1
|
Niu Z, Duan Z, He W, Chen T, Tang H, Du S, Sun J, Chen H, Hu Y, Iijima Y, Han S, Li J, Zhao Z. Kidney function decline mediates the adverse effects of per- and poly-fluoroalkyl substances (PFAS) on uric acid levels and hyperuricemia risk. JOURNAL OF HAZARDOUS MATERIALS 2024; 471:134312. [PMID: 38640681 DOI: 10.1016/j.jhazmat.2024.134312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
Previous studies indicated per- and poly-fluoroalkyl substances (PFAS) were related to uric acid and hyperuricemia risk, but evidence for the exposure-response (E-R) curves and combined effect of PFAS mixture is limited. Moreover, the potential mediation effect of kidney function was not assessed. Hence, we conducted a national cross-sectional study involving 13,979 US adults in NHANES 2003-2018 to examine the associations of serum PFAS with uric acid and hyperuricemia risk, and the mediation effects of kidney function. Generalized linear models and E-R curves showed positive associations of individual PFAS with uric acid and hyperuricemia risk, and nearly linear E-R curves indicated no safe threshold for PFAS. Weighted quantile sum regression found positive associations of PFAS mixture with uric acid and hyperuricemia risk, and PFOA was the dominant contributor to the adverse effect of PFAS on uric acid and hyperuricemia risk. Causal mediation analysis indicated significant mediation effects of kidney function decline in the associations of PFAS with uric acid and hyperuricemia risk, with the mediated proportion ranging from 19 % to 57 %. Our findings suggested that PFAS, especially PFOA, may cause increased uric acid and hyperuricemia risk increase even at low levels, and kidney function decline plays a crucial mediation effect.
Collapse
Affiliation(s)
- Zhiping Niu
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Zhizhou Duan
- Preventive Health Service, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, China
| | - Weixiang He
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, China
| | - Tianyi Chen
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Hao Tang
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Shuang Du
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Jin Sun
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Han Chen
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yuanzhuo Hu
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yuka Iijima
- Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shichao Han
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, China.
| | - Jiufeng Li
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China.
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai 200030, China; IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China; WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai 200438, China.
| |
Collapse
|
2
|
Thompson M, Eatman JA, Dunlop AL, Barr DB, Kannan K, Corwin EJ, Ryan PB, Panuwet P, Yakimavets V, Taibl KR, Tan Y, Liang D, Eick SM. Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and associations with hypertensive disorders of pregnancy in the Atlanta African American Maternal-Child cohort. CHEMOSPHERE 2024; 357:142052. [PMID: 38631500 PMCID: PMC11087190 DOI: 10.1016/j.chemosphere.2024.142052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are man-made chemicals that are slow to break down in the environment and widely detected in humans. Epidemiological evidence suggests that prenatal exposure to perfluorooctanoic acid (PFOA), a legacy PFAS, is linked to gestational hypertension and preeclampsia. However, the relationship between other PFAS, which are structurally similar, and these outcomes remains largely understudied, despite biologic plausibility. Here, we examined associations between serum PFAS mixtures in relation to hypertensive disorders of pregnancy within a birth cohort of African Americans. METHODS Participants in the present study were enrolled in the Atlanta African American Maternal-Child cohort between 2014 and 2020 (n = 513). Serum samples collected between 8 and 14 weeks gestation were analyzed for four PFAS. Logistic regression was used to assess associations between individual natural log transformed PFAS and specific hypertensive disorders of pregnancy (preeclampsia, gestational hypertension), while quantile g-computation was used to estimate mixture effects. Preeclampsia and gestational hypertension were treated as separate outcomes in individual models. All models were adjusted for maternal education, maternal age, early pregnancy body mass index, parity, and any alcohol, tobacco, or marijuana use. RESULTS The geometric mean of PFOS and PFHxS was slightly lower among those with preeclampsia relative to those without a hypertensive disorder (e.g., geometric mean for PFOS was 1.89 and 1.94, respectively). Serum concentrations of PFAS were not strongly associated with gestational hypertension or preeclampsia in single pollutant or mixture models. For example, using quantile g-computation, a simultaneous one quartile increase in all PFAS was not associated with odds of gestational hypertension (odds ratio = 0.86, 95% CI = 0.60, 1.23), relative to those without a hypertensive disorder of pregnancy. CONCLUSIONS In this birth cohort of African Americans, there was no association between serum PFAS measured in early pregnancy and hypertensive disorders of pregnancy, which may be reflective of the fairly low PFAS levels in our study population.
Collapse
Affiliation(s)
- McKenzi Thompson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jasmin A Eatman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY, USA; Department of Environmental Health Sciences, State University of New York at Albany, Albany, NY, USA
| | | | - P Barry Ryan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Parinya Panuwet
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Volha Yakimavets
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kaitlin R Taibl
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Youran Tan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
3
|
Luan M, Tian Y, Yan D, Liang S. Association of plasma trans fatty acid concentrations with blood pressure and hypertension in U.S. adults. Front Endocrinol (Lausanne) 2024; 15:1373095. [PMID: 38711984 PMCID: PMC11070464 DOI: 10.3389/fendo.2024.1373095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Objective The present study aimed to evaluate the association of plasma trans fatty acids (TFAs) biomarkers with the risk of hypertension. Methods Using data from the National Health and Nutrition Examination Surveys (NHANES 2009-2010), we conducted a thorough analysis using both the traditional regression model and the Bayesian Kernel Machine Regression (BKMR) model to investigate the associations of individual TFAs and their mixtures with systolic blood pressure (SBP), diastolic blood pressure (DBP), and the risk of hypertension in a sample of 1,970 American adults. Results The concentrations of TFAs were natural logarithms (ln) transformed to approximate a normal distribution. Multivariate linear regression models showed that each 1-unit increase in ln-transformed plasma concentrations of palmitelaidic, elaidic, vaccenic, and linolelaidic acids was associated with separate 2.94-, 3.60-, 2.46- and 4.78-mm Hg and 2.77-, 2.35-, 2.03-, and 3.70- mm Hg increase in SBP and DBP, respectively (P < 0.05). The BKMR model showed positive associations between the four TFAs mixtures and SBP and DBP. In addition, linolelaidic acid contributed the most to an increased blood pressure. Similar results were observed with the threshold of hypertension (≥130/80 mm Hg). Conclusion Our findings provide preliminary evidence that plasma TFA concentrations are associated with increased blood pressure and the risk of hypertension in US adults. This study also suggests that linolelaidic acid might exhibit more deleterious effects on hypertension than other TFAs. Further studies should be conducted to validate these results.
