Association between bisphenol A levels during pregnancy and spontaneous abortion: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZOU Xuanmin ^1,2 , CHEN Chen ^1,2 , GUAN Tianyue ^1,2 ,  HAO Jiahu ^1,2

1. School of Public Health, Anhui Medical University, Hefei 230032, P. R. China;
2. MOE Key Laboratory of Population Health Across Life Cycle, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, P. R. China;

Corresponding?author：

HAO Jiahu, Email: jia7218@126.com

Keywords：

Bisphenol A; Spontaneous abortion; Meta-analysis; Case-control study; Cohort study

DOI：

10.7507/1672-2531.202205002

Video：

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Objective To systematically review the association between exposure to bisphenol A during pregnancy and spontaneous abortion. Methods The PubMed, Web of Science, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to identify cohort studies and case-control studies related to bisphenol A exposure and spontaneous abortion from inception to April 1^st, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software. Results A total of 7 case-control studies and 1 cohort study were included, with a total of 1 179 subjects. The results of meta-analysis showed that there was a statistically significant difference in bisphenol A concentrations between the spontaneous abortion group and the control group regardless of whether the sample source was serum or urine (SMD_serum=1.05, 95%CI 0.34 to 1.77, P=0.004; SMD_urine=0.20, 95%CI 0.02 to 0.38, P=0.027). Conclusion The current evidence shows that exposure to bisphenol A during pregnancy may lead to unexplained recurrent spontaneous abortion. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： ZOU Xuanmin, CHEN Chen, GUAN Tianyue, HAO Jiahu. Association between bisphenol A levels during pregnancy and spontaneous abortion: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(10): 1149-1154. doi: 10.7507/1672-2531.202205002 Copy

