A pathway level analysis of PFAS exposure and risk of gestational diabetes mellitus

• Published in: Environmental health Vol. 20; no. 1; pp. 63 - 16
• Main Authors: Birru, Rahel L, Liang, Hai-Wei, Farooq, Fouzia, Bedi, Megha, Feghali, Maisa, Haggerty, Catherine L, Mendez, Dara D, Catov, Janet M, Ng, Carla A, Adibi, Jennifer J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.05.2021; BioMed Central; BMC
• Subjects: Biomarkers; Biomarkers - metabolism; Confidence intervals; Development and progression; Diabetes in pregnancy; Diabetes mellitus; Diabetes, Gestational - epidemiology; Diabetes, Gestational - metabolism; Environmental Exposure - adverse effects; Environmental health; Environmental Pollutants - adverse effects; Epidemiology; Exposure; Female; Fluorocarbons - adverse effects; Gestational diabetes mellitus; Glucose; Glucose - metabolism; Health risks; Homeostasis; Hormones; Humans; Insulin; Insulin resistance; PFAS; Pregnancy; Review; Risk; Risk factors; Thyroid; Thyroid gland; Thyroid hormones; Thyroid Hormones - metabolism; Thyroid-stimulating hormone; Thyroxine; Triiodothyronine; Womens health; United States; United States > US; Gestational diabetes mellitus; Glucose metabolism; Thyroid hormones; PFAS
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-021-00740-z

Per- and polyfluoroalkyl substances (PFAS) have been found to be associated with gestational diabetes mellitus (GDM) development, a maternal health disorder in pregnancy with negative effects that can extend beyond pregnancy. Studies that report on this association are difficult to summarize due to weak associations and wide confidence intervals. One way to advance this field is to sharpen the biologic theory on a causal pathway behind this association, and to measure it directly by way of molecular biomarkers. The aim of this review is to summarize the literature that supports a novel pathway between PFAS exposure and GDM development. Epidemiological studies demonstrate a clear association of biomarkers of thyroid hormones and glucose metabolism with GDM development. We report biologic plausibility and epidemiologic evidence that PFAS dysregulation of maternal thyroid hormones and thyrotropin (TSH) may disrupt glucose homeostasis, increasing the risk of GDM. Overall, epidemiological studies demonstrate that PFAS were positively associated with TSH and negatively with triiodothyronine (T3) and thyroxine (T4). PFAS were generally positively associated with glucose and insulin levels in pregnancy. We propose dysregulation of thyroid function and glucose metabolism may be a critical and missing component in the accurate estimation of PFAS on the risk of GDM.