07, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women´s and Children´s Health, Uppsala University, SE-751 85, Uppsala, Sweden
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | - Pauliina Damdimopoulou
- Uppsala clinical Research Center, Uppsala University, SE-751 85, Uppsala, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden
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LIMIT: LIfestyle and Microbiome InTeraction Early Adiposity Rebound in Children, a Study Protocol. Metabolites 2022; 12:metabo12090809. [PMID: 36144214 PMCID: PMC9504829 DOI: 10.3390/metabo12090809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Childhood obesity is a strong predictor of adult obesity with health and economic consequences for individuals and society. Adiposity rebound (AR) is a rise in the Body Mass Index occurring between 3 and 7 years. Early adiposity rebound (EAR) occurs at a median age of 2 years and predisposes to a later onset of obesity. Since obesity has been associated with intestinal dysbiosis, we hypothesize that EAR could be related to early microbiome changes due to maternal/lifestyle changes and environmental exposures, which can increase the unhealthy consequences of childhood obesity. LIMIT is a prospective cohort study that aims at identifying the longitudinal interplay between infant gut microbiome, infant/maternal lifestyle, and environmental variables, in children with EAR vs. AR. Methods. The study evaluated 272 mother-infant pairs, enrolled at an Italian neonatal unit, at different time points (T0, at delivery; T1, 1 month; T2, 6 months; T3, 12 months; T4, 24 months; T5, 36 months after birth). The variables that were collected include maternal/infant anthropometric measurements, lifestyle habits, maternal environmental endocrine disruptor exposure, as well as infant AR. The LIMIT results will provide the basis for early identification of those maternal and infant modifiable factors on which to act for an effective and personalized prevention of childhood obesity.
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Reprotoxic Impact of Environment, Diet, and Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031303. [PMID: 35162326 PMCID: PMC8834893 DOI: 10.3390/ijerph19031303] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 02/01/2023]
Abstract
Reproductive health is progressively declining due to multiples endogenous and exogenous factors, such as environmental contaminants, diet and behavior. Accumulated evidences confirm that fertility and reproductive function have been adversely affected by exposure to chemical contaminants released in the environment. Today, the impact of diet and behavior on reproductive processes is also receiving special attention from the scientific community. Indeed, a close relationship between diet and fertility has been proven. Furthermore, a combination of unhealthy behavior, such as exposure to hazardous compounds and stress factors, poses living organisms at higher risk of reprotoxic effects. In particular, it has been described that poor life behaviors are associated with reduced male and female fertility due to decreased gamete quality and function. Most of the erroneous behaviors are, furthermore, a source of oxidative stress that, leading to epigenetic alterations, results in an impaired reproductive fitness. This review reports the detrimental impact of the most common environmental chemical stressors, diet, and behavior on reproductive functionality and success. Although clear evidences are still scarce, reassuring data are provided that a healthy diet and reverting unhealthy lifestyles may be of help to recover physiological reproductive conditions.
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Tait S, Carli F, Busani L, Ciociaro D, Della Latta V, Deodati A, Fabbrizi E, Pala AP, Maranghi F, Tassinari R, Toffol G, Cianfarani S, Gastaldelli A, La Rocca C. Italian Children Exposure to Bisphenol A: Biomonitoring Data from the LIFE PERSUADED Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211846. [PMID: 34831602 PMCID: PMC8621164 DOI: 10.3390/ijerph182211846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
A human biomonitoring (HBM) study on bisphenol A (BPA) in Italian children and adolescents was performed within the LIFE PERSUADED project, considering the residing areas, sex and age. The median urinary BPA level was 7.02 µg/L, with children living in the South of Italy or in urban areas having higher levels than those residing in the North or in rural areas. Children aged 4–6 years had higher BPA levels than those aged 7–10 and 11–14 years, but no differences were detected between sexes. The exposure in Italian children was higher compared to children from other countries, but lower than the HBM guidance value (135 µg/L). The estimated daily intake was 0.17 μg/kg body weight (bw) per day, about 24-fold below the temporary Tolerable Daily Intake of 4 μg/kg bw per day established by the European Food Safety Authority. However, this threshold was exceeded in 1.44% of the enrolled children, raising concern about the overall exposure of Italian young population.
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Affiliation(s)
- Sabrina Tait
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.T.); (L.B.); (F.M.); (R.T.)
| | - Fabrizia Carli
- National Research Council, Institute of Clinical Physiology, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy; (F.C.); (D.C.); (V.D.L.); (A.P.P.); (A.G.)
| | - Luca Busani
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.T.); (L.B.); (F.M.); (R.T.)
| | - Demetrio Ciociaro
- National Research Council, Institute of Clinical Physiology, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy; (F.C.); (D.C.); (V.D.L.); (A.P.P.); (A.G.)
| | - Veronica Della Latta
- National Research Council, Institute of Clinical Physiology, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy; (F.C.); (D.C.); (V.D.L.); (A.P.P.); (A.G.)
| | - Annalisa Deodati
- Dipartimento Pediatrico, Universitario Ospedaliero “Bambino Gesù” Children’s Hospital, Piazza di Sant’Onofrio, 4, 00165 Rome, Italy; (A.D.); (S.C.)