Collapse
Affiliation(s)
- Min Luan
- Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youping Tian
- National Management Office of Neonatal Screening Project for Congenital Heart Disease (CHD), Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Dandan Yan
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Shuang Liang
- Department of Obstetrics and Gynecology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Qiao JC, Li ZH, Ma YB, Ma HY, Zhang MY, Zhang XJ, Hu CY. Associations of per- and polyfluoroalkyl substances (PFAS) and their mixture with risk of rheumatoid arthritis in the U.S. adult population. Environ Health 2024; 23:38. [PMID: 38609943 PMCID: PMC11015572 DOI: 10.1186/s12940-024-01073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are known environmental contaminants with immunosuppressive properties. Their connection to rheumatoid arthritis (RA), a condition influenced by the immune system, is not well studied. This research explores the association between PFAS exposure and RA prevalence. METHODS This research utilized data from the NHANES, encompassing a sample of 10,496 adults from the 2003-2018 cycles, focusing on serum levels of several PFAS. The presence of RA was determined based on self-reports. This study used multivariable logistic regression to assess the relationship between individual PFAS and RA risk, adjusting for covariates to calculate odds ratios (ORs). The combined effects of PFAS mixtures were evaluated using BKMR, WQS regression, and quantile g-computation. Additionally, sex-specific associations were explored through stratified analysis. RESULTS Higher serum PFOA (OR = 0.88, 95% CI: 0.79, 0.98), PFHxS (OR = 0.91, 95% CI: 0.83, 1.00), PFNA (OR = 0.87, 95% CI: 0.77, 0.98), and PFDA (OR = 0.89, 95% CI: 0.81, 0.99) concentration was related to lower odds of RA. Sex-specific analysis in single chemical models indicated the significant inverse associations were only evident in females. BKMR did not show an obvious pattern of RA estimates across PFAS mixture. The outcomes of sex-stratified quantile g-computation demonstrated that an increase in PFAS mixture was associated with a decreased odds of RA in females (OR: 0.76, 95% CI: 0.62, 0.92). We identified a significant interaction term of the WQS*sex in the 100 repeated hold out WQS analysis. Notably, a higher concentration of the PFAS mixture was significantly associated with reduced odds of RA in females (mean OR = 0.93, 95% CI: 0.88, 0.98). CONCLUSIONS This study indicates potential sex-specific associations of exposure to various individual PFAS and their mixtures with RA. Notably, the observed inverse relationships were statistically significant in females but not in males. These findings contribute to the growing body of evidence indicating that PFAS may have immunosuppressive effects.
Collapse
Affiliation(s)
- Jian-Chao Qiao
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhen-Hua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yu-Bo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Hui-Ya Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
- Management & Checkup Center, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China
| | - Meng-Yue Zhang
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
- Department of Humanistic Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
| |
Collapse
|
5
|
Liang HW, Koistinen H, Barrett ES, Xun X, Yin Q, Kannan K, Moog NK, Ng C, O’Connor TG, Miller R, Adibi JJ. Associations of Serum Perfluoroalkyl Substances and Placental Human Chorionic Gonadotropin in Early Pregnancy, Measured in the UPSIDE Study in Rochester, New York. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47008. [PMID: 38625811 PMCID: PMC11020022 DOI: 10.1289/ehp12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are widely detected in pregnant women and associated with adverse outcomes related to impaired placental function. Human chorionic gonadotropin (hCG) is a dimeric glycoprotein hormone that can indicate placental toxicity. OBJECTIVES Our aim was to quantify the association of serum PFAS with placental hCG, measured as an intact molecule (hCG), as free alpha-(hCG α ) and beta-subunits (hCG β ), and as a hyperglycosylated form (h-hCG), and evaluate effect measure modification by social determinants and by fetal sex. METHODS Data were collected from 326 pregnant women enrolled from 2015 to 2019 in the UPSIDE study in Rochester, New York. hCG forms were normalized for gestational age at the time of blood draw in the first trimester [multiple of the median (MoM)]. Seven PFAS were measured in second-trimester maternal serum. Multivariate imputation by chained equations and inverse probability weighting were used to evaluate robustness of linear associations. PFAS mixture effects were estimated by Bayesian kernel machine regression. RESULTS Perfluorohexane sulfonic acid (PFHxS) [hCG β : 0.29 log MoM units per log PFHxS; 95% confidence interval (CI): 0.08, 0.51] and perfluorodecanoic acid (PFDA) (hCG: - 0.09 ; 95% CI: - 0.16 , - 0.02 ) were associated with hCG in the single chemical and mixture analyses. The PFAS mixture was negatively associated with hCG α and positively with hCG β . Subgroup analyses revealed that PFAS associations with hCG differed by maternal race/ethnicity and education. Perfluoropentanoic acid (PFPeA) was associated with hCG β only in Black participants (- 0.23 ; 95% CI: - 0.37 , - 0.09 ) and in participants with high school education or less (- 0.14 ; 95% CI: - 0.26 , - 0.02 ); conversely, perfluorononanoic acid (PFNA) was negatively associated with hCG α only in White participants (- 0.15 ; 95% CI: - 0.27 , - 0.03 ) and with hCG β only in participants with a college education or greater (- 0.19 ; 95% CI: - 0.36 , - 0.01 ). These findings were robust to testing for selection bias, confounding bias, and left truncation bias where PFAS detection frequency was < 100 % . Two associations were negative in male (and null in female) pregnancies: Perfluoroundecanoic acid (PFUnDA) with hCG α , and PFNA with h-hCG. CONCLUSIONS Evidence was strongest for the association between PFHxS and PFDA with hCG in all participants and for PFPeA and PFNA within subgroups defined by social determinants and fetal sex. PFAS mixture associations with hCG α and hCG β differed, suggesting subunit-specific types of toxicity and/or regulation. Future studies will evaluate the biological, clinical and public health significance of these findings. https://doi.org/10.1289/EHP12950.
