Table 7.

Characteristics of Latin American and the Caribbean studies on pesticide exposure and reproductive outcomes published between 2007 and 2021 ($n=16$).

Study	Year of publication/country	Population and sample size	Study design	Pesticides assessed	Exposure assessment method	Pesticide or metabolite concentrations	Health effect and assessment method/instrument	Results
Studies on OCs
1. Bastos et al.204	2013/Brazil	15 women seeking help for infertility treatment/21 women spontaneously pregnant	Case–control	OCs	Questionnaire (occupational and reproductive history). Serum HCB, DDT, DDE, DDD	$\text{Mean}\pm \text{SD}$ ($\text{ng}/\mathrm{mL}$): Fertile women: $\text{HCB}=0.1\pm 0.10$; $p,p\prime \text{-DDE}=0.9\pm 0.8$; $p,p\prime \text{-DDT}=0.7\pm 0.1$ Infertile women: $\text{HCB}=0.2\pm 0.4$; $p,p\prime \text{-DDE}=3.1\pm 3.6$; $p,p\prime \text{-DDT}=9.1\pm 11.9$	Fertility	Infertile women had higher detectable serum DDE concentrations than fertile women ($p=0.001$).
2. Blanco-Muñoz et al.202	2012/Mexico	84 male floriculture workers	Prospective cohort	OCs	Questionnaire (occupational history) Serum DDE	Median (range) ($\text{ng}/\mathrm{g}$): Rainy season: $p,p\prime \text{-DDE}=677.2(9.4–\mathrm{12,696.5})$ Dry season: $p,p\prime \text{-DDE}=626.7(9.4–\mathrm{13,688.1})$	Serum FSH, LH, prolactin, testosterone, estradiol, inhibin B	$p,p\prime$-DDE concentrations were negatively associated with prolactin ($\mathrm{\beta }=-0.04$; 95% CI: $-0.07$, $-0.01$) and testosterone ($\mathrm{\beta }=-0.04$; 95% CI: $-0.08$, 0.01), but positively associated with inhibin B ($\mathrm{\beta }=0.11$; 95% CI: 0.02, 0.21). Null associations of $p,p\prime$-DDE with FSH, LH, or estradiol.
3. Freire et al.203	2014/Brazil	604 men and women living near an abandoned pesticide factory	Cross-sectional	OCs	Questionnaire (residential exposure history) Serum HCH, HCB, chlordane, trans-nonachlor, heptachlor, DDT, DDE, DDD, endosulfan, aldrin, endrin, dieldrin, methoxychlor, mirex	Median (P25–P75) ($\text{ng}/\mathrm{mL}$): Premenopausal women: $\mathrm{\alpha }\text{-HCH}=2.8(1.0–6.1)$; $\mathrm{\beta }\text{-HCH}=6.3(2.5–14.4)$; $\mathrm{\gamma }\text{-HCH}=0.9(0.4–2.3)$; $\text{HCB}=0.4(0.1–0.6)$; $\mathrm{\alpha }\text{-chlordane}=0.3(<\text{LOD}–0.6)$; $\mathrm{\gamma }\text{-chlordane}=0.2(<\text{LOD}–0.4)$; $trans\text{-nonachlor}=0.4(0.2–0.8)$; $\text{heptachlor}=0.4(<\text{LOD}–0.9)$; $p,p\prime \text{-DDE}=8.0(3.0–21.8)$; $o,p\prime \text{-DDT}=0.4(<\text{LOD}–1.1)$; $p,p\prime \text{-DDT}=3.0(1.0–7.3)$; $p,p\prime \text{-DDD}=0.6(0.2–1.2)$; $\text{endosulfan\hspace{0.17em}}1=0.2(<\text{LOD}–0.4)$; $\text{endosulfan\hspace{0.17em}}2=0.2(<\text{LOD}–0.8)$; $\text{aldrin}=2.1(0.8–13.4)$; $\text{endrin}=0.6(0.3–1.6)$; $\text{dieldrin}=0.6(0.2–1.3)$; $\text{methoxychlor}=0.4(<\text{LOD}–1.0)$; [$\text{mirex}<\text{LOD}<\text{LOD}-0.3$] Peri-/postme nopausal women: $\mathrm{\alpha }\text{-HCH}=2.4(1.1–6.1)$; $\mathrm{\beta }\text{-HCH}=11.7(4.8–36.3)$; $\mathrm{\gamma }\text{-HCH}=1.1(0.6–2.0)$; $\text{HCB}=0.4(0.2–0.8)$; $\mathrm{\alpha }\text{-chlordane}=0.3(0.1–0.6)$; $\mathrm{\gamma }\text{-chlordane}=0.2(<\text{LOD}–0.4)$; $trans\text{-nonachlor}=0.4(0.2–0.8)$; $\text{heptachlor}=0.3(<\text{LOD}–0.7)$; $p,p\prime \text{-DDE}=20.6(6.2–65.6)$; $o,p\prime \text{-DDT}=0.4(<\text{LOD}–1.2)$; $p,p\prime \text{-DDT}=4.7(1.2–10.7)$; $p,p\prime \text{-DDD}=0.9(0.3–1.8)$; $\text{endosulfan\hspace{0.17em}}1=0.2(<\text{LOD}–0.5)$; $\text{endosulfan\hspace{0.17em}}2=0.3(<\text{LOD}–0.6)$; $\text{aldrin}=3.8(1.0–20.1)$; $\text{endrin}=0.5(0.2–1.4)$; $\text{dieldrin}=0.6(0.3–1.2)$; $\text{methoxychlor}=0.5(0.2–1.0)$; $\text{mirex}<\text{LOD\hspace{0.17em}}(<\text{LOD}–0.5)$ Men: $\mathrm{\alpha }\text{-HCH}=2.5(1.0–0.7)$; $\mathrm{\beta }\text{-HCH}=6.0(2.1–15.4)$; $\mathrm{\gamma }\text{-HCH}=1.0(0.4–2.2)$; $\text{HCB}=0.3(0.1–0.6)$; $\mathrm{\alpha }\text{-chlordane}=0.2(<\text{LOD}–0.5)$; $\mathrm{\gamma }\text{-chlordane}=0.2(<\text{LOD}–0.4)$; $trans\text{-nonachlor}=0.3(0.2–0.8)$; $\text{heptachlor}=0.3(<\text{LOD}–0.9)$; $p,p\prime \text{-DDE}=8.3(2.9–21.9)$; $o,p\prime \text{-DDT}=0.3(<\text{LOD}–0.9)$; $p,p\prime \text{-DDT}=3.1(0.9–7.0)$; $p,p\prime \text{-DDD}=0.6(0.2–1.3)$; $\text{endosulfan\hspace{0.17em}}1=0.2(<\text{LOD}–0.5)$; $\text{endosulfan\hspace{0.17em}}2=0.2(<\text{LOD}–0.7)$; $\text{aldrin}=1.9(0.7–11.0)$; $\text{endrin}=0.6(0.2–1.5)$; $\text{dieldrin}=0.6(0.3–1.3)$; $\text{methoxychlor}=0.5(<\text{LOD}–1.0)$; $\text{mirex}<\text{LOD\hspace{0.17em}}(<\text{LOD}–0.3)$	Serum testosterone, estradiol, progesterone, prolactin, LH, FSH	Higher heptachlor and $o,p\prime$-DDT were associated with decreased testosterone levels among men ($\mathrm{\beta }=-0.03$; 95% CI: $-0.04$, $-0.01$, and $\mathrm{\beta }=-0.02$; 95% CI: $-0.05$, $-0.01$, respectively). Among peri-/postmenopausal women, higher aldrin was associated with increased estradiol levels ($\mathrm{\beta }=0.006$; 95% CI: 0.001, 0.01), but decreased LH ($\mathrm{\beta }=-0.01$; 95% CI: $-0.02$, $-0.003$) and FSH ($\mathrm{\beta }=-0.007$; 95% CI: $-0.01$, $-0.001$) levels. Higher $p,p\prime$-DDD and endosulfan 1 were associated with decreased LH ($\mathrm{\beta }=-0.09$; 95% CI: $-0.17$, $-0.02$, and $\mathrm{\beta }=-0.24$; 95% CI: $-0.46$, $-0.03$, respectively) and FSH ($\mathrm{\beta }=-0.09$; 95% CI: $-0.15$, $-0.03$; $\mathrm{\beta }=-0.23$; 95% CI: $-0.41$, $-0.05$, respectively) levels. Higher HCB ($\mathrm{\beta }=-0.13$; 95% CI: $-0.2$, $-0.02$), $p,p\prime$-DDT ($\mathrm{\beta }=-0.01$; 95% CI: $-0.02$, $-0.003$), endosulfan 2 ($\mathrm{\beta }=-0.14$; 95% CI: $-0.25$, $-0.03$), and mirex ($\mathrm{\beta }=-0.07$; 95% CI: $-0.12$, $-0.02$) were also associated with decreased LH levels among this group of women. Among premenopausal women, no associations were found.