1.	趙艷輝, 龐泓, 高銘, 等. 早期自然流產的遺傳學因素分析. 中國優生與遺傳雜志, 2019, 27(1): 55-57,65.
2.	ESHRE Guideline Group on RPL, Bender AR, Christiansen OB, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open, 2018, 2018(2): hoy004.
3.	Rai R, Regan L. Recurrent miscarriage. Lancet, 2006, 368(9535): 601-611.
4.	Zhang C, Deng X, Zhang X, et al. Association between serum TNF-α levels and recurrent spontaneous miscarriage: a meta-analysis. Am J Reprod Immunol, 2016, 75(2): 86-93.
5.	Zhu D, Zou H, Liu J, et al. Inhibition of HMGB1 ameliorates the maternal-fetal interface destruction in unexplained recurrent spontaneous abortion by suppressing pyroptosis activation. Front Immunol, 2021, 12: 782792.
6.	Pei CZ, Kim YJ, Baek KH. Pathogenetic factors involved in recurrent pregnancy loss from multiple aspects. Obstet Gynecol Sci, 2019, 62(4): 212-223.
7.	Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev, 2009, 30(4): 293-342.
8.	吳海瑛, 陳臨琪, 王鳳云, 等. 雙酚A與女童性早熟的關系. 臨床兒科雜志, 2015, (2): 155-159.
9.	Vandenberg LN, Hauser R, Marcus M, et al. Human exposure to bisphenol A (BPA). Reprod Toxicol, 2007, 24(2): 139-177.
10.	Sch?nfelder G, Wittfoht W, Hopp H, et al. Parent bisphenol A accumulation in the human maternal-fetal-placental unit. Environ Health Perspect, 2002, 110(11): A703-707.
11.	Sugiura-Ogasawara M, Ozaki Y, Sonta S, et al. Exposure to bisphenol A is associated with recurrent miscarriage. Hum Reprod, 2005, 20(8): 2325-2329.
12.	劉銀梅. 雙酚A與不明原因復發性流產的1: 2病例-對照研究. 蘇州: 蘇州大學, 2011.
13.	鄭艷敏, 王燕, 趙靜, 等. 血清雙酚A含量與復發性流產的1: 2病例對照研究. 中華流行病學雜志, 2012, 33(8): 841-845.
14.	鄭艷敏. 尿液/血清中雙酚A水平與不明原因復發性流產風險關系的比較研究. 蘇州: 蘇州大學, 2013.
15.	Lathi RB, Liebert CA, Brookfield KF, et al. Conjugated bisphenol A in maternal serum in relation to miscarriage risk. Fertil Steril, 2014, 102(1): 123-128.
16.	李娜. 雙酚A對稽留流產影響及其相關機制研究. 長春: 吉林大學, 2014.
17.	Shen Y, Zheng Y, Jiang J, et al. Higher urinary bisphenol A concentration is associated with unexplained recurrent miscarriage risk: evidence from a case-control study in eastern China. PLoS One, 2015, 10(5): e0127886.
18.	謝倩. 環境雌激素雙酚A對女性生殖功能的影響. 泰安: 泰山醫學院, 2016.
19.	Peng F, Ji W, Zhu F, et al. A study on phthalate metabolites, bisphenol A and nonylphenol in the urine of Chinese women with unexplained recurrent spontaneous abortion. Environ Res, 2016, 150: 622-628.
20.	王明遠, 陳誠, 潘峰, 等. 雙酚A與不明原因復發性流產發生關系的病例對照研究. 第三軍醫大學學報, 2017, 39(6): 579-583.
21.	Ao J, Huo X, Zhang J, et al. Environmental exposure to bisphenol analogues and unexplained recurrent miscarriage: a case-control study. Environ Res, 2022, 204(Pt C): 112293.
22.	自然流產診治中國專家共識編寫組. 自然流產診治中國專家共識(2020年版). 中國實用婦科與產科雜志, 2020, 36(11): 1082-1090.
23.	Hahn RG, Yanase F, Zdolsek JH, et al. Serum creatinine levels and Nephrocheck? values with and without correction for urine dilution-a multicenter observational study. Front Med (Lausanne), 2022, 9: 847129.
24.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
25.	Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res, 2018, 27(6): 1785-1805.
26.	Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
27.	劉東蘋. 流產后關愛門診護理對女性重復流產的控制及避孕依從性的影響觀察. 實用婦科內分泌電子雜志, 2019, 6(18): 161,166.
28.	Whitley CE, Rose SB, Sim D, et al. Association between women's use of long-acting reversible contraception and declining abortion rates in New Zealand. J Womens Health (Larchmt), 2020, 29(1): 21-28.
29.	Kosarac I, Kubwabo C, Lalonde K, et al. A novel method for the quantitative determination of free and conjugated bisphenol A in human maternal and umbilical cord blood serum using a two-step solid phase extraction and gas chromatography/tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci, 2012, 898: 90-94.
30.	Li Q, Davila J, Kannan A, et al. Chronic exposure to bisphenol A affects uterine function during early pregnancy in mice. Endocrinology, 2016, 157(5): 1764-1774.
31.	Tran DN, Jung EM, Ahn C, et al. Effects of bisphenol A and 4-tert-octylphenol on embryo implantation failure in mouse. Int J Environ Res Public Health, 2018, 15(8): 1614.
32.	Du Y, Chen L, Lin J, et al. Chromosomal karyotype in chorionic villi of recurrent spontaneous abortion patients. Biosci Trends, 2018, 12(1): 32-39.
33.	Ogasawara M, Aoki K, Okada S, et al. Embryonic karyotype of abortuses in relation to the number of previous miscarriages. Fertil Steril, 2000, 73(2): 300-304.
34.	Brie?o-Enríquez MA, Reig-Viader R, Cabero L, et al. Gene expression is altered after bisphenol A exposure in human fetal oocytes in vitro. Mol Hum Reprod, 2012, 18(4): 171-183.