Collapse
Affiliation(s)
- Hai-Wei Liang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Hannu Koistinen
- Department of Clinical Chemistry and Haematology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Qing Yin
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, New York University, New York, USA
- Department of Environmental Medicine, New York University, New York, USA
| | - Nora K. Moog
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Carla Ng
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
| | - Rich Miller
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer J. Adibi
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Tomsho KS, Quinn MR, Adamkiewicz G, James-Todd T. Development of a Phthalate Environmental Reproductive Health Literacy (PERHL) Scale. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47013. [PMID: 38669179 PMCID: PMC11050996 DOI: 10.1289/ehp13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Substantial evidence exists linking phthalate exposure to adverse reproductive health outcomes. Current US federal regulations of consumer product chemicals place the onus on individuals to mitigate their exposure to phthalates, with assumptions of sufficient environmental health literacy (EHL). Few validated scales for people of reproductive age exist to evaluate phthalate-specific EHL. OBJECTIVES Our objective is to develop a multidimensional scale characterizing latent factors of phthalate knowledge, risk perception, and self-efficacy to inform individual-level interventions for reducing phthalate exposure. METHODS We distributed a survey with 31 items to 117 participants in the Environmental Reproductive and Glucose Outcomes (ERGO) cohort who gave birth within the last 5 years. Exploratory factor analysis (EFA) was used to identify underlying latent factors. Internal reliability was assessed via omega hierarchical coefficient. Average sum scores for each latent factor and the overall Phthalate Environmental Reproductive Health Literacy (PERHL) score were calculated. Associations between latent factors, overall PERHL score, and sociodemographic characteristics were explored using linear models. RESULTS Six latent factors were identified as follows: "Awareness of Phthalate Reproductive Health Impacts," "Uncertainty," "Protective Behavior/Risk Control," "Regulatory Interest," "Awareness of Phthalate Exposure Pathways," and "General Phthalate Knowledge." Each factor demonstrated acceptable to strong internal reliability, with coefficients ranging between 0.63 and 0.93. Non-white participants had lower scores for the "Awareness of Phthalate Reproductive Health Impacts" [β : - 0.35 , 95% confidence interval (CI): - 0.63 , - 0.07 ], "Awareness of Phthalate Exposure Pathways" (β : - 0.32 , 95% CI: - 0.57 , - 0.07 ), and "General Phthalate Knowledge" (β : - 0.36 , 95% CI: - 0.66 , - 0.06 ), but no significant difference in scores on "Uncertainty" (β : 0.17, 95% CI: - 0.16 , 0.50), "Protective Behavior/Risk Control" (β : - 0.04 , 95% CI: - 0.36 , 0.28), or "Regulatory Interest" (β : - 0.21 , 95% CI: - 0.51 , 0.09). No associations were seen for age or educational attainment and latent or sum factors. DISCUSSION Six latent factors were identified for the PERHL scale. Non-white race and ethnicity was associated with lower scores for knowledge-related scale factors. https://doi.org/10.1289/EHP13128.
Collapse
Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Marlee R. Quinn
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Burdeau JA, Stephenson BJK, Aris IM, Preston EV, Hivert MF, Oken E, Mahalingaiah S, Chavarro JE, Calafat AM, Rifas-Shiman SL, Zota AR, James-Todd T. First trimester plasma PER- AND Polyfluoroalkyl Substances (PFAS) and blood pressure trajectories across the second and third trimesters of pregnancy. ENVIRONMENT INTERNATIONAL 2024; 186:108628. [PMID: 38583297 PMCID: PMC11196104 DOI: 10.1016/j.envint.2024.108628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases risk of high blood pressure (BP) during pregnancy. Prior studies did not examine associations with BP trajectory parameters (i.e., overall magnitude and velocity) during pregnancy, which is linked to adverse pregnancy outcomes. OBJECTIVES To estimate associations of multiple plasma PFAS in early pregnancy with BP trajectory parameters across the second and third trimesters. To assess potential effect modification by maternal age and parity. METHODS In 1297 individuals, we quantified six PFAS in plasma collected during early pregnancy (median gestational age: 9.4 weeks). We abstracted from medical records systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery. BP trajectory parameters were estimated via Super Imposition by Translation and Rotation modeling. Subsequently, Bayesian Kernel Machine Regression (BKMR) was employed to estimate individual and joint associations of PFAS concentrations with trajectory parameters - adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index, income, parity, smoking status, and seafood intake. We evaluated effect modification by age at enrollment and parity. RESULTS We collected a median of 13 BP measurements per participant. In BKMR, higher concentration of perfluorooctane sulfonate (PFOS) was independently associated with higher magnitude of overall SBP and DBP trajectories (i.e., upward shift of trajectories) and faster SBP trajectory velocity, holding all other PFAS at their medians. In stratified BKMR analyses, participants with ≥ 1 live birth had more pronounced positive associations between PFOS and SBP velocity, DBP magnitude, and DBP velocity - compared to nulliparous participants. We did not observe significant associations between concentrations of the overall PFAS mixture and either magnitude or velocity of the BP trajectories. CONCLUSION Early pregnancy plasma PFOS concentrations were associated with altered BP trajectory in pregnancy, which may impact future cardiovascular health of the mother.
Collapse
Affiliation(s)
- Jordan A Burdeau
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Briana J K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, 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, Boston, MA, USA.
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan 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.
| | - 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.
| | - Ami R Zota
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| |
Collapse
|
8
|
Du B, Wang Q, Xu Z, Wang H, Li Z, Wu Y, Niu Y, Zhang Q, Zhang X, Sun K, Wang J. Exploring the impact of prenatal perfluoroalkyl and polyfluoroalkyl substances exposure on blood pressure in early childhood: A longitudinal analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 274:116220. [PMID: 38513531 DOI: 10.1016/j.ecoenv.2024.116220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
Previous research investigating the correlation between prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and subsequent blood pressure (BP) in offspring has yielded limited and contradictory findings. This study was conducted to investigate the potential relationship between maternal PFAS levels during pregnancy and subsequent BP in early childhood. A total of 129 expectant mothers from the Shanghai Birth Cohort were included in the study. Using high-performance liquid chromatography/tandem mass spectrometry, we measured ten PFAS compounds in maternal plasma throughout the pregnancy. When the children reached the age of 4, we examined their systolic BP (SBP) and diastolic BP (DBP), along with mean arterial pressure (MAP) and pulse pressure (PP). Data interpretation employed multiple linear and logistic regression models, complemented by Bayesian kernel machine regression (BKMR).We found that the majority of PFAS concentrations remained stable during pregnancy. The linear and BKMR models indicated a positive relationship between the PFAS mixture in maternal plasma and offspring's DBP and MAP, with perfluorohexanesulphonic acid (PFHxS) having the most significant influence (PFHxS and DBP [first trimester:β=3.03, 95%CI: (1.01,5.05); second trimester: β=2.35, 95%CI: (0.94,3.75); third trimester: β=2.57, 95%CI:(0.80,4.34)]; MAP [first trimester:β=2.55, 95%CI: (0.64,4.45); second trimester: β=2.28, 95%CI: (0.95,3.61); third trimester: β=2.35, 95%CI:(0.68,4.01)]). Logistic regression highlighted an increased risk of prehypertension and hypertension in offspring with higher maternal PFHxS concentrations during all three trimesters [first trimester: OR=2.53, 95%CI:(1.11,5.79), second trimester: OR=2.05, 95%CI:(1.11,3.78), third trimester: OR=3.08, 95%CI:(1.40,6.79)]. A positive correlation was identified between the half-lives of PFAS and the odds ratio (OR) of prehypertension and hypertension in childhood (β=0.139, P=0.010). In conclusion, this research found maternal plasma PFAS concentrations to be positively associated with BP in offspring, with PFHxS showing the most significant influence. This correlation remained consistent throughout pregnancy, and this effect was proportional to the half-lives of PFAS.