4. Ayhan et al.189	2021/Guadeloupea,b	285 mother–child (7 years of age) pairs	Prospective cohort	OCs	Cord and child blood chlordecone, cord blood DDE	Median (P25–P75) ($\mathrm{\mu }\mathrm{g}/\mathrm{L}$): Cord blood chlordecone: $\text{boys}=0.25(0.08–0.41)$, $\text{girls}=0.21(0.07–0.37)$; child chlordecone: $\text{boys}=0.06(<\text{LOD}–0.11)$, $\text{girls}=0.05(<\text{LOD}–0.11)$; cord blood DDE: $\text{boys}=0.22(0.09–0.64)$, $\text{girls}=0.31(0.10–0.74)$	Serum DHEA, TT, DHT, estradiol	Third quartile of cord blood chlordecone was associated with elevated DHEA ($\mathrm{\beta }$ for $\text{boys}=0.5$; 95% CI: 0.1, 1.0; $\mathrm{\beta }$ for $\text{girls}=0.4$; 95% CI: 0, 0.7), TT (OR for $\text{boys}=3.2$; 95% CI: 1.1, 9.6; OR for $\text{girls}=3.3$; 95% CI: 1.3, 8.2), and DHT (OR for $\text{boys}=3.7$; 95% CI: 1.3, 10.6; OR for $\text{girls}=3.2$; 95% CI: 1.0, 10.2) levels in boys and girls, relative to first quartile of cord blood chlordecone.
Studies on OPs or CBs
5. Recio-Vega et al.209	2008/Mexico	19 sprayer farmworkers/16 non-sprayer farmworkers/17 non-farmworkers	Prospective cohort	OPs	Questionnaire (occupational, residential, and seasonal exposure histories). Urinary DAPs	$\text{Mean}\pm \text{SD}$ total DAPs (ppb): $\text{Non-occupationally exposed}=\mathrm{1,004.8}\pm \mathrm{2,380.49}$ Farmworkers but not OP $\text{sprayers}=\mathrm{1,054.6}\pm \mathrm{1,916.2}$ Sprayers exposed to $\text{OP}=\mathrm{1,283.7}\pm \mathrm{2,304.9}$	Semen quality	Sprayer farmworkers had lower sperm volume ($\mathrm{\beta }=-0.7$, $p=0.002$) and lower sperm count ($\mathrm{\beta }=-2.2$, $p=0.03$) than non-farmworkers. During low exposure period, non-sprayer farmworkers had lower rapid progressive motility ($\mathrm{\beta }=-17.2$, $p=0.04$). During medium exposure period sprayer farmworkers had lower sperm volume ($\mathrm{\beta }=-0.3$, $p=0.02$). During high exposure period, seminal parameters were similar among all groups. Sperm vitality was lower at higher levels of DMDTP ($\mathrm{\beta }=-146.3$, $p=0.006$). No other seminal parameters were associated with DAP levels.
