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Kingsley SL, Eliot MN, Kelsey KT, Calafat AM, Ehrlich S, Lanphear BP, Chen A, Braun JM. Variability and predictors of serum perfluoroalkyl substance concentrations during pregnancy and early childhood. ENVIRONMENTAL RESEARCH 2018; 165:247-257. [PMID: 29734025 PMCID: PMC6309672 DOI: 10.1016/j.envres.2018.04.033] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 05/19/2023]
Abstract
Exposure to poly- and perfluoroalkyl substances (PFAS), ubiquitous and persistent environmental contaminants, could be associated with adverse health outcomes, but there are limited longitudinal data assessing patterns and predictors of exposure during childhood. We quantified concentrations of eight different PFAS in sera collected from women during pregnancy and children at delivery and ages 3 and 8 years in 367 mother-child pairs enrolled in a prospective cohort from 2003 to 2006. In general, median childhood PFAS concentrations increased from birth to age 3 and then decreased by age 8. Maternal serum PFAS concentrations during pregnancy were strongly correlated with cord serum concentrations (0.76 < r < 0.94), but were weakly correlated with childhood concentrations (0.12 < r < 0.30). Several sociodemographic factors were associated with maternal PFAS concentrations, including income, race, and parity. In children, serum PFAS concentrations were associated with maternal age at delivery, race, parity, and child age. Breastfeeding duration was positively associated with childhood PFAS concentrations at ages 3 and 8 years. In addition, stain repellant use was associated with higher perfluorooctanoic acid and perfluorohexane sulfonic acid concentrations at age 8 years. Serum PFAS concentrations are higher during early childhood, a potentially sensitive period of development, and were highest among breastfed children.
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Affiliation(s)
- Samantha L Kingsley
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA.
| | - Melissa N Eliot
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA
| | - Karl T Kelsey
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA; Department of Laboratory Medicine & Pathology, Brown University, Providence, RI, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shelley Ehrlich
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA
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102
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Jensen RC, Glintborg D, Timmermann CAG, Nielsen F, Kyhl HB, Andersen HR, Grandjean P, Jensen TK, Andersen M. Perfluoroalkyl substances and glycemic status in pregnant Danish women: The Odense Child Cohort. ENVIRONMENT INTERNATIONAL 2018; 116:101-107. [PMID: 29660612 DOI: 10.1016/j.envint.2018.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are persistent chemicals with suspected endocrine disrupting abilities applied in consumer products. PFASs have potentially modulating effects on glucose homeostasis. Insulin resistance prevails during third trimester of pregnancy, and this challenge of glucose homeostasis may reveal putative effects of PFAS concentrations on glycemic status. OBJECTIVE To investigate associations between five serum PFASs and glucose-related outcomes in pregnant Danish women based on their risk of gestational diabetes mellitus (GDM). METHODS In the prospective Odense Child Cohort serum concentrations of five PFASs - perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) - were measured at median gestational week (GW) 11 in pregnant women. An oral glucose tolerance test (OGTT) was performed at GW 28. The statistical analysis was conducted among 158 women with high GDM risk and 160 women with low GDM risk matched by gestational age. Multiple linear regression models were performed to estimate associations between PFAS concentrations and glucose, insulin, C-peptide, homeostatic model of assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-%β), and insulin sensitivity (Matsuda index) during the 2-h OGTT. RESULTS In women with high risk for GDM, a two-fold increase in PFHxS concentration was significantly associated with increased fasting glucose, fasting insulin and HOMA-IR after adjusting for age, parity, educational level and pre-pregnancy BMI. Adjusting for the same confounders, a doubling in PFNA concentration was associated with higher fasting insulin and HOMA-%β. In women with low GDM risk, no associations were found between PFAS concentrations and glucose-related outcomes. CONCLUSION PFHxS and PFNA concentrations were associated with impaired glycemic status in metabolically vulnerable pregnant women and might further enhance the risk of developing GDM.
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Affiliation(s)
- Richard Christian Jensen
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark; Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark.
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Clara Amalie Gade Timmermann
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark
| | - Flemming Nielsen
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense Patient data Exploratory Network (OPEN), University of Southern, Denmark
| | - Helle Raun Andersen
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark
| | - Philippe Grandjean
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, J.B.Winsløwsvej 17A, 5000 Odense C, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
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103
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Harris MH, Oken E, Rifas-Shiman SL, Calafat AM, Ye X, Bellinger DC, Webster TF, White RF, Sagiv SK. Prenatal and childhood exposure to per- and polyfluoroalkyl substances (PFASs) and child cognition. ENVIRONMENT INTERNATIONAL 2018; 115:358-369. [PMID: 29705692 PMCID: PMC5970086 DOI: 10.1016/j.envint.2018.03.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFASs) are suspected developmental toxicants, but epidemiological evidence on neurodevelopmental effects of PFAS exposure is inconsistent. We examined associations of prenatal and childhood PFAS exposure with performance on assessments of cognition in children. METHODS We included mother-child pairs from Project Viva, a longitudinal Boston-area birth cohort enrolled during 1999-2002. We quantified concentrations of eight PFASs, including perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorohexane sulfonate (PFHxS), in plasma collected from women during pregnancy (median 9.7 weeks gestation) and from children at a visit in mid-childhood (median age 7.7 years). In early childhood (median age 3.2 years) we administered standardized assessments of visual motor skills and vocabulary comprehension, and in mid-childhood we assessed visual motor skills, visual memory, and verbal and non-verbal intelligence. Using multivariable regression, we estimated associations of prenatal and childhood PFAS plasma concentrations with children's cognitive assessment scores, adjusted for relevant covariates including breastfeeding, maternal intelligence, parental education, and household income. Samples sizes ranged from 631 to 971, depending on analysis. RESULTS Prenatal PFAS concentrations were associated with both better and worse cognitive performance; children with top quartile prenatal concentrations of some PFASs had better visual motor abilities in early childhood and non-verbal IQ and visual memory in mid-childhood, while children with upper quartile prenatal PFOA and PFOS had lower mid-childhood visual-motor scores. In cross-sectional analyses of mid-childhood PFAS concentrations and cognitive assessments, visual-motor scores on the Wide Range Assessment of Visual Motor Abilities (WRAVMA) (standardized mean = 100, standard deviation = 15) were lower among children with higher PFHxS (fourth quartile (Q4) vs. Q1: -5.0, 95% confidence interval (CI): -9.1, -0.8). Upper quartiles of childhood PFOA and PFOS were also associated with somewhat lower childhood WRAVMA scores, but childhood PFASs were not associated with verbal or non-verbal IQ or visual memory. CONCLUSIONS We present evidence suggesting associations of prenatal and childhood PFAS exposure with lower childhood visual motor abilities. Other results were inconsistent, with higher prenatal PFASs associated in some cases with better cognitive outcomes.