Collapse
Affiliation(s)
- Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China
| | - Qianchuo Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China
| | - Zhikang Xu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China; Institute For Development And Regenerative Cardiovascular Medicine, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hualin Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China
| | - Zhuoyan Li
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China; Institute For Development And Regenerative Cardiovascular Medicine, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujian Wu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China
| | - Yiwei Niu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China
| | - Qianlong Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China; Institute For Development And Regenerative Cardiovascular Medicine, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai 200092,China; Institute For Development And Regenerative Cardiovascular Medicine, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
9
|
Pang L, Li M, Dukureh A, Li Y, Ma J, Tang Q, Wu W. Association between prenatal perfluorinated compounds exposure and risk of pregnancy complications: A meta-analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116017. [PMID: 38290316 DOI: 10.1016/j.ecoenv.2024.116017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Per- and polyfluoroalkyl substances (PFASs) have been shown to be persistent and bioaccumulative. An elevated danger of pregnancy complications perhaps connected with exposure to PFASs, but the potential effects remain elusive. The objective of this study is to investigate the possible association between PFASs exposure and pregnancy complications, drawing upon existing evidence. METHODS Electronic databases of PubMed, Qvid Medline, Embase, and Web of Science were searched thoroughly to identify eligible research published prior to November 28, 2023, examining the relationship between PFASs and pregnancy-related complications. To evaluate the quality of observational studies incorporated into the article, the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) tool was utilized. The main outcomes assessed in this study included gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), gestational hypertension (GH), and preeclampsia (PE). RESULTS Twenty-five relevant studies involving 30079 participants were finally selected from four databases. The combined estimates indicate that prenatal exposure to perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorobutane sulfonic acid (PFBS), and perfluoroenanthic acid (PFHpA) is associated with gestational diabetes mellitus (GDM) (PFOA: OR = 1.45, 95%CI: 1.07-1.94, P = 0.015; PFHxS: OR = 1.16, 95%CI: 1.00-1.36, P = 0.055; PFBS: OR = 1.44, 95%CI: 1.16-1.79, P = 0.001; PFHpA: OR = 1.41, 95%CI: 1.10-1.82, P = 0.008). The exposure to PFBS is positively associated with HDP (OR = 1.27, 95%CI: 1.14-1.41, P < 0.001), while both PFOA and PFHpA demonstrate statistically significant positive correlations with GH (PFOA: OR = 1.09, 95%CI: 1.00-1.19, P = 0.049; PFHpA: OR = 1.43, 95%CI: 1.15-1.78, P = 0.001). Negative correlations were observed for prenatal perfluorododecanoic acid (PFDoA) exposure and GH (OR = 0.71, 95%CI: 0.57-0.87, P = 0.001). However, no compelling evidence was identified to link PFASs exposure with the risk of PE. CONCLUSION According to the meta-analysis findings, exposure to PFASs may be linked to GDM, HDP, and GH, but it does not significantly raise the risk of PE alone. Further research with larger sample size is required to verify this potential association and explore the biological mechanisms.
Collapse
Affiliation(s)
- Liya Pang
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 213043, China; State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Mei Li
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Abdoulie Dukureh
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 213043, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ying Li
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 213043, China
| | - Jinqi Ma
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 213043, China
| | - Qiuqin Tang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.
| | - Wei Wu
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 213043, China; State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| |
Collapse
|
10
|
Zhao M, Yin N, Yang R, Li S, Zhang S, Faiola F. Understanding the effects of per- and polyfluoroalkyl substances on early skin development: Role of ciliogenesis inhibition and altered microtubule dynamics. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 913:169702. [PMID: 38163615 DOI: 10.1016/j.scitotenv.2023.169702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a class of highly stable chemicals, widely used in everyday products, and widespread in the environment, even in pregnant women. While epidemiological studies have linked prenatal exposure to PFAS with atopic dermatitis in children, little is known about their toxic effects on skin development, especially during the embryonic stage. In this study, we utilized human embryonic stem cells to generate non-neural ectoderm (NNE) cells and exposed them to six PFAS (perfluorooctanoic acid (PFOA), undecafluorohexanoic acid (PFHxA), heptafluorobutyric acid (PFBA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS) and perfluorobutyric acid (PFBS)) during the differentiation process to assess their toxicity to early skin development. Our results showed that PFOS altered the spindle-like morphology of NNE cells to a pebble-like morphology, and disrupted several NNE markers, including KRT16, SMYD1, and WISP1. The six PFAS had a high potential to cause hypohidrotic ectodermal dysplasia (HED) by disrupting the expression levels of HED-relevant genes. Transcriptomic analysis revealed that PFOS treatment produced the highest number (1156) of differentially expressed genes (DEGs) among the six PFAS, including the keratinocyte-related genes KRT6A, KRT17, KRT18, KRT24, KRT40, and KRT81. Additionally, we found that PFOS treatment disturbed several signaling pathways that are involved in regulating skin cell fate decisions and differentiation, including TGF-β, NOTCH, Hedgehog, and Hippo signaling pathways. Interestingly, we discovered that PFOS inhibited, by partially interfering with the expression of cytoskeleton-related genes, the ciliogenesis of NNE cells, which is crucial for the intercellular transduction of the above-mentioned signaling pathways. Overall, our study suggests that PFAS can inhibit ciliogenesis and hamper the transduction of important signaling pathways, leading potential congenital skin diseases. It sheds light on the underlying mechanisms of early embryonic skin developmental toxicity and provides an explanation for the epidemiological data on PFAS. ENVIRONMENTAL IMPLICATION: We employed a model based on human embryonic stem cells to demonstrate that PFOS has the potential to elevate the risk of hypohidrotic ectodermal dysplasia. This is achieved by targeting cilia, inhibiting ciliogenesis, and subsequently disrupting crucial signaling pathways like TGF-β, NOTCH, Hedgehog, and Hippo, during the early phases of embryonic skin development. Our study highlights the dangers and potential impacts of six PFAS pollutants on human skin development. Additionally, we emphasize the importance of closely considering PFHxA, PFBA, PFHxS, and PFBS, as they have shown the capacity to modify gene expression levels, albeit to a lesser degree.
