Soy-Based Infant Formula Feeding and Uterine Fibroid Development in a Prospective Ultrasound Study of Black/African-American Women

Abstract

Background: Uterine fibroids are highly prevalent, benign tumors. They are the leading indication for hysterectomy, and Black women are disproportionally burdened. Soy-based infant formula contains phytoestrogens, and exposure during sensitive developmental windows may adversely affect the developing uterus; early phytoestrogen treatment in rodent studies led to detrimental uterine effects, including increased fibroid risk in Eker rats. Limited epidemiological studies also have suggested increased fibroid development with soy formula infant feeding.

Objective: The goal of this study was to examine the association between soy formula feeding in infancy and fibroid development in adulthood.

Methods: We evaluated this association among 1,610 Black/African-American women age 23-35 y in the Study of Environment, Lifestyle & Fibroids (SELF). Soy formula feeding data was gathered directly from the participants' mothers (89%). A standardized ultrasound examination was conducted during 4 clinic visits over 5 y to detect fibroids $\ge 0.5\mathrm{cm}$ in diameter. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between soy formula feeding and incident fibroids adjusted for early-life and adult factors. Fibroid growth was calculated as change in log-volume for fibroids matched at successive visits.

Results: Of 1,121 fibroid-free participants at baseline, 150 (13%) were ever fed soy formula as infants, and 269 (24%) developed incident fibroids. We did not observe an association between ever being fed soy formula and incident fibroid risk ($\text{HR}=1.08$; 95% CI: 0.75, 1.54). However, participants fed soy formula within 2 months of birth and for $>6\text{months}$ ($n=53$) had an elevated risk of fibroid incidence in comparison with those never fed soy formula ($\text{HR}=1.56$; 95% CI: 0.92, 2.65). Fibroid growth rates did not differ.

Discussion: Adding support to limited human data, this prospective fibroid study found that soy-based formula feeding during infancy was associated with a suggestive increase in risk of ultrasound-identified incident fibroids in adulthood. https://doi.org/10.1289/EHP11089.

Figure 1.

Flowchart of participant selection for incidence analysis, Study of Environment, Lifestyle & Fibroids (SELF), 2010–2018. Of the 1,610 participants at baseline with follow-up data available, a total of 1,121 were included in the analytical sample for incident fibroids ($n=269$).