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Affiliation(s)
- Maria H Harris
- Center for Environmental Research and Children's Health, University of California, Berkeley School of Public Health, Berkeley, CA, USA; Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA, USA.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Sharon K Sagiv
- Center for Environmental Research and Children's Health, University of California, Berkeley School of Public Health, Berkeley, CA, USA; Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA, USA
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Sagiv SK, Rifas-Shiman SL, Fleisch AF, Webster TF, Calafat AM, Ye X, Gillman MW, Oken E. Early-Pregnancy Plasma Concentrations of Perfluoroalkyl Substances and Birth Outcomes in Project Viva: Confounded by Pregnancy Hemodynamics? Am J Epidemiol 2018; 187:793-802. [PMID: 29155920 DOI: 10.1093/aje/kwx332] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/30/2017] [Indexed: 01/09/2023] Open
Abstract
Associations of prenatal exposure to perfluoroalkyl substances (PFAS), ubiquitous chemicals used in stain- and water-resistant products, with adverse birth outcomes may be confounded by pregnancy hemodynamics. We measured plasma concentrations of 4 PFAS in early pregnancy (median length of gestation, 9 weeks) among 1,645 women in Project Viva, a study of a birth cohort recruited during 1999-2002 in eastern Massachusetts. We fitted multivariable models to estimate associations of PFAS with birth weight-for-gestational age z score and length of gestation, adjusting for sociodemographic confounders and 2 hemodynamic markers: 1) plasma albumin concentration, a measure of plasma volume expansion, and 2) plasma creatinine concentration, used to estimate glomerular filtration rate. Perfluorooctane sulfonate (PFOS) and perfluorononanoate (PFNA) were weakly inversely associated with birth weight-for-gestational age z scores (adjusted β = -0.04 (95% confidence interval (CI): -0.08, 0.01) and adjusted β = -0.06 (95% CI: -0.11, -0.01) per interquartile-range increase, respectively). PFOS and PFNA were also associated with higher odds of preterm birth (e.g., for highest PFOS quartile vs. lowest, adjusted odds ratio = 2.4, 95% CI: 1.3, 4.4). Adjusting for markers of pregnancy hemodynamics (glomerular filtration rate and plasma albumin), to the extent that they accurately reflect underlying pregnancy physiology, did not materially affect associations. These results suggest that pregnancy hemodynamics may not confound associations with birth outcomes when PFAS are measured early in pregnancy.
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Affiliation(s)
- Sharon K Sagiv
- Center for Environmental Research and Children’s Health, School of Public Health, University of California, Berkeley, Berkeley, California
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Abby F Fleisch
- Pediatric Endocrinology and Diabetes Program, Maine Medical Center, Portland, Maine
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - Thomas F Webster
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
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105
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Preston EV, Webster TF, Oken E, Claus Henn B, McClean MD, Rifas-Shiman SL, Pearce EN, Braverman LE, Calafat AM, Ye X, Sagiv SK. Maternal Plasma per- and Polyfluoroalkyl Substance Concentrations in Early Pregnancy and Maternal and Neonatal Thyroid Function in a Prospective Birth Cohort: Project Viva (USA). ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:027013. [PMID: 29488882 PMCID: PMC6066354 DOI: 10.1289/ehp2534] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND Prenatal exposure to some per- and polyfluoroalkyl substances (PFASs) may disrupt maternal and neonatal thyroid function, which is critical for normal growth and neurodevelopment. OBJECTIVES We examined associations of PFAS exposure during early pregnancy with maternal and neonatal thyroid hormone levels. METHODS We studied 732 mothers and 480 neonates in Project Viva, a longitudinal prebirth cohort in Boston, Massachusetts. We quantified six PFASs, including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), and maternal thyroid hormones [thyroxine (T4), Free T4 Index (FT4I), thyroid stimulating hormone (TSH)] in plasma samples collected at a median 9.6 wk gestation and neonatal T4 levels from postpartum heel sticks. We estimated associations of PFAS concentrations with thyroid hormone levels using covariate-adjusted linear regression models and explored effect measure modification by maternal thyroid peroxidase antibody (TPOAb) status and infant sex. RESULTS PFAS concentrations were not associated with maternal T4, but PFOA, perfluorohexane sulfonate (PFHxS), and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA) were inversely associated with maternal FT4I [e.g., -1.87% (95% confidence interval (CI): -3.40, -0.31) per interquartile (IQR) increase in PFOA]. PFAS concentrations [PFOA, PFOS, and perfluorononanoate (PFNA)] were inversely associated with TSH levels in TPOAb-positive women only. Prenatal PFOS, PFOA, and PFHxS concentrations were inversely associated with T4 levels in male [e.g., PFHxS, quartile 4 vs.1: -2.51μg/dL (95% CI: -3.99, -1.04 )], but not female neonates [0.40μg/dL (95% CI: -0.98, 1.79)]. CONCLUSIONS In this study, prenatal exposure to some PFASs during early pregnancy was inversely associated with maternal FT4I and neonatal T4 in male infants. These results support the hypothesis that prenatal exposure to PFASs influences thyroid function in both mothers and infants. https://doi.org/10.1289/EHP2534.
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Affiliation(s)
- Emma V Preston
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Deptartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Deptartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lewis E Braverman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon K Sagiv
- Center for Environmental Research and Children's Health, University of California , Berkeley School of Public Health, Berkeley, California, USA
- Department of Environmental Health, Boston University School of Public Health , Boston, Massachusetts, USA
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106
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Rokoff LB, Rifas-Shiman SL, Coull BA, Cardenas A, Calafat AM, Ye X, Gryparis A, Schwartz J, Sagiv SK, Gold DR, Oken E, Fleisch AF. Cumulative exposure to environmental pollutants during early pregnancy and reduced fetal growth: the Project Viva cohort. Environ Health 2018; 17:19. [PMID: 29458383 PMCID: PMC5819079 DOI: 10.1186/s12940-018-0363-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/11/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Reduced fetal growth is associated with perinatal and later morbidity. Prenatal exposure to environmental pollutants is linked to reduced fetal growth at birth, but the impact of concomitant exposure to multiple pollutants is unclear. The purpose of this study was to examine interactions between early pregnancy exposure to cigarette smoke, traffic pollution, and select perfluoroalkyl substances (PFASs) on birth weight-for-gestational age (BW/GA). METHODS Among 1597 Project Viva mother-infant pairs, we assessed maternal cigarette smoking by questionnaire, traffic pollution at residential address by black carbon land use regression model, and plasma concentration of select PFASs in early pregnancy. We calculated sex-specific BW/GA z-scores, an index of fetal growth, from national reference data. We fit covariate-adjusted multi-pollutant linear regression models and examined interactions between exposures, using a likelihood-ratio test to identify a best-fit model. RESULTS Two hundred six (13%) mothers smoked during pregnancy. Mean [standard deviation (SD)] for black carbon was 0.8 (0.3) μg/m3, perfluorooctane sulfonate (PFOS) was 29.1 (16.5) ng/mL, and BW/GA z-score was 0.19 (0.96). In the best-fit model, BW/GA z-score was lower in infants of mothers exposed to greater black carbon [- 0.08 (95% CI: -0.15, - 0.01) per interquartile range (IQR)]. BW/GA z-score (95% CI) was also lower in infants of mothers who smoked [- 0.09 (- 0.23, 0.06)] or were exposed to greater PFOS [- 0.03 (- 0.07, 0.02) per IQR], although confidence intervals crossed the null. There were no interactions between exposures. In secondary analyses, instead of PFOS, we examined perfluorononanoate (PFNA) [mean (SD): 0.7 (0.4) ng/mL], a PFAS more closely linked to lower BW/GA in our cohort. The best-fit multi-pollutant model included positive two-way interactions between PFNA and both black carbon and smoking (p-interactions = 0.03). CONCLUSIONS Concurrent prenatal exposures to maternal smoking, black carbon, and PFOS are additively associated with lower fetal growth, whereas PFNA may attenuate associations of smoking and black carbon with lower fetal growth. It is important to examine interactions between multiple exposures in relation to health outcomes, as effects may not always be additive and may shed light on biological pathways.