6. Yucra et al.208	2008/Peru	31 male farmworkers/31 controls	Cross-sectional	OPs	Questionnaire (occupational exposure history) Urinary DAPs	$\text{Geometric\hspace{0.17em}mean}\pm \text{GSD}$ ($\mathrm{\mu }\mathrm{g}/\mathrm{L}$): Nonexposed: $\text{DEP}=3.0\pm 2.1$; $\text{DEDTP}=10.2\pm 54.5$; $\text{DETP}=2.7\pm 1.0$; $\text{DMP}=9.6\pm 19.5$; $\text{DMDTP}=56.4\pm 6.7$; $\text{DMTP}=9.7\pm 68.7$ Exposed: $\text{DEP}=3.8\pm 8.2$; $\text{DEDTP}=25.3\pm 78.6$; $\text{DETP}=3.9\pm 7.2$; $\text{DMP}=14.2\pm 42.4$; $\text{DMDTP}=5.3\pm 4.5$; $\text{DMTP}=22.9\pm 48.6$	Semen quality Serum testosterone, estradiol, FSH, LH	Higher concentrations of ethylated OP metabolites were associated with lower seminal volume ($p=0.02$), whereas higher concentrations of methylated OP metabolites were associated with higher seminal pH ($p=0.02$). After controlling for ethylated OP metabolites, exposure to pesticides (yes/no) was associated with increased seminal pH ($p=0.02$). After controlling for methylated OP metabolites, exposure to pesticides (yes/no) was associated with increased seminal pH ($p=0.002$) and decreased seminal fructose levels ($p=0.04$). Null associations of pesticide exposure and serum hormone levels.
7. Blanco-Muñoz et al.207	2010/Mexico	104 male floriculture workers	Cross-sectional	OPs	Questionnaire (occupational exposure history) Urinary DAPs	Median (range) ($\mathrm{\mu }\mathrm{g}/\mathrm{g}$ creatinine): Low exposure: $\text{DMP}=17.4(5.4–196.8)$; $\text{DMTP}=11.0(4.6–156.8)$; $\text{DMDTP}=7.8(4.6–165.2)$; $\text{DEP}=16.2(5.4–29.9)$; $\text{DETP}=8.3(4.7–14.4)$; $\text{DEDTP}=8.6(2.4–31.0)$; $\text{total\hspace{0.17em}DAPs}=77.8(35.0–305.3)$ Medium exposure: $\text{DMP}=89.9(12.3–\mathrm{9,213.9})$; $\text{DMTP}=31.6(6.0–377.2)$; $\text{DMDTP}=9.6(3.0–88.1)$; $\text{DEP}=20.3(4.3–113.6)$; $\text{DETP}=10.6(3.5–60.2)$; $\text{DEDTP}=5.5(3.0–51.5)$; total $\text{DAPs}=216.5(59.3–\mathrm{9,324.3})$ High exposure: $\text{DMP}=76.6(6.9–986.3)$; $\text{DMTP}=29.0(3.3–\mathrm{1,359.0})$; $\text{DMDTP}=9.3(3.2–437.0)$; $\text{DEP}=15.9(3.1–153.9)$; $\text{DETP}=9.6(2.7–625.5)$; $\text{DEDTP}=6.2(2.7–34.9)$; $\text{total\hspace{0.17em}DAPs}=190.7(34.3–\mathrm{2,270.8})$	Serum FSH, LH, prolactin, testosterone, inhibin B, estradiol	Higher DMP ($\mathrm{\beta }=-0.001$; 95% CI: $-0.002$, $-0.0002$), DEP ($\mathrm{\beta }=-0.01$; 95% CI: $-0.02$, $-0.002$), DETP ($\mathrm{\beta }=-0.004$; 95% CI: $-0.01$, $-0.0001$) and total DAP ($\mathrm{\beta }=-0.001$; 95%CI: $-0.001$, $-0.0002$) concentrations were associated with decreased inhibin B levels. Higher DEP concentrations were associated with decreased FSH ($\mathrm{\beta }=-0.002$; 95% CI: $-0.004$, $-0.0005$). Higher DEP ($\mathrm{\beta }=0.002$; 95% CI: $-0.00001$, 0.004) and total DAP ($\mathrm{\beta }=0.0001$; 95% CI: 0.000005, 0.0003) concentrations marginally associated with increased testosterone levels. Higher DETP marginally was associated with decreased LH levels ($\mathrm{\beta }=-0.001$; 95% CI: $-0.002$, 0.0001).
