Associations between drinking water disinfection byproducts and menstrual cycle characteristics: A cross-sectional study among women attending an infertility clinic.

Abstract

Disinfection byproducts (DBPs) have been shown to alter ovarian steroidogenesis and cause estrous cyclicity disturbance and prolongation in experimental studies, however human studies are lacking. We aimed to evaluate the cross-sectional associations between drinking water DBPs and menstrual cycle characteristics. A total of 1078 women attending an infertility clinic in Wuhan, China were included between December 2018 and January 2020. Characteristics of menstrual cycle were collected by questionnaires. Concentrations of dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) were measured in urine as biomarkers of drinking water DBPs. Multivariate logistic and linear regression models were used to evaluate the associations between urinary DCAA and TCAA concentrations and menstrual cycle characteristics. Higher urinary DCAA concentrations were associated with increased odds ratios (ORs) of irregular menstrual cycle (OR=1.80; 95% CI: 0.97, 3.33 for the highest vs. lowest quartile; P for trend=0.05) and long menstrual cycle (OR=1.62; 95% CI: 0.97, 2.70 for the highest vs. lowest quartile; P for trend=0.06), as well as prolonged variation in cycle length (β=1.27 days; 95% CI: -0.11, 2.66 for the highest vs. lowest quartile; P for trend=0.04). Higher urinary TCAA concentrations were associated with prolonged bleeding duration (β=0.23 days; 95% CI: -0.06, 0.51 for the highest vs. lowest quartile; P for trend=0.07). These results suggest that exposure to drinking water DBPs is associated with menstrual cycle disturbances. These findings are warranted to confirm in other studies.