In Reply We thank Chen and Chen and Jen et al for their interest in our study1 and for their thoughtful comments. The search for specific congeners of polybrominated diphenyl ethers (PBDE) that may cause hypospadias has led us to further work, showing that in general, the median concentrations of lower brominated congeners were greater than for higher brominated congeners. These findings are consistent with a case-control study2 that found a trend of mean BDE-28, BDE-47, BDE-99. and BDE-100 to be greater in the midpregnancy sera of mothers whose sons had hypospadias compared with controls; however, these differences were not statistically significant.2 The differences seen between cases and controls, especially for the lower brominated congeners, may be owing to the fact that North America was the greatest consumer of both the Penta BDE and Deca BDE commercial PBDE mixes. Indeed, a 2017 study,3 also using maternal hair BPDE levels, has shown a similar effect, with higher levels of PBDE congeners 99 100, 154 among mothers who gave birth to infants with cryptorchidism.3 This further validates the role of specific PBDEs as endocrine disrupters in the embryo toxicity of male genitourinary organs.
Koren G, Aleksa K. Association of Prenatal Exposures of Polybrominated Diphenyl Ethers With Hypospadias—Reply. JAMA Pediatr. Published online November 19, 2018. doi:10.1001/jamapediatrics.2018.4058
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