Reproductive Toxicology 29 (2010) 262–270 Contents lists available at ScienceDirect Reproductive Toxicology j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r e p r o t o x Review Reproductive health effects of aflatoxins: A review of the literature Faisal M.B. Shuaib a,∗ , John Ehiri b , Amina Abdullahi c , Jonathan H. Williams d , Pauline E. Jolly a a Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294-0022, USA b Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Suite A 256, Drachman Hall, 1295 N. Martin Avenue, P.O. Box 245209, Tucson, AZ 85724-5209, USA c Department of Obstetrics and Gynecology, University of Jos Teaching Hospital, Nigeria d College of Agricultural and Environmental Services, University of Georgia, Griffin, GA, USA a r t i c l e i n f o Article history: Received 26 August 2009 Received in revised form 9 December 2009 Accepted 18 December 2009 Available online 5 January 2010 Keywords: Aflatoxins Reproductive health outcomes Aflatoxins and birth outcomes Aflatoxins and breast milk a b s t r a c t Context: Although it is known that aflatoxins have many adverse health effects, there is no systematic summary of how it affects the reproductive system or its reproductive health effects. Objective: Summarize evidence on the reproductive health effects of aflatoxins. Results: The search yielded 121 potential studies, of which 25 were retained. One study found a higher concentration of aflatoxins in the semen of infertile men (40% of cases compared to 8% of controls). Six studies found significant associations or correlations between low birth weight and aflatoxins while one study did not find any correlation. One study found maternal serum aflatoxin to be a risk factor for jaundice in infants (OR,2.68; CI,1.18–6.10). Overall,maternal breast milk in developing countries had higher rates of aflatoxin contamination than in high income countries. Conclusions: Stakeholders in developing countries need to take steps to reduce exposure of vulnerable populations to the toxic effects of aflatoxins. © 2009 Elsevier Inc. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 3.1. Aflatoxins and fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 3.2. Aflatoxins and birth outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 3.3. Aflatoxins and contamination of body fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Role of funding source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Conflict of interest statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 1. Introduction Although it is hypothesized that aflatoxins have adverse effects on birth outcomes [1] there has been no critical summary of the literature on the subject. Reproductive health addresses the repro- ductive processes,functions and systems at all stages of life [2]. Central to reproductive health is “the right of access to appro- priate health care services that will enable women to go safely ∗ Corresponding author. Tel.: +1 205 934 1823; fax: +1 205 975 3329. E-mail addresses: faisals@uab.edu (F.M.B. Shuaib), jehiri@email.arizona.edu (J. Ehiri), kameenah@yahoo.com (A. Abdullahi), twillia@griffin.uga.edu (J.H. Williams), jollyp@uab.edu (P.E. Jolly). through pregnancy and childbirth and provide couples with the best chance of having a healthy infant” [2]. Globally, one useful indi- cator of reproductive health is birth weight. It is estimated that more than 20 million infants worldwide, representing 15.5 per- cent of all births, are born with low birth weight with 95.6 percent occurring in developing countries [3]. A baby’s low weight at birth (defined as birth weight less than 2500 g) is either the result of preterm birth (before 37 weeks of gestation) or due to restricted fetal (intrauterine) growth. Low birth weight is closely associated with fetal and neonatal morbidity and mortality, inhibited growth, poor cognitive development, and chronic diseases later in life [3]. About 4.5 billion people, mostly in developing countries, are at risk of chronic exposure to aflatoxins from contaminated food crops [4]. Aflatoxins are a family of toxic metabolites which are pro- 0890-6238/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.reprotox.2009.12.005