8. Cecchi et al.26	2012/Argentinaa	97 pregnant women living in a rural area with intensive use of pesticides	Prospective cohort	OPs	Questionnaire (residential exposure history) Blood AChE and BChE $\mathrm{\beta }\text{-glucuronidase}$	Not applicable	Serum progesterone (measured during spray and prespray season)	Higher AChE activity was associated with increased progesterone levels ($\mathrm{\beta }=57.8$; $p\le 0.05$).
9. Miranda-Contreras et al.200	2013/Venezuelab	64 male farmworkers/35 controls	Cross-sectional	OPs, CBs	Questionnaire (occupational exposure history) Blood AChE and BChE	Not applicable	Semen quality Sperm chromatin integrity (DFI) Serum testosterone, FSH, LH, PRL	Farmworkers had higher seminal pH ($p=0.004$) and lower percentage of live sperm ($p<0.001$) than controls. Farmworkers with decreased BChE activity had higher DFI ($r=-0.3$, $p=0.027$). Null associations of serum hormones with cholinesterase levels.
10. Aguilar-Garduño et al.205	2013/Mexico	136 male floricultural workers	Prospective cohort	OPs	Urinary DAPs	Median (GM) total DAPs ($\mathrm{\mu }\text{mol}/\mathrm{g}$ creatinine): $\text{Rainy\hspace{0.17em}season}=1.62\left(2.00\right)$; $\text{Dry\hspace{0.17em}season}=0.48\left(0.48\right)$	Serum FSH, LH, prolactin, testosterone, estradiol, inhibin B	Higher total DAP concentrations were associated with increased FSH and prolactin levels ($p<0.01$ for each) and decreased testosterone ($p<0.01$) and inhibin B levels ($p=0.11$).
11. Silvia et al.210	2020/Argentinac	53 pregnant women living in areas with intensive pesticide application	Cross-sectional	OPs, CBs	Questionnaire (residential exposure history) Blood AChE, BChEd	Not applicable	Plasma estradiol, progesterone (measured during spray and non-spray season)	Progesterone and estradiol levels did not differ between spray and non-spray seasons.
Studies on other pesticides or multiple pesticide classes
12. Sanin et al.211	2009/Colombia	2,592 fertile women from regions with different levels of aerial glyphosate spraying	Retrospective cohort	Glyphosate	Questionnaire (residential and occupational exposure history) Ecological exposure index (different levels of exposure according to agricultural practices)	Not applicable	TTP	Reduced fecundability was not associated with aerial glyphosate spraying.
13. Rojas and Guevara212	2014/Venezuela	180 women of reproductive age	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history)	Not applicable	Menstrual cycle and bleeding duration	Women who were occupationally exposed to pesticides had longer menstrual cycles than women who did not have contact with pesticides ($p<0.01$). Null association between bleeding duration and pesticide exposure.
14. Miranda-Contreras et al.213	2015/Venezuela	64 male farmworkers/64 controls	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational exposure history)	Not applicable	Semen quality Sperm chromatin integrity (DFI)	Farmworkers had decreased sperm concentration ($p=0.01$), vitality ($p<0.001$), slow progressive motility ($p=0.01$), lower sperm membrane integrity ($p=0.001$), and high DFI ($p<0.001$) compared with controls.
