Preconception serum DDT and pregnancy loss: a prospective study using a biomarker of pregnancy

Previous studies of pregnancy losses and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT) were limited because they did not include losses prior to clinical detection of pregnancy and because exposures were measured after the pregnancies of interest. The authors examined the association of preconception serum total DDT (sum of DDT isomers and metabolites) concentration and subsequent pregnancy losses in 388 newly married, nonsmoking, female textile workers in China between 1996 and 1998. Upon stopping contraception, subjects provided daily urine specimens and records of vaginal bleeding for up to 1 year or until clinical pregnancy. Daily urinary human chorionic gonadotropin was assayed to detect conception and early pregnancy losses, and pregnancies were followed to detect clinical spontaneous abortions. There were 128 (26%) early pregnancy losses in 500 conceptions and 36 (10%) spontaneous abortions in 372 clinical pregnancies. Subjects were grouped in tertiles by preconception serum total DDT concentration (group 1: 5.5-22.9 ng/g; group 2: 23.0-36.5 ng/g; group 3: 36.6-113.3 ng/g). Compared with group 1, group 2 had adjusted relative odds of early pregnancy losses of 1.23 (95% confidence interval (CI): 0.72, 2.10), and group 3 had adjusted odds of 2.12 (95% CI: 1.26, 3.57). The relative odds of early pregnancy losses associated with a 10-ng/g increase in serum total DDT were 1.17 (95% CI: 1.05, 1.29). The small number of spontaneous abortions following clinical detection of pregnancy were not associated with serum total DDT. In this population, there was a positive, monotonic, exposure-response association between preconception serum total DDT and the risk of subsequent early pregnancy losses.