Anti-Müllerian Hormone and Lifestyle, Reproductive, and Environmental Factors Among Women in Rural South Africa

Abstract

Background Few data exist regarding antiMüllerian hormone, a marker of ovarian reserve, in relation to environmental factors with potential ovarian toxicity. Methods This analysis included 420 women from Limpopo, South Africa studied in 2010–2011. Women were administered comprehensive questionnaires, and plasma concentrations of antiMüllerian hormone and DDT were determined. We used separate multivariable models to examine the associations between natural log-transformed antiMüllerian hormone concentration (ng/ml) and each of the lifestyle, reproductive, and environmental factors of interest, adjusted for age, body mass index, education, and parity. Results The median age of women was 24 years (interquartile range [IQR]=22 to 26); the median antiMüllerian hormone concentration was 3.1 ng/ml (IQR=2.0 to 6.0). Women who reported indoor residual spraying in homes with painted walls (indicative of exposure to pyrethroids) had 25% lower (95% confidence interval [CI]=−39% to −8%) antiMüllerian hormone concentrations compared with women who reported no spraying. Little evidence of decreased antiMüllerian hormone concentrations was observed among women with the highest DDT levels. Compared with women who used an electric stove, no association was observed among women who cooked indoors over open wood fires. The findings also suggested lower antiMüllerian hormone concentrations among women who drank coffee (−19% [95% CI=−31% to −5%]) or alcohol (−21% [95% CI=−36% to −3%]). Conclusions These are among the first data regarding antiMüllerian hormone concentrations relative to pesticides and indoor air pollution. Our results are suggestive of decreased ovarian reserve associated with exposure to pyrethroid pesticides, which is consistent with laboratory animal data.

Antimüllerian hormone in relation to tobacco and marijuana use and sources of indoor heating/cooking

“…Few studies have considered the impact of household air pollution on reproductive outcomes. One previous study of South African women found no association between AMH levels and self-reported indoor cooking over wood fires (15). However, this study did not consider artificial firelogs, which are manufactured logs composed of pressed sawdust and wax.…”

“…Few previous studies have considered adult ETS exposure with respect to AMH levels and the two that did found no association with AMH (15, 19). Though active smoking is usually considered a greater health risk than ETS, there are different levels of the various compounds in sidestream compared to mainstream smoke.…”

“…Epidemiologic and clinical studies suggest that reproductive health, as measured by AMH, may also be impacted by other environmental exposures, such as radiation and smoking (13, 14). A recent study reported a negative association between self-reported indoor residual spraying (application of pesticides to the inside of dwellings) with pyrethroids and AMH levels in South Africa (15). …”

“…Few studies have considered the potential role of environmental tobacco smoke (ETS) (19). One previous study considered household air pollution from the use of indoor cook stoves in women 20–30 years of age, but did not find an association with AMH levels (15). Cigarette smoking, marijuana use and burning fuel for heating and cooking in the home all result in exposure to similar combustion by-products including polycyclic aromatic hydrocarbons (PAH) (23, 24).…”

Anti-Müllerian Hormone Serum Concentrations of Women With Germline BRCA1 or BRCA2 Mutations

“…For each gene (BRCA1 and BRCA2), a difference in mean AMH concentration between mutation carriers and non-carriers was tested by linear regression, modelling the natural logarithm of AMH as the outcome variable and carrier status as the explanatory variable. This log transformation was applied to correct for the asymmetry in the distribution of AMH values, as consistently reported in other studies (Su et al, 2013;Whitworth et al, 2015). The exponential of the regression coefficient for carrier status (and its 95% confidence interval (CI) limits) was taken as an estimate of mean AMH concentration on the natural scale for carriers relative to non-carriers.…”