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Affiliation(s)
- Lisa B. Rokoff
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Andres Cardenas
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Sharon K. Sagiv
- Center for Environmental Research and Children’s Health, University of California, Berkeley, CA USA
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA USA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Abby F. Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME USA
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME USA
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107
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Mora AM, Fleisch AF, Rifas-Shiman SL, Woo Baidal JA, Pardo L, Webster TF, Calafat AM, Ye X, Oken E, Sagiv SK. Early life exposure to per- and polyfluoroalkyl substances and mid-childhood lipid and alanine aminotransferase levels. ENVIRONMENT INTERNATIONAL 2018; 111:1-13. [PMID: 29156323 PMCID: PMC5801004 DOI: 10.1016/j.envint.2017.11.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Growing evidence suggests that exposure to per- and polyfluoroalkyl substances (PFASs) may disrupt lipid homeostasis and liver function, but data in children are limited. OBJECTIVE We examined the association of prenatal and mid-childhood PFAS exposure with lipids and alanine aminotransferase (ALT) levels in children. METHODS We studied 682 mother-child pairs from a Boston-area pre-birth cohort. We quantified PFASs in maternal plasma collected in pregnancy (median 9.7weeks gestation, 1999-2002) and in child plasma collected in mid-childhood (median age 7.7years, 2007-2010). In mid-childhood we also measured fasting total (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and ALT. We then derived low-density lipoprotein cholesterol (LDL-C) from TC, HDL-C, and TG using the Friedewald formula. RESULTS Median (interquartile range, IQR) perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorodecanoate (PFDeA) concentrations in child plasma were 6.2 (5.5), 4.3 (3.0), and 0.3 (0.3) ng/mL, respectively. Among girls, higher child PFOS, PFOA, and PFDeA concentrations were associated with detrimental changes in the lipid profile, including higher TC and/or LDL-C [e.g., β per IQR increment in PFOS=4.0mg/dL (95% CI: 0.3, 7.8) for TC and 2.6mg/dL (-0.5, 5.8) for LDL-C]. However, among both boys and girls, higher plasma concentrations of these child PFASs were also associated with higher HDL-C, which predicts better cardiovascular health, and slightly lower ALT, which may indicate better liver function. Prenatal PFAS concentrations were also modestly associated with improved childhood lipid and ALT levels. CONCLUSIONS Our data suggest that prenatal and mid-childhood PFAS exposure may be associated with modest, but somewhat conflicting changes in the lipid profile and ALT levels in children.
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Affiliation(s)
- Ana M Mora
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica.
| | - Abby F Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Medical Center, New York, NY, USA
| | - Larissa Pardo
- Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sharon K Sagiv
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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108
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Fang X, Wu C, Li H, Yuan W, Wang X. Elevation of intracellular calcium and oxidative stress is involved in perfluorononanoic acid–induced neurotoxicity. Toxicol Ind Health 2017; 34:139-145. [DOI: 10.1177/0748233717742262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perfluorononanoic acid (PFNA) is one of the major perfluorinated compounds found in both biological and abiotic samples and has recently been demonstrated to cause neurobehavioral defects in mammals. In this study, pheochromocytoma-12 (PC12) cells were exposed to various doses of PFNA to explore the cytotoxicity of PFNA to neurons and the possible mechanisms underlying these effects. The results showed that exposure to PFNA dose-dependently decreased the viability of PC12 cells and increased the release of lactate dehydrogenase into cell culture media. Exposure to PFNA increased the malondialdehyde content and decreased the total antioxidant capacity and glutathione peroxidase activity in PC12 cell culture supernatants. Exposure to PFNA increased the intracellular calcium level and upregulated the Ca2+/calmodulin-dependent protein kinase II (CaMKII) expression in PC12 cells. PFNA also decreased Bcl-2 expression and increased Bax expression in PC12 cells. These results suggested that exposure to PFNA elevated the intracellular calcium level and activated the CaMKII signaling pathway, which may aggravate oxidative stress in PC12 cells and lead to cell damage or cell apoptosis.
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Affiliation(s)
- Xuemei Fang
- School of Biological and Food Engineering, Suzhou University, Suzhou, People’s Republic of China
| | - Chao Wu
- School of Biological and Food Engineering, Suzhou University, Suzhou, People’s Republic of China
| | - Hongxia Li
- School of Biological and Food Engineering, Suzhou University, Suzhou, People’s Republic of China
| | - Weifeng Yuan
- School of Biological and Food Engineering, Suzhou University, Suzhou, People’s Republic of China
| | - Xin Wang
- School of Biological and Food Engineering, Suzhou University, Suzhou, People’s Republic of China
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109
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Matilla-Santander N, Valvi D, Lopez-Espinosa MJ, Manzano-Salgado CB, Ballester F, Ibarluzea J, Santa-Marina L, Schettgen T, Guxens M, Sunyer J, Vrijheid M. Exposure to Perfluoroalkyl Substances and Metabolic Outcomes in Pregnant Women: Evidence from the Spanish INMA Birth Cohorts. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:117004. [PMID: 29135438 PMCID: PMC5947948 DOI: 10.1289/ehp1062] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Exposure to perfluoroalkyl substances (PFASs) may increase risk for metabolic diseases; however, epidemiologic evidence is lacking at the present time. Pregnancy is a period of enhanced tissue plasticity for the fetus and the mother and may be a critical window of PFAS exposure susceptibility. OBJECTIVE We evaluated the associations between PFAS exposures and metabolic outcomes in pregnant women. METHODS We analyzed 1,240 pregnant women from the Spanish INMA [Environment and Childhood Project (INfancia y Medio Ambiente)] birth cohort study (recruitment period: 2003-2008) with measured first pregnancy trimester plasma concentrations of four PFASs (in nanograms/milliliter). We used logistic regression models to estimate associations of PFASs (log10-transformed and categorized into quartiles) with impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM), and we used linear regression models to estimate associations with first-trimester serum levels of triglycerides, total cholesterol, and C-reactive protein (CRP). RESULTS Perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were positively associated with IGT (137 cases) [OR per log10-unit increase=1.99 (95% CI: 1.06, 3.78) and OR=1.65 ( 95% CI: 0.99, 2.76), respectively]. PFOS and PFHxS associations with GDM (53 cases) were in a similar direction, but less precise. PFOS and perfluorononanoate (PFNA) were negatively associated with triglyceride levels [percent median change per log10-unit increase=-5.86% (95% CI: -9.91%, -1.63%) and percent median change per log10-unit increase=-4.75% (95% CI: -8.16%, -0.61%, respectively], whereas perfluorooctanoate (PFOA) was positively associated with total cholesterol [percent median change per log10-unit increase=1.26% (95% CI: 0.01%, 2.54%)]. PFASs were not associated with CRP in the subset of the population with available data (n=640). CONCLUSIONS Although further confirmation is required, the findings from this study suggest that PFAS exposures during pregnancy may influence lipid metabolism and glucose tolerance and thus may impact the health of the mother and her child. https://doi.org/10.1289/EHP1062.
