Associations of perfluoroalkyl and polyfluoroalkyl substances with gestational hypertension and blood pressure during pregnancy: A cohort study

• Published in: Environmental research Vol. 215; no. Pt 2; p. 114284
• Main Authors: Yang, Lan, Ji, Honglei, Liang, Hong, Yuan, Wei, Song, Xiuxia, Li, Xiufeng, Niu, Jinbo, Shi, Huijuan, Wen, Sheng, Miao, Maohua
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.12.2022
• Subjects: Alkanesulfonic Acids; Bayes Theorem; Bayesian theory; Blood Pressure; Cohort Studies; Environmental Pollutants - toxicity; equations; Female; females; fetus; Fluorocarbons - toxicity; Gestational exposure; Gestational hypertension; Humans; hypertension; Hypertension, Pregnancy-Induced - chemically induced; Hypertension, Pregnancy-Induced - epidemiology; Mixture; Perfluoroalkyl and polyfluoroalkyl substances; perfluorohexane sulfonic acid; Pregnancy; regression analysis; risk; Gestational exposure; Blood pressure; Perfluoroalkyl and polyfluoroalkyl substances; Gestational hypertension; Mixture
• ISSN: 0013-9351; 1096-0953; 1096-0953
• DOI: 10.1016/j.envres.2022.114284

Previous studies have reported inconsistent associations between perfluoroalkyl and polyfluoroalkyl substances (PFAS) and gestational hypertension (GH) and blood pressure (BP) during pregnancy. Herein, we aimed to evaluate individual and overall effects of PFAS on GH and longitudinal BP measures during pregnancy. We included 826 pregnant women from the Jiashan Birth Cohort established between 2016 and 2018. Concentrations of thirteen PFAS were quantified using plasma samples collected within 16 weeks of gestation. Longitudinal BP measures were obtained from medical records, and more than nine measurements were available for 85.60% of participants. GH was defined as new-onset hypertension occurring after 20 weeks of gestation. Logistic regression models were used to examine the effect of PFAS on GH, while generalized estimating equation models evaluated the average effect of PFAS on BP in each trimester. The potential effect modification by fetal sex was also examined. Bayesian kernel machine regression (BKMR) and quantile g-computation (QgC) were implemented to explore the overall effect of the PFAS mixture. PFOA, PFOS, and PFHxS presented the highest median concentrations of 11.99, 8.81 and 5.43 ng/mL, respectively. Overall, 5.57% of subjects developed GH. PFOS, PFDA, PFUdA, and PFDoA were significantly associated with lower GH odds, and odds ratios ranged between 0.62 and 0.68. We noted associations between PFAS and lower systolic BP and diastolic BP in the third trimester, with PFDA and PFUdA exhibiting the effect on systolic BP only in pregnant women carrying a female fetus. These associations were further confirmed by BKMR and QgC, showing an inverse overall effect of the PFAS mixture. Higher concentrations of PFAS during early pregnancy were associated with lower GH risk and longitudinal BP measures in the third trimester in a population with relatively high exposure levels. Fetal sex might modify the effects of PFDA and PFUdA on systolic BP in the third trimester. [Display omitted] •PFAS is associated with decreased risk of gestational hypertension.•PFAS exposure decreased SBP and DBP in the third trimester.•BKMR and QgC models show a consistent inverse overall effect of PFAS mixture.•Fetal sex might modify the effects of PFAS on SBP in the third trimester.•Our findings may reflect the effect of PFAS at relatively high exposure level.