Collapse
Affiliation(s)
- Miaomiao Zhao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Nuoya Yin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Renjun Yang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shichang Li
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shuxian Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Francesco Faiola
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| |
Collapse
|
11
|
Liao D, Xiong S, An S, Tao L, Dai L, Tian Y, Chen W, He C, Xu P, Wu N, Liu X, Zhang H, Hu Z, Deng M, Liu Y, Li Q, Shang X, Shen X, Zhou Y. Association of urinary polycyclic aromatic hydrocarbon metabolites with gestational diabetes mellitus and gestational hypertension among pregnant women in Southwest China: A cross-sectional study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123206. [PMID: 38145636 DOI: 10.1016/j.envpol.2023.123206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
The association of polycyclic aromatic hydrocarbons (PAHs) with gestational diabetes mellitus (GDM) and gestational hypertension during pregnancy has not yet been established. To investigate the association between PAH exposure and GDM and gestational hypertension, we conducted a cross-sectional study of 4206 pregnant women from the Zunyi birth cohort in southwestern China. Gas chromatography/mass spectrometry was used to detect the urinary levels of 10 monohydroxylated PAHs (OH-PAHs). GDM and gestational hypertension were diagnosed and the relevant information was documented by specialist obstetricians and gynecologists. Logistic regression and restricted cubic spline regression were employed to investigate their single and nonlinear associations. Stratified analyses of pregnancy and body mass index data were conducted to determine their moderating effects on the abovementioned associations. Compared with the first quartile of urinary ∑OH-PAHs, the third or fourth quartile in all study participants was associated with an increased risk of GDM (quartile 3: odds ratio [OR] = 1.35, 95% confidence interval [CI]: 1.03-1.77) and gestational hypertension (quartile 3: OR = 1.88, 95% CI: 1.26-2.81; quartile 4: OR = 1.58, 95% CI: 1.04-2.39), respectively. Nonlinear associations of 1-OH-PYR with GDM (cutoff level: 0.02 μg/g creatinine [Cr]) and 1-OH-PHE with gestational hypertension (cutoff level: 0.06 μg/g Cr) were also observed. In pregnant women with overweight or obesity, 1-OH-PHE and 3-OH-PHE were more strongly associated with gestational hypertension. Our results indicate that exposure to PAH during pregnancy may significantly increase the maternal risks of GDM and gestational hypertension; however, this finding still needs to be confirmed through larger-scale prospective studies and biological evidence.
Collapse
Affiliation(s)
- Dengqing Liao
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Shimin Xiong
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Songlin An
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Lin Tao
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Lulu Dai
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Yingkuan Tian
- Medical Department, Xingyi People's Hospital, Xingyi, 562400, China
| | - Wei Chen
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Caidie He
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Pei Xu
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Nian Wu
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Xiang Liu
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Haonan Zhang
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Zhongmei Hu
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China; Reproductive Centre, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Mingyu Deng
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China; Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Yijun Liu
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Quan Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Xuejun Shang
- Department of Andrology, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, 210002, China
| | - Xubo Shen
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China
| | - Yuanzhong Zhou
- School of Public Health, Zunyi Medical University, Zunyi, 563000, China; Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, China.
| |
Collapse
|
12
|
Li J, Ye S, Zhao Z, Xue Z, Ren S, Guan Y, Sun C, Yao Q, Chen L. Association of PFDeA exposure with hypertension (NHANES, 2013-2018). Sci Rep 2024; 14:918. [PMID: 38195691 PMCID: PMC10776849 DOI: 10.1038/s41598-024-51187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
Perfluoroalkyl and polyfluoroalkyl substances (PFASs) is a series of artificial compounds which is associated with human health. However, there are few studies on the relationship between PFASs and hypertension. In this study, we examined the association between different kinds of PFASs and hypertension. Multivariable logistic regression and subgroup analysis were adopted to assess the associations between PFASs and hypertension. Spline smoothing plots and linear regression were used to assess the relationship between PFASs and blood pressure. We found a positive association between serum PFDeA concentrations and the prevalence of hypertension after fully adjusting confounders (OR = 1.2, P = 0.01), but other types of PFASs showed no positive results. Subgroup analysis stratified by ethnicity showed there was a stronger relationship among non-Hispanics than Hispanics. Serum PFDeA concentrations were positively associated with systolic pressure (β = 0.7, P< 0.01) and diastolic blood pressure (β = 0.8, P< 0.01) among non-Hispanics who did not take antihypertensive drugs. This study showed that PFDeA exposure was associated with hypertension in Americans who identify as non-Hispanic. There was a positive association between PFDeA and blood pressure in non-Hispanic Americans who did not take antihypertensive drugs.
Collapse
Affiliation(s)
- Jie Li
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Suling Ye
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zeyuan Zhao
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhao Xue
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shupeng Ren
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yue Guan
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chuang Sun
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiying Yao
- Department of Physiology, Dalian Medical University, Dalian, China.
| | - Liang Chen
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| |
Collapse
|
13
|
Ebel M, Rylander L, Fletcher T, Jakobsson K, Nielsen C. Gestational hypertension, preeclampsia, and gestational diabetes mellitus after high exposure to perfluoroalkyl substances from drinking water in Ronneby, Sweden. ENVIRONMENTAL RESEARCH 2023; 239:117316. [PMID: 37805182 DOI: 10.1016/j.envres.2023.117316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Leakage of fire-fighting foam from an airfield caused contamination of the drinking water supplied to a third of the population in Ronneby, resulting in very high serum levels of predominantly perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). The results of studies investigating the association between exposure to perfluorinated alkyl substances (PFAS) and pregnancy complications are inconsistent, and studies at high exposures of PFOS and PFHxS are lacking. OBJECTIVES To investigate the association between exposure to high levels of PFAS and gestational hypertension and preeclampsia, and gestational diabetes mellitus. METHODS We retrieved data on 27 292 childbirths between 1995 and 2013 from the National Medical Birth Register for women that had a residential address in Blekinge county for at least one year before delivery. Residential history was used as a proxy for exposure by categorizing women into high-, intermediate-, or background exposed based on their residential address during the five-year period before childbirth. Data on confounders were retrieved from administrative registers. The outcomes were defined based on International Classification of Diseases codes. We used logistic regression to estimate odds ratios (OR) for gestational hypertension and preeclampsia, and gestational diabetes mellitus. We also investigated effect modification by fetal sex. RESULTS We found no evidence of increased risk of gestational hypertension and preeclampsia (OR 0.80; CI 0.63-1.03), nor gestational diabetes (OR 1.03; CI 0.67-1.58) after high PFAS exposure. There was no effect modification by fetal sex. DISCUSSION This was the first study to investigate the association between high exposure to PFOS and PFHxS and pregnancy complications. The results from this study add important knowledge to public health management as new hotspots with high levels of PFAS are continuously discovered.