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Affiliation(s)
- Nuria Matilla-Santander
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Damaskini Valvi
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria-Jose Lopez-Espinosa
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat de València, Valencia, Spain
| | - Cyntia B Manzano-Salgado
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ferran Ballester
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat de València, Valencia, Spain
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastián, Spain
- Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
| | - Loreto Santa-Marina
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastián, Spain
- Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
| | - Thomas Schettgen
- Institute for Occupational Medicine, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Mònica Guxens
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jordi Sunyer
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Martine Vrijheid
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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110
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Makey CM, Webster TF, Martin JW, Shoeib M, Harner T, Dix-Cooper L, Webster GM. Airborne Precursors Predict Maternal Serum Perfluoroalkyl Acid Concentrations. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:7667-7675. [PMID: 28535063 DOI: 10.1021/acs.est.7b00615] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Human exposure to persistent perfluoroalkyl acids (PFAAs), including perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorooctanesulfonate (PFOS), can occur directly from contaminated food, water, air, and dust. However, precursors to PFAAs (PreFAAs), such as dipolyfluoroalkyl phosphates (diPAPs), fluorotelomer alcohols (FTOHs), perfluorooctyl sulfonamides (FOSAs), and sulfonamidoethanols (FOSEs), which can be biotransformed to PFAAs, may also be a source of exposure. PFAAs were analyzed in 50 maternal sera samples collected in 2007-2008 from participants in Vancouver, Canada, while PFAAs and PreFAAs were measured in matching samples of residential bedroom air collected by passive sampler and in sieved vacuum dust (<150 μm). Concentrations of PreFAAs were higher than for PFAAs in air and dust. Positive associations were discovered between airborne 10:2 FTOH and serum PFOA and PFNA and between airborne MeFOSE and serum PFOS. On average, serum PFOS concentrations were 2.3 ng/mL (95%CI: 0.40, 4.3) higher in participants with airborne MeFOSE concentrations in the highest tertile relative to the lowest tertile. Among all PFAAs, only PFNA in air and vacuum dust predicted serum PFNA. Results suggest that airborne PFAA precursors were a source of PFOA, PFNA, and PFOS exposure in this population.
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Affiliation(s)
- Colleen M Makey
- Boston University School of Public Health , Department of Environmental Health, 715 Albany Street T4W, Boston, Massachusetts 02118, United States
| | - Thomas F Webster
- Boston University School of Public Health , Department of Environmental Health, 715 Albany Street T4W, Boston, Massachusetts 02118, United States
| | - Jonathan W Martin
- Division of Analytical & Environmental Toxicology, Department of Laboratory Medicine & Pathology, University of Alberta , Edmonton, Alberta T6G 2R3, Canada
| | - Mahiba Shoeib
- Air Quality Processes Research Section, Environment and Climate Change Canada , Toronto, Ontario M3H 5T4, Canada
| | - Tom Harner
- Air Quality Processes Research Section, Environment and Climate Change Canada , Toronto, Ontario M3H 5T4, Canada
| | - Linda Dix-Cooper
- Environmental Health Services, BC Centre for Disease Control , Vancouver, British Columbia V5Z 4R4, Canada
| | - Glenys M Webster
- Faculty of Health Sciences, Simon Fraser University , Burnaby, British Columbia V5A 1S6, Canada
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111
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Hartman TJ, Calafat AM, Holmes AK, Marcus M, Northstone K, Flanders WD, Kato K, Taylor EV. Prenatal Exposure to Perfluoroalkyl Substances and Body Fatness in Girls. Child Obes 2017; 13:222-230. [PMID: 28128969 PMCID: PMC5444423 DOI: 10.1089/chi.2016.0126] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are used in surface coatings that resist stains, grease, and water. METHODS The association between in utero PFAS exposure and girls' body fatness at age 9 was analyzed in The Avon Longitudinal Study of Parents and Children (UK). Maternal serum [median 15 weeks: interquartile range (IQR) 10 and 28 weeks of gestation] was analyzed for perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA). Body composition was measured by dual X-ray emission absorptiometry, and percent total body fat (%BF) was calculated. Associations between PFASs and body fatness were modeled by multivariable linear regression. RESULTS Among 359 girls, median (IQR) %BF was 27.5 (IQR 21.7-34.6). Median (IQR) concentrations (all ng/mL) were 3.7 (2.9-4.8) for PFOA, 19.8 (15.0-25.3) for PFOS, 1.6 (1.3-2.2) for PFHxS, and 0.5 (0.4-0.7) for PFNA. Maternal PFAS concentrations were not significantly associated with daughters' total %BF overall. Mothers' educational status modified associations for PFOA and PFOS with %BF (P-interactions: 0.005 and 0.02, respectively). %BF was higher [1.4%; 95% confidence interval (95% CI): 0.3 to 2.5] for each one unit (ng/mL) higher PFOA among girls with mothers in the middle education group, but lower (-0.6%; 95% CI: -1.12 to -0.04) for the corresponding comparison among girls with mothers with the highest education. %BF was lower (-0.2%; 95% CI: -0.3 to -0.1) for each one unit higher PFOS among girls with the most educated mothers. CONCLUSIONS Prenatal exposure to PFOA and PFOS was associated with girls' %BF within some strata of maternal education status. PFHxS and PFNA were not associated with %BF.
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Affiliation(s)
- Terryl J. Hartman
- Centers for Disease Control and Prevention, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.,Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kate Northstone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - W. Dana Flanders
- Centers for Disease Control and Prevention, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.,Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kayoko Kato
- Centers for Disease Control and Prevention, Atlanta, GA
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112
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Chen F, Yin S, Kelly BC, Liu W. Isomer-Specific Transplacental Transfer of Perfluoroalkyl Acids: Results from a Survey of Paired Maternal, Cord Sera, and Placentas. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:5756-5763. [PMID: 28434222 DOI: 10.1021/acs.est.7b00268] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Currently, information regarding isomer-specific concentrations of PFHxS, PFOS, and PFOA in human placenta, and corresponding placental-maternal ratios (RPM) of these compounds does not exist. The objective of the present study was to assess the occurrence, and distribution of different PFHxS, PFOS, and PFOA isomers in maternal serum, umbilical cord serum, and placenta to gain a better understanding of transplacental transport efficiency and prenatal exposure risks. The study involved quantitative determination of isomer-specific concentrations of PFHxS, PFOS, and PFOA in samples of maternal serum (n = 32), cord serum (n = 32), and placenta (n = 32) from pregnant women in Wuhan, China. The results indicate that both linear and branched PFHxS, PFOS and PFOA can be efficiently transported across the placenta, with exposure levels ordered maternal serum > cord serum > placenta. For PFOS isomers, the concentration ratios between cord serum and maternal serum (RCM) were ordered n < iso < 4m < (3 + 5)m < 1m < ∑m2. The RPM values exhibited a similar trend for branched PFOS isomers: iso < 4m ≈ (3 + 5)m < 1m ≈ ∑m2. Conversely, PFOA isomers did not exhibit an obvious structure-activity relationship for RCM and RPM. n-PFHxS transported across the placenta to a greater extent than br-PFHxS. To the best of our knowledge, this is the first study to report the occurrence of PFHxS, PFOS, and PFOA isomers in human placenta. Further, RPM values of these compounds are reported here for the first time. The findings help to better understand the mechanisms of the placental transfer and neonatal exposure to these important contaminants of concern.