15. Cremonese et al.214	2017/Brazil	99 rural young men/36 urban young men	Cross-sectional	Multiple pesticide classes	Questionnaire (residential, occupational, and reproductive exposure history) Blood AChE and BChE	Not applicable	Semen quality Genital measurements (AGD, TV) Serum testosterone, LH, FSH, SHBG, prolactin	Rural men had decreased normal sperm morphology ($\mathrm{\beta }=0.7$; 95% CI: 0.6, 0.9), increased sperm count ($\mathrm{\beta }=1.6$; 95% CI: 1.01, 2.5), increased TV ($\mathrm{\beta }=1.3$; 95% CI: 1.1, 1.5), decreased LH levels ($\mathrm{\beta }=0.8$; 95% CI: 0.7, 1.0) and increased T:LH ratio ($\mathrm{\beta }=1.3$; 95% CI: 1.1, 1.6) compared with urban men. Farmers who had $\ge 6$ y working had decreased T:LH ratio ($\mathrm{\beta }=0.8$; 95% CI: 0.7, 1.0) and decreased TV ($\mathrm{\beta }=0.8$; 95% CI: 0.8, 1.0) ($\text{Ref}<6$); who had $>1$ y handling pesticides had decreased LH levels ($\mathrm{\beta }=0.8$; 95% CI: 0.7, 1.0), increased T:LH ratio ($\mathrm{\beta }=1.2$; 95% CI: 1.1, 1.4), lower normal morphology ($\mathrm{\beta }=0.7$; 95% CI: 0.6, 0.9) and increased TV ($\mathrm{\beta }=1.2$; 95% CI: 1.1, 1.4) (Ref $\le 1$), and who had $\ge 5$ d/y handling pesticides had increased LH levels ($\mathrm{\beta }=1.2$; 95% CI: 1.0, 1.4) and lower normal morphology ($\mathrm{\beta }=0.8$; 95% CI: 0.8, 1.0) ($\text{Ref}<5$). Those farmworkers who used pesticides in the high use season had increased prolactin levels ($\mathrm{\beta }=1.4$; 95% CI: 1.2, 1.7), and those who did not use PPE had decreased testosterone levels ($\mathrm{\beta }=0.9$; 95% CI: 0.8, 1.0) and TV ($\mathrm{\beta }=0.8$; 95% CI: 0.8, 1.0). Maternal farming during pregnancy was associated with increased AGD ($\mathrm{\beta }=1.1$; 95% CI: 1.01, 1.1) and TV ($\mathrm{\beta }=1.2$; 95% CI: 1.02, 1.3). Cholinesterase activities were not associated with reproductive hormones or semen quality.
16. Santos et al.201	2019/Brazilb	122 farmworkers and their families	Cross-sectional	Multiple pesticide classes	Questionnaire (occupational, residential, and seasonal exposure history)	Not applicable	Serum LH, testosterone, estradiol, LH, FSH	Recent use of fungicides in general ($\%\text{\hspace{0.17em}change}=41\%$; 95% CI: 11, 80), $\mathrm{\lambda }\text{-cyhalothrin}$ (59%; 95% CI: 13, 123), and phthalimide (95%; 95% CI: 37, 176) was associated with increased LH levels in men. Working in agriculture (1–30 y) was associated with increased testosterone levels in men (20%; 95% CI: 2, 40) (reference group never worked in agriculture).

Note: %change, percentage change; AChE, acetylcholinesterase; AGD, anogenital distance; BChE, butyrylcholinesterase; CBs, carbamate pesticides; CE, carboxylesterases; CI, confidence interval; DAP, dialkylphosphate; DDD, dichlorodiphenyldichloroethane; DDE, dichlorodiphenyldichloroethylene; DDT, dichlorodiphenyltrichloroethane; DEDTP, Diethyldithiophosphate; DEP, diethylphosphate; DETP, diethylthiophosphate; DFI, fragmentation Index; DHEA, dehydroepiandrosterone; DHT, dihydrotestosterone; DMDTP, dimethyldithiophosphate; DMP, dimethylphosphate; FSH, follicle-stimulating hormone; GSD, geometric standard deviation; HCB, hexa-chlorobenzene; IQR, interquartile range; LH, luteinizing hormone; LOD, limit of detection; OC, organochlorine; OP, organophosphate; P, percentile; PPE, personal protective equipment; PRL, Prolactin; Ref, reference group; SD, standard deviation; SHBG, sex hormone-binding globulin; T:LH, testosterone/luteinizing hormone ratio; TT, total testosterone; TTP, time to pregnancy; TV, testis volume.

^a Also included in Table 9 (other health outcomes).

^b Also included in Table 6 (thyroid function).

^c Also included in Table 8 (birth size and child growth).

^d Investigators did not use exposure biomarker concentrations in multivariate analyses.