{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:20:18Z","timestamp":1789996818164,"version":"4.0.1"},"reference-count":90,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T00:00:00Z","timestamp":1552608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K12DK083014-06"],"award-info":[{"award-number":["K12DK083014-06"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: Investigate whether residential prenatal exposure to heavy metal hazardous air pollutants (HMHAPs) is associated with an increased risk of hypospadias. Methods: Data on non-syndromic hypospadias cases (n = 8981) and control patients delivered in Texas were obtained from the Texas Birth Defects Registry and matched 1:10 by birth year. Average exposure concentrations of HMHAPs were obtained from the 2005 U.S. Environmental Protection Agency National-Scale Air Toxics Assessment and categorized into quintiles. Odds ratios and 95% confidence intervals were estimated. STROBE reporting guidelines were followed. Results: We observed associations between hypospadias and prenatal HMHAP exposure. Manganese demonstrated significant increased risk of hypospadias at the medium, medium-high and high exposure quintiles; lead in the medium-high and high exposure quintiles. Cadmium, mercury and nickel demonstrated a significant inverted \u201cU-shaped\u201d association for exposures with significant associations in the medium and medium-high quintiles but not in the medium-low and high quintiles. Arsenic and chromium demonstrated a significant bivalent association for risk of hypospadias in a lower quintile as well as a higher quintile with non-significant intermediate quintiles. Conclusions: Using data from one of the world\u2019s largest active surveillance birth defects registries, we identified significant associations between hypospadias and HMHAP exposures. These results should be used in counseling for maternal demographic risk factors as well as avoidance of heavy metals and their sources.<\/jats:p>","DOI":"10.3390\/ijerph16060930","type":"journal-article","created":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T04:06:55Z","timestamp":1552882015000},"page":"930","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Hypospadias Risk from Maternal Residential Exposure to Heavy Metal Hazardous Air Pollutants"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9015-7719","authenticated-orcid":false,"given":"Jeffrey T.","family":"White","sequence":"first","affiliation":[{"name":"Pediatric Urology, Norton Children\u2019s Hospital, Louisville, KY 40207, USA"},{"name":"Department of Urology, University of Louisville School of Medicine, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Kovar","sequence":"additional","affiliation":[{"name":"Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany M.","family":"Chambers","sequence":"additional","affiliation":[{"name":"Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunj R.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Division of Pediatric Urology, Department of Surgery, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-8381","authenticated-orcid":false,"given":"Erin C.","family":"Peckham-Gregory","sequence":"additional","affiliation":[{"name":"Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Department of Pediatrics, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisol","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Department Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-4963","authenticated-orcid":false,"given":"Peter H.","family":"Langlois","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX 78751, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9203-6331","authenticated-orcid":false,"given":"Carolina J.","family":"Jorgez","sequence":"additional","affiliation":[{"name":"Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Division of Pediatric Urology, Department of Surgery, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Lupo","sequence":"additional","affiliation":[{"name":"Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Department of Pediatrics, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Seth","sequence":"additional","affiliation":[{"name":"Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA"},{"name":"Division of Pediatric Urology, Department of Surgery, Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/bdra.23021","article-title":"Environmental and genetic contributors to hypospadias: a review of the epidemiologic evidence","volume":"94","author":"Carmichael","year":"2012","journal-title":"Birth Defects Res. 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