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Affiliation(s)
- Fangfang Chen
- Ministry of Education Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University , Hangzhou 310058, China
| | - Shanshan Yin
- Ministry of Education Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University , Hangzhou 310058, China
| | - Barry C Kelly
- Department of Civil and Environmental Engineering, National University of Singapore , Singapore 117576, Singapore
| | - Weiping Liu
- Ministry of Education Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University , Hangzhou 310058, China
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Harris MH, Rifas-Shiman SL, Calafat AM, Ye X, Mora AM, Webster TF, Oken E, Sagiv SK. Predictors of Per- and Polyfluoroalkyl Substance (PFAS) Plasma Concentrations in 6-10 Year Old American Children. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:5193-5204. [PMID: 28325044 PMCID: PMC5576362 DOI: 10.1021/acs.est.6b05811] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Certain per- and polyfluoroalkyl substances (PFASs) are suspected developmental toxicants, but data on PFAS concentrations and exposure routes in children are limited. We measured plasma PFASs in children aged 6-10 years from the Boston-area Project Viva prebirth cohort, and used multivariable linear regression to estimate associations with sociodemographic, behavioral, and health-related factors, and maternal PFASs measured during pregnancy. PFAS concentrations in Project Viva children (sampled 2007-2010) were similar to concentrations among youth participants (aged 12-19 years) in the 2007-8 and 2009-10 National Health and Nutrition Examination Survey (NHANES); mean concentrations of most PFASs declined from 2007 to 2010 in Project Viva and NHANES. In mutually adjusted models, predictors of higher PFAS concentrations included older child age, lower adiposity, carpeting or a rug in the child's bedroom, higher maternal education, and higher neighborhood income. Concentrations of perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexanesulfonate (PFHxS), and 2-(N-methyl-perfluorooctane sulfonamido) acetate (Me-PFOSA-AcOH) were 26-36% lower in children of black mothers compared to children of white mothers and increased 12-21% per interquartile range increase in maternal pregnancy PFASs. Breastfeeding duration did not predict childhood PFAS concentrations in adjusted multivariable models. Together, the studied predictors explained the observed variability in PFAS concentrations to only a modest degree.
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Affiliation(s)
- Maria H. Harris
- Center for Environmental Research and Children's Health, University of California, Berkeley School of Public Health, Berkeley, California, United States
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, California, United States
- Corresponding Author: Phone: (510) 642-9508; fax: (510) 642-9083; ., Maria H. Harris: 0000-0002-4421-0224, Xiaoyun Ye: 0000-0001-5837-2542
| | - Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta
| | - Ana Maria Mora
- Georgia, United States Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States
- Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica
| | - Thomas F. Webster
- Georgia, United States Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States
| | - Sharon K. Sagiv
- Center for Environmental Research and Children's Health, University of California, Berkeley School of Public Health, Berkeley, California, United States
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, California, United States
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Li M, Zeng XW, Qian ZM, Vaughn MG, Sauvé S, Paul G, Lin S, Lu L, Hu LW, Yang BY, Zhou Y, Qin XD, Xu SL, Bao WW, Zhang YZ, Yuan P, Wang J, Zhang C, Tian YP, Nian M, Xiao X, Fu C, Dong GH. Isomers of perfluorooctanesulfonate (PFOS) in cord serum and birth outcomes in China: Guangzhou Birth Cohort Study. ENVIRONMENT INTERNATIONAL 2017; 102:1-8. [PMID: 28297681 DOI: 10.1016/j.envint.2017.03.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 05/25/2023]
Abstract
Prior investigations on the associations of polyfluoroalkyl substances (PFASs) with fetal growth are mixed. Moreover, little research has accrued pertaining to the association between isomers of PFASs with gestational age and birth weight. To address this gap and present novel information, we conducted a study including 321 pairs of mothers and their infants recruited from Guangzhou, China. High performance liquid chromatography-mass spectrometry was utilized to analyze isomers of perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA) along with other PFAS levels in cord serum samples. Mothers' and infants' characteristics were gathered from medical records. The resulting data revealed that higher PFOS, PFOA and isomers of PFOS were associated with lower birth weight. Per ln-unit (ng/mL) increase in cord serum total branched PFOS isomers was associated with a 126.3g (95% CI: -195.9, -56.8) reduction in the weight of infants at birth, while an ln-unit (ng/mL) increase of serum linear PFOS isomers (n-PFOS) was associated with a 57.2g (95% CI: -103.1, -11.3) reduction in the weight of infants at birth upon the subsequent adjustment for potential confounding variables. Notably, the association between cord PFAS level and birth weight was more pronounced in male infants. Furthermore, a positive association among branched PFOS isomers (1m-PFOS and 3+4+5m-PFOS) and gestational age was found. No associations could be found among other PFASs in conjunction with gestational age or birth weight. In conclusion, this investigation suggests that higher PFAS concentrations are associated with lower birth weight, and branched PFOS isomers show greater impact on infant birth weight than linear PFOS.
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Affiliation(s)
- Meng Li
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao-Wen Zeng
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhengmin Min Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Sébastien Sauvé
- Department of Chemistry, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Gunther Paul
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Shao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York, Albany, NY 12144-3445, USA
| | - Long Lu
- Liwan District Maternal and Child Health Hospital, Guangzhou 510375, China
| | - Li-Wen Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yang Zhou
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao-Di Qin
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shu-Li Xu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen-Wen Bao
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya-Zhi Zhang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ping Yuan
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jia Wang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chuan Zhang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan-Peng Tian
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Min Nian
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiang Xiao
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chuanxi Fu
- Zhejiang Chinese Medical University, Hangzhou 310053, China; Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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115
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Romano ME, Hawley NL, Eliot M, Calafat AM, Jayatilaka NK, Kelsey K, McGarvey S, Phipps MG, Savitz DA, Werner EF, Braun JM. Variability and predictors of urinary concentrations of organophosphate flame retardant metabolites among pregnant women in Rhode Island. Environ Health 2017; 16:40. [PMID: 28399857 PMCID: PMC5387223 DOI: 10.1186/s12940-017-0247-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/30/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Organophospate flame retardants (PFRs) are chemicals of emerging concern due to restrictions on polybrominated diphenyl ether flame retardant formulations. We describe the occurrence, variability, and predictors of urinary metabolites of PFRs among pregnant women. METHODS In 2014-2015, 59 women from Providence, RI provided up to 3 spot urine samples during pregnancy (~12, 28, and 35 weeks' gestation). We created a pooled urine sample per woman and measured nine relevant metabolites in individual and pooled samples. We used linear mixed models to calculate intraclass correlation coefficients (ICCs) across the 3 measurements and to assess sociodemographic and dietary predictors of PFRs. RESULTS The median (IQR) of bis-2-chloroethyl phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), and diphenyl phosphate (DPhP), the metabolites most frequently detected, from pooled samples were: 0.31 μg/L (0.17-0.54), 1.18 μg/L (0.64-2.19), 0.93 μg/L (0.72-1.97), respectively. We observed fair to good reproducibility for BCEP (ICC = 0.50), BDCPP (ICC = 0.60), and DPhP (ICC = 0.43), and excellent agreement between the urinary flame retardant metabolite concentrations averaged across pregnancy versus pooled urine sample concentrations for BCEP (ICC = 0.95), BDCPP (ICC = 0.89), and DPhP (ICC = 0.93). Adjusting for pertinent sociodemographic factors and gestational week of urine collection, each 1 kg increase in pre-pregnancy weight was associated with greater BCEP (1.1%; 95% CI: 0.1, 2.1), BDCPP (1.5%; 95% CI: 0.3, 2.7), and DPhP (0.5%; 95% CI: 0.0, 1.1). Dietary factors were generally not associated with urinary flame retardant metabolites. CONCLUSIONS Urinary concentrations of BCEP, BDCPP, and DPhP were frequently detected among women in this pilot study and had fair reproducibility across pregnancy. Body size may be an important predictor of urinary flame retardant metabolite concentrations.
