Table 17.
Outcome | Studies (design in parentheses) | Factors that increase confidence | Factors that decrease confidence | Summary of findings | Confidence judgement for outcome | Confidence judgement for overall hazard |
---|---|---|---|---|---|---|
Anogenital distance | Medium confidence Bornehag et al., 2015 (C) Jensen et al., 2016 (C) Swan et al., 2015 (C) Low confidence Bustamante-Montes et al., 2013 (C) Suzuki et al., 2012 (C) Swan, 2008 (C) |
Among medium confidence studies:
Overall:
|
|
Inverse associations between DEHP exposure and anogenital distance reported in 5/6 studies (Jensen et al., 2016, Swan et al., 2015, Bornehag et al., 2015, Swan, 2008, Suzuki et al., 2012), of which 2 were statistically significant (Swan et al., 2015, Swan, 2008). Among 3 medium confidence studies, effect size increased with increasing exposure levels (Fig. 2). | ⨁⨁◯ MODERATE | ⨁⨁⨁ ROBUST Supported by coherence across outcomes. |
Semen parameters | Medium confidence Axelsson et al., 2015a, 2015b (CS) Bloom et al., 2015 (C) Han et al., 2014 (CS) Hauser et al., 2006 (CS) Huang et al., 2013 (CS) Jurewicz et al., 2013 (CS) Liu et al., 2012 (CS) Pan et al., 2015 (CS) Specht et al., 2014 (CS) Thurston et al., 2016 (CS) Wang et al., 2015a, 2015b, 2015c (CS) Wirth et al., 2008 (CS) Low confidence Den Hond et al., 2015 (CS) Herr et al., 2009 (CS) |
|
|
Inverse associations between DEHP exposure and sperm concentration in 7/14 studies (Herr et al., 2009, Huang et al., 2011, Wirth et al., 2008, Specht et al., 2014, Bloom et al., 2015, Hauser et al., 2006), of which 1 was statistically significant (Bloom et al., 2015). Four studies reported an inverse association with motility (Axelsson et al., 2015a; Huang et al., 2013; Huang et al., 2011, and Jurewicz et al., 2013), and 2 were statistically significant (Axelsson et al., 2015a; Jurewicz et al., 2013) (Table 4). Biological plausibility-Studies showed increased apoptosis (Huang et al., 2014); (Wang et al., 2016b; You et al., 2015), increased reactive oxygen species generation (Huang et al., 2014), and increased sperm aneuploidy (Jurewicz et al., 2013) with increased exposure. |
⨁⨁◯ MODERATE for concentration | |
Testosterone | Medium confidence Axelsson et al., 2015a, 2015b (CS) Han et al., 2014 (CS) Jurewicz et al., 2013 (CS) Meeker and Ferguson, 2014 (CS) Meeker et al., 2009 (CS) Mendiola et al., 2011 (C) Pan et al., 2015 (CS) Specht et al., 2014 (CS) Wang et al., 2015c (CS) Low confidence Chang et al. (2015) (CS) Den Hond et al., 2015 (CS) Pan et al., 2006 (CS) Park et al., 2010 (CS) |
|
|
Inverse associations between DEHP exposure and testosterone levels in 8/13 studies (Specht et al., 2014, Meeker and Ferguson, 2014, Wang et al., 2015b, Meeker et al., 2009, Axelsson et al., 2015a, Park et al., 2010, Jurewicz et al., 2013, Pan et al., 2015), 2 of which were statistically significant (Specht et al., 2014, Jurewicz et al., 2013), with the former showing an exposure-response trend, other studies did not examine exposure-response gradient (Table 13). | ⨁⨁◯ MODERATE | |
Time to Pregnancy | ⨁◯◯ SLIGHT | |||||
Hypospadias/cryptorchidism and pubertal development | ◯◯◯ INDETERMINATE |
C: cohort, CC: case-control, CS: cross-sectional.