1. 趙艷輝, 龐泓, 高銘, 等. 早期自然流產的遺傳學因素分析. 中國優生與遺傳雜志, 2019, 27(1): 55-57,65.
2. ESHRE Guideline Group on RPL, Bender AR, Christiansen OB, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open, 2018, 2018(2): hoy004.
3. Rai R, Regan L. Recurrent miscarriage. Lancet, 2006, 368(9535): 601-611.
4. Zhang C, Deng X, Zhang X, et al. Association between serum TNF-α levels and recurrent spontaneous miscarriage: a meta-analysis. Am J Reprod Immunol, 2016, 75(2): 86-93.
5. Zhu D, Zou H, Liu J, et al. Inhibition of HMGB1 ameliorates the maternal-fetal interface destruction in unexplained recurrent spontaneous abortion by suppressing pyroptosis activation. Front Immunol, 2021, 12: 782792.
6. Pei CZ, Kim YJ, Baek KH. Pathogenetic factors involved in recurrent pregnancy loss from multiple aspects. Obstet Gynecol Sci, 2019, 62(4): 212-223.
7. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev, 2009, 30(4): 293-342.
8. 吳海瑛, 陳臨琪, 王鳳云, 等. 雙酚A與女童性早熟的關系. 臨床兒科雜志, 2015, (2): 155-159.
9. Vandenberg LN, Hauser R, Marcus M, et al. Human exposure to bisphenol A (BPA). Reprod Toxicol, 2007, 24(2): 139-177.
10. Sch?nfelder G, Wittfoht W, Hopp H, et al. Parent bisphenol A accumulation in the human maternal-fetal-placental unit. Environ Health Perspect, 2002, 110(11): A703-707.
11. Sugiura-Ogasawara M, Ozaki Y, Sonta S, et al. Exposure to bisphenol A is associated with recurrent miscarriage. Hum Reprod, 2005, 20(8): 2325-2329.
12. 劉銀梅. 雙酚A與不明原因復發性流產的1: 2病例-對照研究. 蘇州: 蘇州大學, 2011.
13. 鄭艷敏, 王燕, 趙靜, 等. 血清雙酚A含量與復發性流產的1: 2病例對照研究. 中華流行病學雜志, 2012, 33(8): 841-845.
14. 鄭艷敏. 尿液/血清中雙酚A水平與不明原因復發性流產風險關系的比較研究. 蘇州: 蘇州大學, 2013.
15. Lathi RB, Liebert CA, Brookfield KF, et al. Conjugated bisphenol A in maternal serum in relation to miscarriage risk. Fertil Steril, 2014, 102(1): 123-128.
16. 李娜. 雙酚A對稽留流產影響及其相關機制研究. 長春: 吉林大學, 2014.
17. Shen Y, Zheng Y, Jiang J, et al. Higher urinary bisphenol A concentration is associated with unexplained recurrent miscarriage risk: evidence from a case-control study in eastern China. PLoS One, 2015, 10(5): e0127886.
18. 謝倩. 環境雌激素雙酚A對女性生殖功能的影響. 泰安: 泰山醫學院, 2016.
19. Peng F, Ji W, Zhu F, et al. A study on phthalate metabolites, bisphenol A and nonylphenol in the urine of Chinese women with unexplained recurrent spontaneous abortion. Environ Res, 2016, 150: 622-628.
20. 王明遠, 陳誠, 潘峰, 等. 雙酚A與不明原因復發性流產發生關系的病例對照研究. 第三軍醫大學學報, 2017, 39(6): 579-583.
21. Ao J, Huo X, Zhang J, et al. Environmental exposure to bisphenol analogues and unexplained recurrent miscarriage: a case-control study. Environ Res, 2022, 204(Pt C): 112293.
22. 自然流產診治中國專家共識編寫組. 自然流產診治中國專家共識(2020年版). 中國實用婦科與產科雜志, 2020, 36(11): 1082-1090.
23. Hahn RG, Yanase F, Zdolsek JH, et al. Serum creatinine levels and Nephrocheck? values with and without correction for urine dilution-a multicenter observational study. Front Med (Lausanne), 2022, 9: 847129.
24. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
25. Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res, 2018, 27(6): 1785-1805.
26. Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
27. 劉東蘋. 流產后關愛門診護理對女性重復流產的控制及避孕依從性的影響觀察. 實用婦科內分泌電子雜志, 2019, 6(18): 161,166.
28. Whitley CE, Rose SB, Sim D, et al. Association between women's use of long-acting reversible contraception and declining abortion rates in New Zealand. J Womens Health (Larchmt), 2020, 29(1): 21-28.
29. Kosarac I, Kubwabo C, Lalonde K, et al. A novel method for the quantitative determination of free and conjugated bisphenol A in human maternal and umbilical cord blood serum using a two-step solid phase extraction and gas chromatography/tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci, 2012, 898: 90-94.
30. Li Q, Davila J, Kannan A, et al. Chronic exposure to bisphenol A affects uterine function during early pregnancy in mice. Endocrinology, 2016, 157(5): 1764-1774.
31. Tran DN, Jung EM, Ahn C, et al. Effects of bisphenol A and 4-tert-octylphenol on embryo implantation failure in mouse. Int J Environ Res Public Health, 2018, 15(8): 1614.
32. Du Y, Chen L, Lin J, et al. Chromosomal karyotype in chorionic villi of recurrent spontaneous abortion patients. Biosci Trends, 2018, 12(1): 32-39.
33. Ogasawara M, Aoki K, Okada S, et al. Embryonic karyotype of abortuses in relation to the number of previous miscarriages. Fertil Steril, 2000, 73(2): 300-304.
34. Brie?o-Enríquez MA, Reig-Viader R, Cabero L, et al. Gene expression is altered after bisphenol A exposure in human fetal oocytes in vitro. Mol Hum Reprod, 2012, 18(4): 171-183.

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