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Int. J. Environ. Res. Public Health 2016, 13(12), 1247;

Increased Urinary Phthalate Levels in Women with Uterine Leiomyoma: A Case-Control Study

Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University, 170 Joohwa-ro, Goyang-si, Kyeogi-do 10380, Korea
Department of Health, Environment and Safety, School of Human & Environmental Service, Eulji University, 553 Sansung-daero, Seongnam-si, Kyeogi-do 13135, Korea
Department of Biomedical and Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, University of Montana, 32 Campus Drive, Skaggs 283, Missoula, MT 59812, USA
Author to whom correspondence should be addressed.
Academic Editor: William Chi-shing Cho
Received: 28 September 2016 / Revised: 9 December 2016 / Accepted: 11 December 2016 / Published: 15 December 2016
(This article belongs to the Section Environmental Health)
Full-Text   |   PDF [321 KB, uploaded 15 December 2016]


We assessed the urinary concentration of 16 phthalate metabolites in 57 women with and without uterine leiomyoma (n = 30 and 27; respectively) to determine the association between phthalate exposure and uterine leiomyoma. To evaluate exposure to di-(2-ethylhexyl) phthalate (DEHP); we calculated the molar sum of DEHP metabolites; ∑3-DEHP (combining mono-(2-ethylhexyl) phthalate (MEHP); mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP); and mono-(2-ethyl-5-oxohexyl) phthalate); ∑4-DEHP (∑3-DEHP plus mono-(2-ethyl-5-carboxypentyl) phthalate); and ∑5-DEHP (∑4-DEHP plus mono (2-(carboxylmethyl)hexyl) phthalate (2cx-MMHP)). The log transformed urinary levels of MEHP; MEHHP; 2cx-MMHP; ∑3-DEHP; ∑4-DEHP; and ∑5-DEHP in the leiomyoma group were significantly higher than those of controls. When we adjusted for age; waist circumference; and parity using multiple logistic regression analyses; we found log ∑3-DEHP (OR = 10.82; 95% CI = 1.25; 93.46) and ∑4-DEHP (OR = 8.78; 95% CI = 1.03; 75.29) were significantly associated with uterine leiomyoma. Our findings suggest an association between phthalate exposure and uterine leiomyoma. However; larger studies are needed to investigate potential interactions between phthalate exposure and uterine leiomyoma. View Full-Text
Keywords: phthalates; uterine leiomyoma; ∑3-DEHP; ∑4-DEHP phthalates; uterine leiomyoma; ∑3-DEHP; ∑4-DEHP
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Kim, Y.A.; Kho, Y.; Chun, K.C.; Koh, J.W.; Park, J.W.; Bunderson-Schelvan, M.; Cho, Y.H. Increased Urinary Phthalate Levels in Women with Uterine Leiomyoma: A Case-Control Study. Int. J. Environ. Res. Public Health 2016, 13, 1247.

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