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Affiliation(s)
- Megan E. Romano
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Diseases), Yale University School of Public Health, New Haven, CT USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Nayana K. Jayatilaka
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Karl Kelsey
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Stephen McGarvey
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Anthropology, Brown University, Providence, RI USA
| | - Maureen G. Phipps
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, and Women & Infants Hospital of Rhode Island, Providence, RI USA
| | - David A. Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, and Women & Infants Hospital of Rhode Island, Providence, RI USA
| | - Erika F. Werner
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, and Women & Infants Hospital of Rhode Island, Providence, RI USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
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Mora AM, Oken E, Rifas-Shiman SL, Webster TF, Gillman MW, Calafat AM, Ye X, Sagiv SK. Prenatal Exposure to Perfluoroalkyl Substances and Adiposity in Early and Mid-Childhood. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:467-473. [PMID: 27352404 PMCID: PMC5332178 DOI: 10.1289/ehp246] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/19/2016] [Accepted: 05/31/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Few studies have examined whether prenatal exposure to perfluoroalkyl substances (PFASs) is associated with childhood adiposity. OBJECTIVE We examined associations of prenatal exposure to PFASs with adiposity in early and mid-childhood. METHODS We measured plasma PFAS concentrations in 1,645 pregnant women (median, 9.6 weeks gestation) enrolled in Project Viva, a prospective pre-birth cohort study in Massachusetts (USA), between 1999 and 2002. We assessed overall and central adiposity in 1,006 children in early childhood (median, 3.2 years) and 876 in mid-childhood (median, 7.7 years) using anthropometric and dual X-ray absorptiometry (DXA) measurements. We fitted multivariable linear regression models to estimate exposure-outcome associations and evaluated effect modification by child sex. RESULTS Median (25-75th percentiles) prenatal plasma perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) concentrations in children assessed in early childhood were 5.6 (4.1-7.7), 24.8 (18.4-33.9), 2.4 (1.6-3.8), and 0.6 (0.5-0.9) ng/mL, respectively. Among girls, each interquartile range increment of prenatal PFOA concentrations was associated with 0.21 kg/m2 (95% CI: -0.05, 0.48) higher body mass index, 0.76 mm (95% CI: -0.17, 1.70) higher sum of subscapular and triceps skinfold thickness, and 0.17 kg/m2 (95% CI: -0.02, 0.36) higher DXA total fat mass index in mid-childhood. Similar associations were observed for PFOS, PFHxS, and PFNA. We observed null associations for boys and early-childhood adiposity measures. CONCLUSIONS In this cohort, prenatal exposure to PFASs was associated with small increases in adiposity measurements in mid-childhood, but only among girls. Citation: Mora AM, Oken E, Rifas-Shiman SL, Webster TF, Gillman MW, Calafat AM, Ye X, Sagiv SK. 2017. Prenatal exposure to perfluoroalkyl substances and adiposity in early and mid-childhood. Environ Health Perspect 125:467-473; http://dx.doi.org/10.1289/EHP246.
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Affiliation(s)
- Ana María Mora
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Thomas F. Webster
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon K. Sagiv
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Fleisch AF, Rifas-Shiman SL, Mora AM, Calafat AM, Ye X, Luttmann-Gibson H, Gillman MW, Oken E, Sagiv SK. Early-Life Exposure to Perfluoroalkyl Substances and Childhood Metabolic Function. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:481-487. [PMID: 27586368 PMCID: PMC5332186 DOI: 10.1289/ehp303] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/29/2016] [Accepted: 07/29/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are synthetic chemicals that may persist in the environment and in humans. There is a possible association between early-life PFAS exposure and metabolic dysfunction in later life, but data are limited. METHODS We studied 665 mother-child pairs in Project Viva, a Boston, Massachusetts-area cohort recruited 1999-2002. We quantified concentrations of PFASs [perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS), and perfluorodecanoate (PFDeA)] in maternal plasma collected at the first prenatal visit (median, 9.6 weeks gestation) and in child plasma from the mid-childhood research visit (median, 7.7 years). We assessed leptin, adiponectin, and homeostatic model assessment of insulin resistance (HOMA-IR) in mid-childhood. We fit covariate-adjusted linear regression models and conducted stratified analyses by child sex. RESULTS Children with higher PFAS concentrations had lower HOMA-IR [e.g., -10.1% (95% CI: -17.3, -2.3) per interquartile range increment in PFOA]. This inverse association between child PFAS and HOMA-IR was more pronounced in females [e.g., PFOA: -15.6% (95% CI: -25.4, -4.6) vs. -6.1% (95% CI: -16.2, 5.2) for males]. Child PFAS plasma concentrations were not associated with leptin or adiponectin. Prenatal PFAS plasma concentrations were not associated with leptin, adiponectin, or HOMA-IR in offspring. CONCLUSIONS We found no evidence for an adverse effect of early-life PFAS exposure on metabolic function in mid-childhood. In fact, children with higher PFAS concentrations had lower insulin resistance. Citation: Fleisch AF, Rifas-Shiman SL, Mora AM, Calafat AM, Ye X, Luttmann-Gibson H, Gillman MW, Oken E, Sagiv SK. 2017. Early-life exposure to perfluoroalkyl substances and childhood metabolic function. Environ Health Perspect 125:481-487; http://dx.doi.org/10.1289/EHP303.
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Affiliation(s)
- Abby F. Fleisch
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ana M. Mora
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sharon K. Sagiv
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Univariate predictors of maternal concentrations of environmental chemicals: The MIREC study. Int J Hyg Environ Health 2017; 220:77-85. [PMID: 28109710 DOI: 10.1016/j.ijheh.2017.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The developing fetus and pregnant woman can be exposed to a variety of environmental chemicals that may adversely affect their health. Moreover, environmental exposure and risk disparities are associated with different social determinants, including socioeconomic status (SES) and demographic indicators. Our aim was to investigate whether and how maternal concentrations of a large panel of persistent and non-persistent environmental chemicals vary according to sociodemographic and lifestyle characteristics in a large pregnancy and birth cohort. METHODS Data were analyzed from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a cohort of pregnant women (N=2001) recruited over four years (2008-2011) in 10 cities across Canada. In all, 1890 urine and 1938 blood samples from the first trimester (1st and 3rd trimester for metals) were analysed and six sociodemographic and lifestyle indicators were assessed: maternal age, household income, parity, smoking status, country of birth and pre-pregnancy body mass index (BMI). RESULTS We found these indicators to be significantly associated with many of the chemicals measured in maternal blood and urine. Women born outside Canada had significantly higher concentrations of di-2-ethylhexyl and diethyl phthalate metabolites, higher levels of all metals except cadmium (Cd), as well as higher levels of polychlorinated biphenyls (PCBs) and legacy organochlorine pesticides (OCPs). Nulliparity was associated with higher concentrations of dialkyl phosphates (DAPs), arsenic, dimethylarsinic acid (DMAA), perfluoroalkyl substances (PFASs) and many of the persistent organic pollutants. Smokers had higher levels of bisphenol A, Cd and perfluorohexane sulfonate, while those women who had never smoked had higher levels of triclosan, DMAA, manganese and some OCPs. CONCLUSION Our results demonstrated that inequitable distribution of exposure to chemicals among populations within a country can occur. Sociodemographic and lifestyle factors are an important component of a thorough risk assessment as they can impact the degree of exposure and may modify the individual's susceptibility to potential health effects due to differences in lifestyle, cultural diets, and aging.