Collapse
Affiliation(s)
- Matilda Ebel
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Lars Rylander
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kristina Jakobsson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christel Nielsen
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
Zhang Y, Lv J, Fan YJ, Tao L, Xu J, Tang W, Sun N, Zhao LL, Xu DX, Huang Y. Evaluating the Effect of Gestational Exposure to Perfluorohexane Sulfonate on Placental Development in Mice Combining Alternative Splicing and Gene Expression Analyses. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:117011. [PMID: 37995155 PMCID: PMC10666825 DOI: 10.1289/ehp13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Perfluorohexane sulfonate (PFHxS) is a frequently detected per- and polyfluoroalkyl substance in most populations, including in individuals who are pregnant, a period critical for early life development. Despite epidemiological evidence of exposure, developmental toxicity, particularly at realistic human exposures, remains understudied. OBJECTIVES We evaluated the effect of gestational exposure to human-relevant body burden of PFHxS on fetal and placental development and explored mechanisms of action combining alternative splicing (AS) and gene expression (GE) analyses. METHODS Pregnant ICR mice were exposed to 0, 0.03, and 0.3 μ g / kg / day from gestational day 7 to day 17 via oral gavage. Upon euthanasia, PFHxS distribution was measured using liquid chromatography-tandem mass spectrometry. Maternal and fetal phenotypes were recorded, and histopathology was examined for placenta impairment. Multiomics was adopted by combining AS and GE analyses to unveil disruptions in mRNA quality and quantity. The key metabolite transporters were validated by quantitative real-time PCR (qRT-PCR) for quantification and three-dimensional (3D) structural simulation by AlphaFold2. Targeted metabolomics based on liquid chromatography-tandem mass spectrometry was used to detect amino acid and amides levels in the placenta. RESULTS Pups developmentally exposed to PFHxS exhibited signs of intrauterine growth restriction (IUGR), characterized by smaller fetal weight and body length (p < 0.01 ) compared to control mice. PFHxS concentration in maternal plasma was 5.01 ± 0.54 ng / mL . PFHxS trans-placenta distribution suggested dose-dependent transfer through placental barrier. Histopathology of placenta of exposed dams showed placental dysplasia, manifested with an attenuated labyrinthine layer area and deescalated blood sinus counts and placental vascular development index marker CD34. Combined GE and AS analyses pinpointed differences in genes associated with key biological processes of placental development, proliferation, metabolism, and transport in placenta of exposed dams compared to that of control dams. Further detection of placental key transporter gene expression, protein structure simulation, and amino acid and amide metabolites levels suggested that PFHxS exposure during pregnancy led to impairment of placental amino acid transportation. DISCUSSION The findings from this study suggest that exposure to human-relevant very-low-dose PFHxS during pregnancy in mice caused IUGR, likely via downregulating of placental amino acid transporters, thereby impairing placental amino acid transportation, resulting in impairment of placental development. Our findings confirm epidemiological findings and call for future attention on the health risk of this persistent yet ubiquitous chemical in the early developmental stage and provide a new approach for understanding gene expression from both quantitative and qualitative omics approaches in toxicological studies. https://doi.org/10.1289/EHP13217.
Collapse
Affiliation(s)
- Yihao Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jia Lv
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yi-Jun Fan
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
- Department of Gynecology and Obstetrics, Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Lin Tao
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jingjing Xu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Weitian Tang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Nan Sun
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Ling-Li Zhao
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the PRC, Hefei, China
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the PRC, Hefei, China
| |
Collapse
|
15
|
Xu Z, Du B, Wang H, Li Z, Wu Y, Wang Q, Niu Y, Zhang Q, Sun K, Wang J, Chen S. Perfluoroalkyl substances in umbilical cord blood and blood pressure in offspring: a prospective cohort study. Environ Health 2023; 22:72. [PMID: 37858165 PMCID: PMC10585876 DOI: 10.1186/s12940-023-01023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Humans are widely exposed to perfluoroalkyl substances (PFAS), which have been found to be associated with various adverse birth outcomes. As blood pressure (BP) is an important parameter reflecting cardiovascular health in early life, it is necessary to investigate the association of PFAS exposure during early lifetime and BP in childhood. Therefore, we investigated the potential association between PFAS levels in umbilical cord blood and BP of the offspring at 4 years of age in a prospective cohort study. METHODS PFAS in umbilical cord blood samples after birth were measured with high-performance liquid chromatography/tandem mass spectrometry in the Shanghai Birth Cohort. BP was measured at 4 years of age in the offspring. Multiple linear regression model was used to investigate the association between individual PFAS level and BP of the offspring. Bayesian kernel machine regression (BKMR) was used to analyze the relationship between the PFAS mixture and BP of the offspring, while weighted quantile sum (WQS) regression was utilized for sensitivity analysis. RESULTS A total of 129 mother-child pairs were included in our analysis. In multiple linear regressions, we observed that long-chain PFAS, mainly including perfluorooctane sulfonate (PFOS), perfluorodecanoic acid (PFDA) and perfluoroundecanoic acid (PFUA), was negatively associated with systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP). BKMR showed that an increase in umbilical cord blood PFAS mixture levels was significantly associated with a decrease in SBP, DBP and MAP [Estimated differences (SD): -0.433 (0.161); -0.437 (0.176); -0.382 (0.179), respectively]. The most important component in the association with SBP, DBP, and MAP was PFUA. PFDoA was found to be positively associated with SBP, DBP and MAP in both models. Sensitivity analysis with WQS regression showed consistent results. CONCLUSION Our findings suggested that umbilical blood PFAS exposure was negatively associated with BP in offspring at 4 years of age, including SBP, DBP, and MAP.
Collapse
Affiliation(s)
- Zhikang Xu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Hualin Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Zhuoyan Li
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Yujian Wu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Qianchuo Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Yiwei Niu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Qianlong Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
| |
Collapse
|
16
|
Conley JM, Lambright CS, Evans N, Farraj AK, Smoot J, Grindstaff RD, Hill D, McCord J, Medlock-Kakaley E, Dixon A, Hines E, Gray LE. Dose additive maternal and offspring effects of oral maternal exposure to a mixture of three PFAS (HFPO-DA, NBP2, PFOS) during pregnancy in the Sprague-Dawley rat. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 892:164609. [PMID: 37271399 PMCID: PMC10681034 DOI: 10.1016/j.scitotenv.2023.164609] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Simultaneous exposure to multiple per- and polyfluoroalkyl substances (PFAS) is common in humans across the globe. Individual PFAS are associated with adverse health effects, yet the nature of mixture effects after exposure to two or more PFAS remains unclear. Previously we reported that oral administration of hexafluoropropylene oxide-dimer acid (HFPO-DA, or GenX), Nafion byproduct 2 (NBP2), or perfluorooctane sulfonate (PFOS) individually during pregnancy produced maternal and F1 effects. Here, we hypothesized that responses to the combined exposure to these three PFAS would be dose additive. Pregnant Sprague-Dawley rats were exposed to a fixed-ratio equipotent mixture where the top dose contained each PFAS at their ED50 for neonatal mortality (100 % dose = PFOS 3 mg/kg; NBP2 10 mg/kg; HFPO-DA 110 mg/kg), followed by a dilution series (33.3, 10, 3.3, and 1 %) and vehicle controls (0 % dose). Consistent with the single chemical studies, dams were exposed from gestation day (GD)14-18 or from GD8-postnatal day (PND2). Fetal and maternal livers on GD18 displayed multiple significantly upregulated genes associated with lipid and carbohydrate metabolism at all dose levels, while dams displayed significantly increased liver weight (≥3.3 % dose) and reduced serum thyroid hormones (≥33.3 % dose). Maternal exposure from GD8-PND2 significantly reduced pup bodyweights at birth (≥33.3 % dose) and PND2 (all doses), increased neonatal liver weights (≥3.3 % dose), increased pup mortality (≥3.3 % dose), and reduced maternal bodyweights and weight gain at the top dose. Echocardiography of adult F1 males and females identified significantly increased left ventricular anterior wall thickness (~10 % increase), whereas other cardiac morphological, functional, and transcriptomic measures were unaffected. Mixture effects in maternal and neonatal animals conformed to dose addition using a relative potency factor (RPF) analysis. Results support dose addition-based cumulative assessment approaches for estimating combined effects of PFAS co-exposure.
