Systematic reviews and meta-analyses of human and animal evidence of prenatal diethylhexyl phthalate exposure and changes in male anogenital distance.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies and animal experiments
PubMed 30199328 · doi:10.1080/10937404.2018.1505354
What was done
The authors conducted a systematic review and meta-analysis across PubMed, Embase, and Toxline (searched through August 15, 2016) evaluating human and experimental animal evidence regarding in utero diethylhexyl phthalate (DEHP) exposure and male anogenital distance (AGD). Eligible studies were assessed for quality, and data were synthesized across 6 human studies and 19 experimental animal studies.
What was found
Meta-analysis of 5 human prospective cohort studies revealed that higher maternal urinary concentrations of DEHP metabolites were associated with a -4.07% (95% CI, -6.49% to -1.66%) decrease in boys' AGD per log10 rise in DEHP metabolites. Meta-analysis and meta-regression of 19 experimental animal studies demonstrated reduced AGD with DEHP treatment showing a dose-response gradient, with heterogeneity explained by species and strain.
Why it matters
This review integrates toxicological and human epidemiological streams to conclude that prenatal DEHP acts as a presumed reproductive toxicant altering male genital development.
Limits
The human evidence is observational and limited to 5 prospective cohort studies, carrying risks of residual confounding and exposure misclassification. The abstract does not report individual participant counts, specific exposure windows, or exact effect sizes from animal subgroups.
Cited by
- supports Higher maternal phthalate levels during pregnancy correlate with reduced anogenital distance in male infants.