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Pan Y, Zhu Y, Zheng T, Cui Q, Buka SL, Zhang B, Guo Y, Xia W, Yeung LWY, Li Y, Zhou A, Qiu L, Liu H, Jiang M, Wu C, Xu S, Dai J. Novel Chlorinated Polyfluorinated Ether Sulfonates and Legacy Per-/Polyfluoroalkyl Substances: Placental Transfer and Relationship with Serum Albumin and Glomerular Filtration Rate. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:634-644. [PMID: 27931097 DOI: 10.1021/acs.est.6b04590] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Per- and polyfluoroalkyl substances (PFASs) may cross the placental barrier and lead to fetal exposure. However, little is known about the factors that influence maternal-fetal transfer of these chemicals. PFAS concentrations were analyzed in 100 paired samples of human maternal sera collected in each trimester and cord sera at delivery; these samples were collected in Wuhan, China, 2014. Linear regression was used to estimate associations of transfer efficiencies with factors. Chlorinated polyfluorinated ether sulfonates (Cl-PFAESs, 6:2 and 8:2) were frequently detected (>99%) in maternal and cord sera. A significant decline in PFAS levels during the three trimesters was observed. A U-shape trend for transfer efficiency with increasing chain length was observed for both carboxylates and sulfonates. Higher transfer efficiencies of PFASs were associated with advancing maternal age, higher education, and lower glomerular filtration rate (GFR). Cord serum albumin was a positive factors for higher transfer efficiency (increased 1.1-4.1% per 1g/L albumin), whereas maternal serum albumin tended to reduce transfer efficiency (decreased 2.4-4.3% per 1g/L albumin). Our results suggest that exposure to Cl-PFAESs may be widespread in China. The transfer efficiencies among different PFASs were structure-dependent. Physiological factors (e.g., GFR and serum albumin) were observed for the first time to play critical roles in PFAS placental transfer.
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Affiliation(s)
- Yitao Pan
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences , Beijing 100101, P. R. China
| | - Yingshuang Zhu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University , Providence, Rhode Island 02912, United States
| | - Qianqian Cui
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences , Beijing 100101, P. R. China
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University , Providence, Rhode Island 02912, United States
| | - Bin Zhang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
- Women and Children Medical and Healthcare Center of Wuhan , Wuhan 430030, Hubei, P. R. China
| | - Yong Guo
- Key Laboratory of Organofluorine Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences , Shanghai 200032, P. R. China
| | - Wei Xia
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Leo W Y Yeung
- Man-Technology-Environment Research Centre (MTM), School of Science and Technology, Örebro University , SE-70182, Örebro, Sweden
| | - Yuanyuan Li
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan , Wuhan 430030, Hubei, P. R. China
| | - Lin Qiu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
- Women and Children Medical and Healthcare Center of Wuhan , Wuhan 430030, Hubei, P. R. China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Minmin Jiang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Chuansha Wu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Shunqing Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430030, Hubei, P. R. China
| | - Jiayin Dai
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences , Beijing 100101, P. R. China
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Fanga C, Megharaj M, Naidu R. Electrochemical Detection of Thioether-Based Fluorosurfactants in Aqueous Film-Forming Foam (AFFF). ELECTROANAL 2016. [DOI: 10.1002/elan.201600724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Cheng Fanga
- Global Centre for Environmental Remediation (GCER), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
| | - Mallavarapu Megharaj
- Global Centre for Environmental Remediation (GCER), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
| | - Ravi Naidu
- Global Centre for Environmental Remediation (GCER), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), ACT Building; University of Newcastle; Callaghan NSW 2308 Australia
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121
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Lauritzen HB, Larose TL, Øien T, Odland JØ, van de Bor M, Jacobsen GW, Sandanger TM. Factors Associated with Maternal Serum Levels of Perfluoroalkyl Substances and Organochlorines: A Descriptive Study of Parous Women in Norway and Sweden. PLoS One 2016; 11:e0166127. [PMID: 27824939 PMCID: PMC5100957 DOI: 10.1371/journal.pone.0166127] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/24/2016] [Indexed: 01/01/2023] Open
Abstract
Introduction Perfluoroalkyl substances (PFASs) and organochlorines (OCs) are ubiquitous and persistent in the environment and proposed endocrine disrupting chemicals (EDCs). They can be transferred across the placenta during pregnancy, and studies suggest that the prenatal period may be particularly sensitive for influences on fetal growth and development. Several studies have investigated socio-demographic and pregnancy related factors associated with maternal serum PFAS and OC levels, but few studies have been conducted in time periods with increasing emissions of PFASs and recent emissions of OCs. Methods Serum from 424 pregnant women participating in the NICHD Scandinavian Successive Small-for-gestational Age (SGA) births study was collected in 1986–1988, and analyses of two PFASs and six OCs were conducted. Associations between EDCs and geographic, time dependent, socio-demographic and pregnancy related variables were evaluated by using multivariable linear regression models. Results Previous breastfeeding duration, time since last breastfeeding period, sampling date and country of residence were important factors associated with serum levels of PFOS and PFOA. Smoking status and pre-pregnancy BMI were negatively associated with PFOS, and maternal height was borderline negatively associated with PFOS and PFOA. Glomerular filtration rate (GFR) was negatively associated with PFOS in a sub-sample. Maternal serum levels of OCs were positively associated with maternal age, and negatively associated with previous breastfeeding duration and sampling date. Smoking had a consistently negative association with PCB 118 in a dose-dependent manner. Education level, pre-pregnancy BMI and alcohol consumption varied in importance according to the compound under study. Conclusions Several maternal factors, including potentially modifiable factors, markers of pregnancy physiology and factors also related to perinatal outcomes were associated with EDC levels. Results from this study are relevant to populations with still high PFAS and OC levels, i.e. developing countries. Moreover, we can use this knowledge about associated factors on emerging EDCs with similar properties.
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Affiliation(s)
- Hilde B. Lauritzen
- Department of Public Health and General Practice, Norwegian University for Science and Technology, Trondheim, Norway
- * E-mail:
| | - Tricia L. Larose
- Department of Public Health and General Practice, Norwegian University for Science and Technology, Trondheim, Norway
| | - Torbjørn Øien
- Department of Public Health and General Practice, Norwegian University for Science and Technology, Trondheim, Norway
| | - Jon Ø. Odland
- Department of Community Medicine, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Margot van de Bor
- Section of Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Geir W. Jacobsen
- Department of Public Health and General Practice, Norwegian University for Science and Technology, Trondheim, Norway
| | - Torkjel M. Sandanger
- Department of Community Medicine, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
- NILU-Norwegian Institute for Air Research, Tromsø, Norway
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Timmermann CAG, Budtz-Jørgensen E, Petersen MS, Weihe P, Steuerwald U, Nielsen F, Jensen TK, Grandjean P. Shorter duration of breastfeeding at elevated exposures to perfluoroalkyl substances. Reprod Toxicol 2016; 68:164-170. [PMID: 27421579 DOI: 10.1016/j.reprotox.2016.07.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/13/2016] [Accepted: 07/09/2016] [Indexed: 01/27/2023]
Abstract
The aim of this study was to determine whether maternal exposure to persistent perfluoroalkyl substances (PFASs) affect the capability to breastfeed. In two Faroese birth cohorts (N=1130), concentrations of five PFASs were measured in maternal serum during pregnancy or two weeks after term. Duration of breastfeeding was assessed by questionnaire and clinical interview. In adjusted linear regression models, a doubling of maternal serum PFASs was associated with a reduction in duration of both total and exclusive breastfeeding, most pronounced for perfluorooctane sulfonic acid (PFOS) where a doubling was associated with a reduction in total breastfeeding of 1.4 (95% CI: 0.6; 2.1) months and perfluorooctanoic acid (PFOA) where a doubling was associated with a reduction in exclusive breastfeeding of 0.5 (0.3; 0.7) months. The associations were evident among both primiparous and multiparous women, and thus cannot be explained by confounding from previous breastfeeding.
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Affiliation(s)
- Clara Amalie Gade Timmermann
- Department of Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000 Odense C, Denmark.
| | - Esben Budtz-Jørgensen
- Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, Sigmundargøta 5, 100 Tórshavn, Faroe Islands, Denmark.