Collapse
Affiliation(s)
- Justin M Conley
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Christy S Lambright
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Nicola Evans
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Aimen K Farraj
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Jacob Smoot
- ORISE Participant, U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Rachel D Grindstaff
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA
| | - Donna Hill
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - James McCord
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Environmental Measurement and Modeling, Research Triangle Park, NC, USA.
| | - Elizabeth Medlock-Kakaley
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Aaron Dixon
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - Erin Hines
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| | - L Earl Gray
- U.S. Environmental Protection Agency, Office of Research & Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA.
| |
Collapse
|
17
|
Zhang M, Aris IM, Lin PD, Rifas‐Shiman SL, Brady TM, James‐Todd T, Oken E, Hivert M. Prenatal and Childhood Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Blood Pressure Trajectories From Birth to Late Adolescence in a Prospective US Prebirth Cohort. J Am Heart Assoc 2023; 12:e030760. [PMID: 37642023 PMCID: PMC10547341 DOI: 10.1161/jaha.123.030760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Background Evidence is limited regarding the associations of prenatal and childhood per- and polyfluoroalkyl substance (PFAS) exposures with blood pressure (BP) trajectories in children. Methods and Results Participants are from Project Viva, a prospective prebirth cohort in eastern Massachusetts. We measured PFAS in early-pregnancy maternal (median, 9.6 weeks) and midchildhood (median, 7.7 years) plasma samples. We conducted standardized BP measurements at 6 research visits: birth, infancy (median, 6.3 months), early childhood (median, 3.2 years), midchildhood (median, 7.7 years), early adolescence (median, 12.9 years), and late adolescence (median, 17.5 years). We used linear regression to examine associations of individual PFASs with BP at each visit, linear spline mixed-effects regression to model BP trajectories, and a mixture approach to estimate PFAS exposure burden. We included 9036 BP measures from 1506 participants. We observed associations between particular individual prenatal PFASs and child BP at specific time points, for example, prenatal 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EtFOSAA) and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA) with higher systolic BP at birth; prenatal perfluorooctane sulfonate (PFOS) and EtFOSAA with lower diastolic BP in infancy; and prenatal PFOS, perfluorooctanoate (PFOA), and EtFOSAA with higher systolic BP at midchildhood. No prenatal or childhood PFAS was consistently associated with BP across all visits. Diastolic BP trajectories from 0 to 20 years differed slightly by prenatal PFOA, perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) (P values 0.01-0.09). Diastolic BP trajectories from 6 to 20 years differed slightly by midchildhood PFHxS and MeFOSAA (P-values 0.03-0.08). Prenatal or childhood PFAS mixture burden scores were not associated with BP. Conclusions We found associations of prenatal and childhood PFAS exposures with BP at specific time points between birth and late adolescence but no consistent associations across all time points or PFAS types.
Collapse
Affiliation(s)
- Mingyu Zhang
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Izzuddin M. Aris
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl L. Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Tammy M. Brady
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Tamarra James‐Todd
- Departments of Environmental Health and EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Emily Oken
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Marie‐France Hivert
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Diabetes UnitMassachusetts General HospitalBostonMAUSA
| |
Collapse
|
18
|
Hu CY, Qiao JC, Gui SY, Xu KX, Dzhambov AM, Zhang XJ. Perfluoroalkyl and polyfluoroalkyl substances and hypertensive disorders of pregnancy: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2023; 231:116064. [PMID: 37178750 DOI: 10.1016/j.envres.2023.116064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women. Several environmental toxins, particularly those that affect the normal function of the placenta and the endothelium, are emerging as potential risk factors for HDP. Among them, per- and polyfluoroalkyl substances (PFAS), widely used in a variety of commercial products, have been related to a variety of adverse health effects including HDP. This study was conducted by searching three databases for observational studies reporting associations between PFAS and HDP, all of which were published before December 2022. We used random-effects meta-analysis to calculate pooled risk estimates, and assessing each combination of exposure and outcome for quality and level of evidence. In total, 15 studies were included in the systematic review and meta-analysis. The results from meta-analyses showed that risk of PE was increased with exposure to PFOA (perfluorooctanoic acid) (RR = 1.39, 95% CI = 1.05, 1.85; N = 6 studies; exposure = 1 ln-unit increment; low certainty), PFOS (perfluorooctane sulfonate) (RR = 1.51, 95% CI = 1.23, 1.86; N = 6 studies; exposure = 1 ln-unit increment; moderate certainty), and PFHxS (perfluorohexane sulfonate) (RR = 1.39, 95% CI = 1.10, 1.76; N = 6 studies; exposure = 1 ln-unit increment; low certainty). PFOS was also associated with an increased risk of HDP (RR = 1.39, 95% CI = 1.10, 1.76; exposure = 1 ln-unit increment; low certainty). Exposure to legacy PFAS (PFOA, PFOS, PFHxS) is associated with an increased risk of PE, and PFOS is further associated with HDP. In view of the limitations of meta-analysis and quality of evidence, these findings should be interpreted with caution. Further research is required that assesses exposure to multiple PFAS in diverse and well-powered cohorts.
Collapse
Affiliation(s)
- Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jian-Chao Qiao
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Si-Yu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Ke-Xin Xu
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria, 15A Vassil Aprilov Blvd., Plovdiv, 4002, Bulgaria; Research group "Health and Quality of Life in a Green and Sustainable Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
| |
Collapse
|
19
|
Chen C, Song Y, Tang P, Pan D, Wei B, Liang J, Sheng Y, Liao Q, Huang D, Liu S, Qiu X. Association between prenatal exposure to perfluoroalkyl substance mixtures and intrauterine growth restriction risk: A large, nested case-control study in Guangxi, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115209. [PMID: 37418866 DOI: 10.1016/j.ecoenv.2023.115209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
Intrauterine growth restriction (IUGR) is an abnormal fetal growth pattern that can lead to neonatal morbidity and mortality. IUGR may be affected by prenatal exposure to environmental pollutants, including perfluoroalkyl substances (PFASs). However, research linking PFAS exposure to IUGR is limited, with inconsistent results. We aimed to investigate the association between PFAS exposure and IUGR by using nested casecontrol study based on Guangxi Zhuang Birth Cohort (GZBC), in Guangxi, China. A total of 200 IUGR cases and 600 controls were enrolled in this study. The maternal serum concentrations of nine PFASs were measured using ultrahigh-performance liquid chromatography-tandem mass spectrometry (UPLCMS). The associations single and mixed effects of prenatal PFAS exposure on IUGR risk were assessed using conditional logistic regression (single-exposure), Bayesian kernel machine regression (BKMR) and quantile g-computation (qgcomp) models. In the conditional logistic regression models, the log10-transformed concentrations of perfluoroheptanoic acid (PFHpA, adjusted OR: 4.41, 95% CI: 3.03-6.41), perfluorododecanoic acid (PFDoA, adjusted OR: 1.94, 95% CI: 1.14-3.32), and perfluorohexanesulfonate (PFHxS, adjusted OR: 1.83, 95% CI: 1.15-2.91) were positively associated with risk of IUGR. In the BKMR models, the combined effect of PFASs was positively associated with IUGR risk. In the qgcomp models, we also found an increased IUGR risk (OR=5.92, 95% CI: 2.33-15.06) when all nine PFASs increased by one tertile as a whole, and PFHpA (43.9%) contributed the largest positive weights. These findings suggested prenatal exposure to single and mixtures of PFASs may increase IUGR risk, with the effect being largely driven by the PFHpA concentration.
