Early-pregnancy plasma per- and polyfluoroalkyl substance (PFAS) concentrations and hypertensive disorders of pregnancy in the Project Viva cohort. (July 2022)

• Record Type: Journal Article
• Authors: Preston, Emma V.; Hivert, Marie-France; Fleisch, Abby F.; Calafat, Antonia M.; Sagiv, Sharon K.; Perng, Wei; Rifas-Shiman, Sheryl L.; Chavarro, Jorge E.; Oken, Emily; Zota, Ami R.; James-Todd, Tamarra
• Is Part Of: Environment international. Volume 165(2022)
• Publication Date: 2022-07
• Subjects: PFAS -- Hypertensive disorders of pregnancy -- Preeclampsia -- Gestational hypertension -- Blood pressure; BKMR Bayesian kernel machine regression -- BMI body mass index -- BP blood pressure -- CDC Centers for Disease Control and Prevention -- CI confidence interval -- DASH Dietary Approaches to Stop Hypertension -- DBP diastolic blood pressure -- eGFR estimated glomerular filtration rate -- EtFOSAA 2-(N-ethyl-perfluorooctane sulfonamido) acetate -- FOSA perfluorooctane sulfonamide -- GWG gestational weight gain -- HDP hypertensive disorders of pregnancy -- LOD limit of detection -- MeFOSAA 2-(N-methyl-perfluorooctane sulfonamide) acetate -- OR odds ratio -- PBDE polybrominated diphenyl ether -- PFAS per- and polyfluoroalkyl substances -- PFDA perfluorodecanoate -- PFHxS perfluorohexane sulfonate -- PFNA perfluorononanoate -- PFOA perfluorooctanoate -- PFOS perfluorooctane sulfonate -- PIP posterior inclusion probability -- PPAR peroxisome proliferator-activated receptor -- SBP systolic blood pressure -- SD standard deviation -- U.S. United States; Environmental protection -- Periodicals; Environmental health -- Periodicals; Environmental monitoring -- Periodicals; Environmental Monitoring -- Periodicals; Environnement -- Protection -- Périodiques; Hygiène du milieu -- Périodiques; Environnement -- Surveillance -- Périodiques; Environmental health; Environmental monitoring; Environmental protection; Periodicals; 333.705
• DOI: 10.1016/j.envint.2022.107335
• Languages: English
• ISSNs: 0160-4120

Abstract

Graphical abstract: Highlights: Hypertensive disorders of pregnancy (HDP) cause substantial morbidity and mortality. PFAS exposure may adversely affect cardiometabolic health during pregnancy. We estimated associations of plasma PFAS and PFAS mixtures with HDP and BP. PFAS were associated with higher odds of gestational hypertension, not preeclampsia. PFAS were positively associated with mean 2nd and 3rd trimester diastolic BP. Abstract: Background: Hypertensive disorders of pregnancy (HDP), defined here as hypertensive disorders with onset in pregnancy (i.e., gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension), affect up to 10% of pregnancies in the United States and are associated with substantial maternal and neonatal morbidity and mortality. Per- and polyfluoroalkyl substances (PFAS) are associated with adverse cardiometabolic outcomes during pregnancy, but associations between PFAS and HDP are inconsistent and joint effects of PFAS mixtures have not been evaluated. Methods: We studied 1, 558 pregnant individuals from the Project Viva cohort, recruited during 1999–2002. We quantified concentrations of eight PFAS in plasma samples (median 9.7 weeks of gestation). Using clinical records, we calculated trimester-specific mean systolic (SBP) and diastolic (DBP) blood pressure and categorized HDP status [no HDP (normotensive & chronic hypertension), gestational hypertension, preeclampsia]. We estimated associations of individual PFAS with HDP using multinomial logistic regression and estimated associations with blood pressure using linear regression. We used Bayesian kernel machine regression (BKMR) and quantile g-computation to assess joint effects of the PFAS mixture on HDP and blood pressure measures. Results: Four percent of participants developed preeclampsia and 7% developed gestational hypertension. We observed higher odds of gestational hypertension, but not preeclampsia, per doubling of perfluorooctanoate (PFOA) [OR = 1.51 (95% confidence interval: 1.12, 2.03)], perfluorooctane sulfonate (PFOS) [OR = 1.38 (1.04, 1.82)], and perfluorohexane sulfonate [OR = 1.28 (1.06, 1.54)] concentrations. We observed higher mean DBP per doubling of PFOA [2nd trimester (T2): 0.39 mmHg (−0.01, 0.78); 3rd trimester (T3): 0.56 mmHg (0.14, 0.98)] and PFOS [T2: 0.46 mmHg (0.11, 0.82); T3: 0.43 mmHg (0.05, 0.80)]. The PFAS mixture was positively associated with odds of gestational hypertension [75th vs. 50th percentile: OR = 1.14 (95% credible interval:1.03, 1.25), BKMR] and mean DBP [T2 = 0.17 mmHg (−0.06, 0.40); T3 = 0.22 mmHg (−0.03, 0.48), BKMR]. Conclusions: These findings suggest that exposure to certain PFAS may increase the odds of gestational hypertension during pregnancy, with potential implications for subsequent maternal and child health outcomes.