ArticleFrontiers in public health2026
Associations between serum persistent organic pollutants and polycystic ovary syndrome risk: a case-control study with mediation analysis.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Persistent organic pollutants (POPs), including organochlorine pesticides (OCPs) and per- and polyfluoroalkyl substances (PFAS), are endocrine-disrupting chemicals potentially linked to polycystic ovary syndrome (PCOS). However, evidence on their combined effects and underlying mechanisms remains limited. Methods: We conducted a case-control study including 146 women with PCOS and 241 controls recruited from the Affiliated Hospital of Hebei University, China (2023-2025). Serum concentrations of 15 POPs (6 OCPs and 9 PFAS) were measured using GC-MS/MS and UPLC-MS/MS. Associations with PCOS were evaluated using multivariable logistic regression, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR). Mediation analysis examined whether sex hormones mediated these associations. Results: In single-pollutant analyses, PFOS (OR = 2.63, 95% CI: 1.78-3.88), p,p'-DDE (OR = 2.25, 95% CI: 1.54-3.28), heptachlor (OR = 1.99, 95% CI: 1.26-3.14), and PFHxS (OR = 1.74, 95% CI: 1.15-2.62) were significantly associated with increased PCOS risk. Mixture analyses revealed strong positive associations between the overall POPs mixture and PCOS (WQS OR = 9.29, 95% CI: 3.38-25.50; qgcomp OR = 7.04, 95% CI: 2.79-17.80), with PFOS and p,p'-DDE identified as predominant contributors. BKMR confirmed PFOS (PIP = 1.000) and p,p'-DDE (PIP = 0.998) as the most important contributors. Mediation analysis indicated that testosterone mediated 49.3% of the PFOS-PCOS association, while progesterone mediated 20.9% of the PFOS-PCOS and 24.8% of the p,p'-DDE-PCOS associations. Conclusion: Exposure to POPs, particularly PFOS and p,p'-DDE, was associated with elevated PCOS risk among Chinese women. Sex hormones, especially testosterone and progesterone, partially mediated these associations, suggesting hormonal disruption as a potential mechanism linking POPs exposure to PCOS.
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