TY - JOUR
T1 - Lifestyle in Pregnancy and Hypospadias in Sons
T2 - A Study of 85,923 Mother-Son Pairs from Two Danish Pregnancy Cohorts
AU - Kjersgaard, Camilla Lomholt
AU - Arendt, Linn Håkonsen
AU - Ernst, Andreas
AU - Lindhard, Morten Sondergaard
AU - Olsen, Jørn
AU - Henriksen, Tine Brink
AU - Strandberg-Larsen, Katrine
AU - Ramlau-Hansen, Cecilia Host
PY - 2022
Y1 - 2022
N2 - Purpose: Hypospadias is one of the most frequent male congenital malformations. It remains controversial whether maternal lifestyle during pregnancy may affects the risk of having a son with hypospadias, especially for smoking with many suggesting lower risk. We assessed the individual and joint associations between maternal cigarette smoking, prepregnancy body mass index (BMI), alcohol consumption, binge drinking, and caffeine consumption and occurrence of hypospadias in sons. Patients and Methods: This cohort study utilized the Danish National Birth Cohort and the Aarhus Birth Cohort, holding detailed information on lifestyle factors in early pregnancy between 1989 and 2012. The Danish health registers were used to identify boys with hypospadias, according to International Classification of Diseases. Potential confounders and covariates were identified by literature search and use of directed acyclic graphs. Missing data were handled by multiple imputation and Cox proportional hazards models were applied to analyse data. Results: In total, 85,923 live-born singleton boys were included in the study of whom 502 (0.6%) were diagnosed with hypospadias. Maternal smoking in early pregnancy was associated with lower occurrence of hypospadias. An increase of one cigarette smoked per day was associated with lower risk of having a son with hypospadias (adjusted hazard ratio (HR) 0.97 (95% confidence interval (CI) 0.94, 1.00)). However, sub-analyses suggested that the results may be prone to unadjusted confounding. We found no association between prepregnancy BMI, alcohol consumption, binge drinking, or caffeine consumption and hypospadias. Conclusion: Maternal smoking during pregnancy was associated with lower occurrence of hypospadias but we cannot exclude uncontrolled confounding. The other investigated maternal lifestyle factors were not associated with hypospadias in sons.
AB - Purpose: Hypospadias is one of the most frequent male congenital malformations. It remains controversial whether maternal lifestyle during pregnancy may affects the risk of having a son with hypospadias, especially for smoking with many suggesting lower risk. We assessed the individual and joint associations between maternal cigarette smoking, prepregnancy body mass index (BMI), alcohol consumption, binge drinking, and caffeine consumption and occurrence of hypospadias in sons. Patients and Methods: This cohort study utilized the Danish National Birth Cohort and the Aarhus Birth Cohort, holding detailed information on lifestyle factors in early pregnancy between 1989 and 2012. The Danish health registers were used to identify boys with hypospadias, according to International Classification of Diseases. Potential confounders and covariates were identified by literature search and use of directed acyclic graphs. Missing data were handled by multiple imputation and Cox proportional hazards models were applied to analyse data. Results: In total, 85,923 live-born singleton boys were included in the study of whom 502 (0.6%) were diagnosed with hypospadias. Maternal smoking in early pregnancy was associated with lower occurrence of hypospadias. An increase of one cigarette smoked per day was associated with lower risk of having a son with hypospadias (adjusted hazard ratio (HR) 0.97 (95% confidence interval (CI) 0.94, 1.00)). However, sub-analyses suggested that the results may be prone to unadjusted confounding. We found no association between prepregnancy BMI, alcohol consumption, binge drinking, or caffeine consumption and hypospadias. Conclusion: Maternal smoking during pregnancy was associated with lower occurrence of hypospadias but we cannot exclude uncontrolled confounding. The other investigated maternal lifestyle factors were not associated with hypospadias in sons.
KW - smoking
KW - prenatal exposures
KW - alcohol
KW - caffeine
KW - BMI
KW - birth defects
KW - ENVIRONMENTAL RISK-FACTORS
KW - MATERNAL SMOKING
KW - BIRTH-WEIGHT
KW - CRYPTORCHIDISM
KW - POPULATION
KW - BOYS
KW - PREVALENCE
KW - EXPOSURES
KW - ETIOLOGY
U2 - 10.2147/CLEP.S335877
DO - 10.2147/CLEP.S335877
M3 - Journal article
C2 - 35173488
VL - 14
SP - 149
EP - 157
JO - Clinical Epidemiology
JF - Clinical Epidemiology
SN - 1179-1349
ER -