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, Sigmundargøta 5, 100 Tórshavn, Faroe Islands, Denmark; Faculty of Natural and Health Sciences, University of The Faroe Islands, J.C. Svabos gøta 14, 100 Tórshavn, Faroe Islands, Denmark.
| | - Ulrike Steuerwald
- Department of Occupational Medicine and Public Health, Sigmundargøta 5, 100 Tórshavn, Faroe Islands, Denmark.
| | - Flemming Nielsen
- Department of Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000 Odense C, Denmark.
| | - Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000 Odense C, Denmark.
| | - Philippe Grandjean
- Department of Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000 Odense C, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
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Jusko TA, Oktapodas M, Murinová LP, Babinská K, Babjaková J, Verner MA, DeWitt JC, Thevenet-Morrison K, Čonka K, Drobná B, Chovancová J, Thurston SW, Lawrence BP, Dozier AM, Järvinen KM, Patayová H, Trnovec T, Legler J, Hertz-Picciotto I, Lamoree MH. Demographic, Reproductive, and Dietary Determinants of Perfluorooctane Sulfonic (PFOS) and Perfluorooctanoic Acid (PFOA) Concentrations in Human Colostrum. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:7152-62. [PMID: 27244128 PMCID: PMC5256678 DOI: 10.1021/acs.est.6b00195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To determine demographic, reproductive, and maternal dietary factors that predict perfluoroalkyl substance (PFAS) concentrations in breast milk, we measured perfluorooctane sulfonic (PFOS) and perfluorooctanoic acid (PFOA) concentrations, using liquid chromatography-mass spectrometry, in 184 colostrum samples collected from women participating in a cohort study in Eastern Slovakia between 2002 and 2004. During their hospital delivery stay, mothers completed a food frequency questionnaire, and demographic and reproductive data were also collected. PFOS and PFOA predictors were identified by optimizing multiple linear regression models using Akaike's information criterion (AIC). The geometric mean concentration in colostrum was 35.3 pg/mL for PFOS and 32.8 pg/mL for PFOA. In multivariable models, parous women had 40% lower PFOS (95% CI: -56 to -17%) and 40% lower PFOA (95% CI: -54 to -23%) concentrations compared with nulliparous women. Moreover, fresh/frozen fish consumption, longer birth intervals, and Slovak ethnicity were associated with higher PFOS and PFOA concentrations in colostrum. These results will help guide the design of future epidemiologic studies examining milk PFAS concentrations in relation to health end points in children.
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Affiliation(s)
- Todd A. Jusko
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Marina Oktapodas
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Katarina Babinská
- Institute of Physiology, Comenius University, Faculty of Medicine, Bratislava, Slovak Republic
| | - Jana Babjaková
- Institute of Hygiene, Comenius University, Faculty of Medicine, Bratislava, Slovak Republic
| | - Marc-André Verner
- Department of Occupational and Environmental Health, School of Public Health and Université de Montréal Public Health Research Institute (IRSPUM), Université de Montréal, Montreal, Quebec, Canada
| | - Jamie C. DeWitt
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Kelly Thevenet-Morrison
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kamil Čonka
- Department of Toxic Organic Pollutants, Slovak Medical University, Bratislava, Slovak Republic
| | - Beata Drobná
- Department of Toxic Organic Pollutants, Slovak Medical University, Bratislava, Slovak Republic
| | - Jana Chovancová
- Department of Toxic Organic Pollutants, Slovak Medical University, Bratislava, Slovak Republic
| | - Sally W. Thurston
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - B. Paige Lawrence
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ann M. Dozier
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kirsi M. Järvinen
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Henrieta Patayová
- Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - Tomáš Trnovec
- Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - Juliette Legler
- Institute of Environmental Studies, VU University, Amsterdam, Netherlands
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, Division of Environmental and Occupational Health, School of Medicine, UC Davis, California, USA
| | - Marja H. Lamoree
- Institute of Environmental Studies, VU University, Amsterdam, Netherlands
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Manzano-Salgado CB, Casas M, Lopez-Espinosa MJ, Ballester F, Martinez D, Ibarluzea J, Santa-Marina L, Schettgen T, Vioque J, Sunyer J, Vrijheid M. Variability of perfluoroalkyl substance concentrations in pregnant women by socio-demographic and dietary factors in a Spanish birth cohort. ENVIRONMENT INTERNATIONAL 2016; 92-93:357-65. [PMID: 27132161 DOI: 10.1016/j.envint.2016.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/24/2016] [Accepted: 04/04/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Prenatal exposure to perfluoroalkyl substances (PFAS) might affect child health; but maternal determinants of PFAS exposure are unclear. We evaluated the socio-demographic and dietary factors of prenatal PFAS concentrations in a Spanish birth cohort. METHODS We analyzed perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in 1216 plasma samples collected during the 1(ST) trimester of pregnancy (2003-2008). We used multivariable linear regressions to assess the geometric mean (GM) ratios of PFAS concentrations by socio-demographic and dietary factors. We used analysis of variance (ANOVA) to assess the variability of PFAS concentrations by maternal factors. RESULTS GM PFAS concentrations ranged from 0.55ng/mL for PFHxS to 5.77ng/mL for PFOS. Women born outside of Spain had lower PFAS concentrations (e.g. GM ratio for PFHxS 0.53[95%CI: 0.46, 0.60] than Spanish women. PFHxS and PFOA concentrations were higher in mothers from the regions of Sabadell (2.13[1.93, 2.35] and 1.73[1.60, 1.88], respectively) and Valencia (1.40[1.28, 1.54] and 1.42[1.31, 1.53], respectively) than Gipuzkoa. PFOA and PFNA concentrations decreased with parity (≥2 children: 0.79[0.67, 0.94] and 0.82[0.68, 0.99], respectively). Younger women (i.e. <25years) had lower PFHxS (0.73[0.62, 0.86]) and PFOS (0.85[0.75, 0.96]) concentrations than older women. PFHxS and PFOA concentrations were lower in women who previously breastfed for >6months compared to those who never breastfed (0.79[0.67, 0.94] and 0.82[0.71, 0.95], respectively). High intake of fish and shellfish during pregnancy (i.e. ≥5.6 servings/week) was associated with 11% (1.11[1.04, 1.18]) higher PFOS concentrations than the lowest intake group. Our ANOVA models explained 26% to 40% of PFAS concentrations variability. CONCLUSIONS Prenatal PFAS concentrations were mainly determined by maternal country of birth, region of residence, previous breastfeeding and age. Fish and shellfish intake also contributed to PFOS and PFOA concentrations.
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Affiliation(s)
- Cyntia B Manzano-Salgado
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Maribel Casas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria-Jose Lopez-Espinosa
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; FISABIO Universitat de València-Universitat Jaume I Joint Research Unit, Valencia, Spain
| | - Ferran Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; FISABIO Universitat de València-Universitat Jaume I Joint Research Unit, Valencia, Spain
| | - David Martinez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jesus Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Subdirección de Salud Pública y Adicciones de Gipuzkoa, Donostia-San Sebastián, Spain; Instituto de Investigación Sanitaria BIODONOSTIA, Donostia-San Sebastián, Spain
| | - Loreto Santa-Marina
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Subdirección de Salud Pública y Adicciones de Gipuzkoa, Donostia-San Sebastián, Spain; Instituto de Investigación Sanitaria BIODONOSTIA, Donostia-San Sebastián, Spain
| | - Thomas Schettgen
- Institute for Occupational Medicine, RWTH Aachen University, Aachen, Germany
| | - Jesus Vioque
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universidad Miguel Hernandez, San Juan de Alicante, Spain
| | - Jordi Sunyer
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Martine Vrijheid
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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