| | - Enrica Fabbrizi
- Unità Operativa Complessa Pediatria e Neonatologia, Ospedale Civile Augusto Murri, Via Augusto Murri, 21, 63900 Fermo, Italy;
- Civitanova Marche Hospital, ASUR MARCHE Area Vasta 3, 62012 Civitanova Marche, Italy
| | - Anna Paola Pala
- National Research Council, Institute of Clinical Physiology, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy; (F.C.); (D.C.); (V.D.L.); (A.P.P.); (A.G.)
| | - Francesca Maranghi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.T.); (L.B.); (F.M.); (R.T.)
| | - Roberta Tassinari
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.T.); (L.B.); (F.M.); (R.T.)
| | - Giacomo Toffol
- Associazione Culturale Pediatri, Via Montiferru, 6, 09070 Narbolia, Italy;
| | - Stefano Cianfarani
- Dipartimento Pediatrico, Universitario Ospedaliero “Bambino Gesù” Children’s Hospital, Piazza di Sant’Onofrio, 4, 00165 Rome, Italy; (A.D.); (S.C.)
- Department of Systems Medicine, University of Rome Tor Vergata, Via Cracovia, 50, 00133 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet and University Hospital, Solnavägen 1, 171 77 Stockholm, Sweden
| | - Amalia Gastaldelli
- National Research Council, Institute of Clinical Physiology, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy; (F.C.); (D.C.); (V.D.L.); (A.P.P.); (A.G.)
| | - Cinzia La Rocca
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.T.); (L.B.); (F.M.); (R.T.)
- Correspondence: ; Tel.: +39-06-4990-2992
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Caporossi L, Viganò P, Paci E, Capanna S, Alteri A, Campo G, Pigini D, De Rosa M, Tranfo G, Papaleo B. Female Reproductive Health and Exposure to Phthalates and Bisphenol A: A Cross Sectional Study. TOXICS 2021; 9:toxics9110299. [PMID: 34822691 PMCID: PMC8622554 DOI: 10.3390/toxics9110299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
The xenoestrogenicity of some plasticisers (phthalates and bisphenol A) is documented in the literature and may pose a risk to female reproductive health. The aim of this study was to assess exposure to six phthalates. This was achieved by measuring their respective metabolites (mono-ethylphthalate (MEP); mono-n-butylphthalate (MnBP); mono-n-ottylphthalate (MnOP); and monobenzylphthalate (MBzP)), as well as the sum of two of the diethyl-hexyl phthalate metabolites-(∑DEHP) and bisphenol A (BPA) in a female population with infertility problems, and by conducting a correlation analysis between infertility factors, work activities, and lifestyle habits, in order to formulate a causal hypothesis. A cross-sectional epidemiological study was carried out and women under 43 years of age were recruited from an assisted reproduction technology (ART) center; the sample of 186 women was given a specific questionnaire and a spot urine sample was collected. Phthalate metabolites and urinary BPA were analyzed by HPLC/MS/MS. The results showed significantly higher mean values for MEP in women with recurrent pregnancy loss (RPL) (820.5 ± 1929.5 µg/g of creatinine) and idiopathic infertility (230.0 ± 794.2 µg/g of creatinine) than in women with other infertility factors (76.9 ± 171.8 µg/g of creatinine). Similarly, for MnOP levels, women with idiopathic infertility (2.95 ± 3.44 µg/g of creatinine) showed significantly higher values than women with the other infertility factors taken together (1.35 ± 2.05 µg/g of creatinine). Women with tubal factors of infertility, RPL, and endocrine dysfunctions show higher values of DEHP (p = 0.032). Considering occupations, women working in commerce showed more than twice as much urinary BPA levels (1.10 ± 0.48 µg/g of creatinine) compared to women working in other industries (0.45 ± 0.35 µg/g of creatinine). The presence of significantly higher values of certain phthalates, DEHP in particular, especially in women with RPL and idiopathic infertility, suggests a possible involvement of these compounds as competing factors in reproductive issues. The study of sources of exposure suggested that the working activity in trade, as a casher in particular, represents a major one for BPA (p = 0.015).
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Affiliation(s)
- Lidia Caporossi
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
- Correspondence:
| | - Paola Viganò
- Fondazione Scientific Institute for Research, Hospitalization and Healthcare Ca’ Granda Ospedale Maggiore Policlinico, Infertility Unit, Via M. Fanti, 20132 Milan, Italy;
| | - Enrico Paci
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
| | - Silvia Capanna
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
| | - Alessandra Alteri
- Scientific Institute for Research, Hospitalization and Healthcare San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, Via Olgettina 60, 20132 Milan, Italy; (A.A.); (G.C.)
| | - Giovanni Campo
- Scientific Institute for Research, Hospitalization and Healthcare San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, Via Olgettina 60, 20132 Milan, Italy; (A.A.); (G.C.)
| | - Daniela Pigini
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
| | - Mariangela De Rosa
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
| | - Giovanna Tranfo
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
| | - Bruno Papaleo
- INAIL—National Institute for Insurance against Accidents at Work, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (E.P.); (S.C.); (D.P.); (M.D.R.); (G.T.); (B.P.)
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