Shruthi Mahalingaiah: Reproductive Scientist Development Program HD000849, and a research grant from the Boston University Department of Obstetrics and Gynecology, Stacey Missmer: R01HD57210 from the National Institute of Child Health and Human Development and the Massachusetts Institute of Technology Center for Environmental Health Sciences Translational Pilot Project Program, R01CA50385 from the National Cancer Institute, Jaime Hart and Francine Laden: 5R01ES017017 from the National Institute for Environmental Health Sciences, Jaime Hart: P30 ES00002 from the National Institute for Environmental Health Sciences at the National Institute of Health, The Nurses' Health Study II is supported by infrastructure grant UM1CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services The authors have no conflicts of interest to declare.

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Objectives Dietary factors may play a role in uterine fibroids etiology due to their potential to modify endogenous hormones and their inflammatory effects – these processes may be influenced by food contaminants including pesticides. We sought to examine the association between pesticide residue intake from consumption of fruits and vegetables and risk of ultrasound or hysterectomy-confirmed fibroids. Methods A prospective cohort study using data collected from 52,982 premenopausal women from 1999–2009 in the Nurses’ Health Study II. Every four years, diet was assessed with a validated food frequency questionnaire. We classified fruits and vegetables into high- or low-pesticide-residues using a validated method based on surveillance data from the U.S. Department of Agriculture. Multivariable Cox proportional hazards models were used to calculate RR and 95% CIs for the association between high- and low-pesticide-residue fruit and vegetable intake and fibroids. Results During 10 years of follow-up (median age at baseline 42 years), 4,285 incident cases of ultrasound or hysterectomy-confirmed fibroids were reported. No association was observed between intake of high-pesticide-residue (RR for 5th vs 1st quintile = 0.91; 95% CI = 0.80–1.03; ptrend = 0.12) nor the low-pesticide-residue (RR for 5th vs 1st quintile = 1.01; 95% CI = 0.88–1.14; ptrend = 0.84) fruits and vegetables and fibroids. Conclusions No clear associations were observed between intake of high- or low-pesticide-residue fruits and vegetables and risk of uterine fibroids. These results suggest that pesticide residues on fruits and vegetables are not strong contributors to fibroid risk among women in their 30s, 40s, and 50s. Additional studies examining an exposure window more proximal to fibroid initiation among younger women and assessing class specific pesticides are needed. Funding Sources National Institutes of Health.

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