Occup Environ Med doi:10.1136/oem.2009.047373
  • Original article

Use of biocides and insect repellents and risk of hypospadias

  1. Julien Dugas1,
  2. Mark J Nieuwenhuijsen1,*,
  3. David Martinez2,
  4. Nina Iszatt3,
  5. Paul Nelson3,
  6. Paul Elliott3
  1. 1 Center for Research in Environmental Epidemiology (CREAL), Spain;
  2. 2 CREAL, Spain;
  3. 3 Imperial College London, United Kingdom
  1. Correspondence to: Mark J Nieuwenhuijsen, Research Professor in Environmental Epidemiol, Center for Research in Environmental Epidemiology (CREAL), Parc de Recerca Biomèdica de Barcelona - PRBB (office 183.05), C. Doctor Aiguader, 88, Prince Consort Road, Barcelona, 08003, Spain; mnieuwenhuijsen{at}
  • Received 2 April 2009
  • Accepted 30 July 2009
  • Published Online First 1 December 2009


Introduction and aim: The aim was to examine the relationships between use of biocides, insect repellents, and the risk of hypospadias in a large case-control study in the South East of England.

Methods: Case-control study among 471 cases of hypospadias referred to surgeons, and 490 randomly selected population-based controls, born between 1st January 1997 to 30th September 1998 and with telephone interview between September 2000 and March 2003. The questionnaire included information on demographic, lifestyle and environmental factors, including the use of biocides and insect repellents, during pregnancy. A total biocides score was created from summing positive responses to an eight item biocide exposure questionnaire.

Results: The use of insect repellent (Adjusted OR= 1.81, 95% CI 1.06-3.11) during the first trimester of pregnancy was associated with risk of hypospadias, but none of the biocides, or indicators for them, except for the total biocide score for the highest two exposure categories (score = 3 adjusted OR = 1.73, 95% CI 1.02-2.94, and score 4 and 5 combined adjusted OR = 2.98, 95% CI 1.01-8.78 respectively) showed statistically significant associations.

Conclusion: We found an association between the use of insect repellent and total biocide score and risk of hypospadias. Particularly the use of insect repellent warrants further investigation, specifically in relation to type, content and frequency of use since this information was missing in the current study.


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