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Cited by 184Endometriosis Research and TreatmentEffects and risks of endocrine disrupting chemicalsCancer Risks and Factors

In utero exposures and the incidence of endometriosis

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Missmer, Stacey A., Hankinson, Susan E., Spiegelman, Donna, Barbieri, Robert L., Michels, Karin B., Hunter, David J.·2004·Fertility and Sterility
DOI 10.1016/j.fertnstert.2004.04.065
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Abstract

Objective To investigate the relation between the fetal environment and endometriosis.Design Prospective cohort study.Setting Nurses' Health Study II with 10 years of follow-up.Participant(s) Eighty-four thousand, four hundred forty-six women aged 25-42 who had never been diagnosed with endometriosis, infertility, or cancer at baseline in 1989.Main outcome measure(s) Incidence of laparoscopically confirmed endometriosis according to birthweight, prematurity, multiple gestation, diethylstilbestrol (DES) exposure, and having been breastfed.Result(s) During 566,250 woman-years of follow-up, 1,226 cases of laparoscopically-confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, parity, race, and body mass index at age 18, we observed a linear increase in the incidence rate with decreasing birthweight (rate ratio [RR] = 1.3 for birthweight <5.5 pounds versus 7.0-8.4 pounds, 95% confidence interval [CI] = 1.0-1.8, P value, test for trend = .01). In addition, women who were born as one of a multiple gestation (i.e., twins or greater number) were at increased risk even after controlling for birthweight (RR = 1.7, CI = 1.2-2.5). The rate of endometriosis was also 80% greater among women exposed to diethylstilbestrol in utero (RR = 1.8, CI = 1.2-2.8). Neither premature delivery nor having been breastfed were associated with the incidence of endometriosis. None of these effect estimates were modified by infertility status at the time of endometriosis diagnosis.Conclusion(s) The fetal environment is associated with subsequent laparoscopically confirmed endometriosis in this cohort of US women.

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  • Prenatal exposure to estrogenic and antiandrogenic chemicals are known to predict endometriosis risk.

    “Third, prenatal exposure to estrogenic and antiandrogenic chemicals are known to predict endometriosis risk (Missmer et al., 2004).”

    From Endometriosis and polycystic ovary syndrome are diametric disorders (2021) · cites this paper as Missmer et al., 2004

  • Estrogenic prenatal environments decrease AGD and increase endometriosis risk.

    “Estrogenic prenatal environments do decrease AGD (Stewart et al., 2018) and increase endometriosis risk (Missmer et al., 2004), so this interpretation is accurate but incomplete.”

    From Endometriosis and polycystic ovary syndrome are diametric disorders (2021) · cites this paper as Missmer et al., 2004

  • In utero exposure to the xenoestrogen diethylstilbesterol (DES) increases a woman's risk of developing endometriosis as an adult by 80% (RR=1.8, CI=1.2-2.8).

    “in utero exposure to the xenoestrogen diethylstilbesterol (DES) increases a woman's risk of developing endometriosis as an adult by 80% (relative risk [RR] ¼ 1.8, confidence interval [CI]¼1.2-2.8).56”

    From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [56]

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Authors
Missmer, S. A., Hankinson, S. E., Spiegelman, D., Barbieri, R. L., Michels, K. B., & Hunter, D. J.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
Corresponding author
Missmer, Stacey A.
ORCID
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2004-12
Volume
82
Issue
6
Pages
1501-1508
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2004.04.065
OpenAlex
W2028602232
Cited by
184
References
65
Citations by year
2026: 4 · 2025: 5 · 2024: 4 · 2023: 11 · 2022: 6 · 2021: 10 · 2020: 15 · 2019: 6 · 2018: 11 · 2017: 9 · 2016: 9 · 2015: 16 · 2014: 8 · 2013: 14 · 2012: 11
FWCI
3.90
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Cancer Institute (CA50385, R01CA050385)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD040882, HD40882)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
endometriosis, prenatal exposure, intrauterine environment, birth weight, multiple pregnancy, diethylstilbestrol, breastfeeding, preterm birth, infertility, Nurses' Health Study II
MeSH terms
Adult, Birth Weight, Diethylstilbestrol, Endometriosis, Estrogens, Non-Steroidal, Female, Humans, Pregnancy, Pregnancy, Multiple, Prenatal Exposure Delayed Effects, Prospective Studies, Cohort Studies, Incidence

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