Collapse
Affiliation(s)
- Chenchun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Yanye Song
- The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, China
| | - Peng Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Bincai Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Yonghong Sheng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Qian Liao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning 530021, China.
| | - Shun Liu
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning 530021, China.
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning 530021, China.
| |
Collapse
|
20
|
Yao W, Xu J, Tang W, Gao C, Tao L, Yu J, Lv J, Wang H, Fan Y, Xu DX, Huang Y. Developmental toxicity of perfluorohexane sulfonate at human relevant dose during pregnancy via disruption in placental lipid homeostasis. ENVIRONMENT INTERNATIONAL 2023; 177:108014. [PMID: 37315490 DOI: 10.1016/j.envint.2023.108014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
Perfluorohexyl sulfonate (PFHxS) is the third most abundant per- and polyfluoroalkyl substances and its developmental toxicity remains very poorly understood. Here, pregnant mice exposed to PFHxS at human relevant dose showed increased fetal death incidence in the high-dose PFHxS-H group (P < 0.01). Body distribution analyses suggested that PFHxS crossed the placental barrier reaching the fetus in a dose-dependent manner. Histopathological data demonstrated impairment in the placenta with reduced blood sinus volume, placental labyrinth area as well as thickness of labyrinthine layer. Further lipidomic and transcriptomic data together showed that PFHxS exposure caused significant disruption in placental lipid homeostasis, including total lipid accumulation in the placenta, and dysregulation in phospholipid and glycerol lipid metabolism. Gene expression analyses uncovered elevation in key placental fatty acid transporters including fabp2, whereas protein expression showed transporter specific disruptions following exposure. Together, gestational exposure to human relevant level of PFHxS may increase the incidence of fetal deaths and caused placental dysplasia via disruption in lipid metabolism homeostasis. These findings raise the concern regarding the highly prevalent and persistent chemical towards early sensitive developing stages and provide basis for further understanding of its effects on lipid metabolism and underlying mechanisms.
Collapse
Affiliation(s)
- Wencong Yao
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jingjing Xu
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Weitian Tang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Chang Gao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lin Tao
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jie Yu
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jia Lv
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yijun Fan
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
| |
Collapse
|
21
|
Groisman L, Berman T, Quinn A, Pariente G, Rorman E, Karakis I, Gat R, Sarov B, Novack L. Levels of PFAS concentrations in the placenta and pregnancy complications. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115165. [PMID: 37348217 DOI: 10.1016/j.ecoenv.2023.115165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Recent research has raised concerns about the potential health effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) exposure, particularly during critical periods of development such as pregnancy. In this study, we sought to investigate the presence and potential impacts of PFAS in the placenta. METHODS We measured 13 PFAS compounds in placental tissue samples among 50 women who gave birth at a tertiary medical center in southern Israel. The sample comprised of 10 women with pregnancy-related complications (preterm birth, preeclampsia, gestational diabetes or small-for-gestational age) and 40 women without complications individually matched to cases by age. RESULTS For five (5) out of 13 PFAS compounds (Perfluorooctane Sulfonate (PFOS), perfluorooctanoic acid (PFOA), Perfluorohexanesulphonic acid (PFHxS), Perfluorononanoic acid (PFNA), Perfluorodecanoic acid (PFDA)) median concentrations were lower or comparable to placental measurements in different international populations. Geometric mean was estimated at 0.09 ng/g (90%CI:0.07;0.10) for PFOA, 0.05 ng/g for PFNA (90%CI:0.04;0.07), 0.03 ng/g for PFDA (90%CI:0.01;0.03), 0.06 ng/g for PFHxS (90%CI:0.05;0.07), 0.23 ng/g for PFOS linear measurement (90%CI:0.20;0.26) and 0.25 ng/g (90%CI:0.22;0.30) for PFOS summed concentrations that included non-linear isomers. Composite outcome of pregnancy-related complications was associated with elevated PFOA placental concentrations at an odds ratio (OR)= 1.82 (90%CI:1.06;3.13) for an increase of one quintile of PFOA value and adjusted to maternal gravidity in a conditional logistic regression. CONCLUSION This pilot study indicates a widespread exposure to multiple PFAS compounds in placental tissue of pregnant women in Israel. These findings warrant further validation through comprehensive national human biomonitoring initiatives.
Collapse
Affiliation(s)
- Luda Groisman
- National Public Health Laboratory, Israel Ministry of Health, Tel Aviv, Israel
| | - Tamar Berman
- Department of Health Promotion, Tel Aviv University, Israel; Department of Environmental Health, Israel Ministry of Health, Israel, Tel Aviv University, Israel
| | - Anna Quinn
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Israel
| | - Gali Pariente
- The Division of Obstetrics and Gynecology, Soroka University Medical Center, Israel
| | - Efrat Rorman
- National Public Health Laboratory, Israel Ministry of Health, Tel Aviv, Israel
| | - Isabella Karakis
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Israel; Department of Environmental Epidemiology, Israel Ministry of Health, Israel
| | - Roni Gat
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Israel; Soroka University Medical Center, Negev Environmental Health Research Institute, Israel
| | - Batia Sarov
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Israel
| | - Lena Novack
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Israel; Soroka University Medical Center, Negev Environmental Health Research Institute, Israel.
| |
Collapse
|
22
|
Pavuk M, Rosenbaum PF, Lewin MD, Serio TC, Rago P, Cave MC, Birnbaum LS. Polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, pesticides, and diabetes in the Anniston Community Health Survey follow-up (ACHS II): single exposure and mixture analysis approaches. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 877:162920. [PMID: 36934946 DOI: 10.1016/j.scitotenv.2023.162920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023]
Abstract
Dioxins and dioxin-like compounds measurements were added to polychlorinated biphenyls (PCBs) and organochlorine pesticides to expand the exposure profile in a follow-up to the Anniston Community Health Survey (ACHS II, 2014) and to study diabetes associations. Participants of ACHS I (2005-2007) still living within the study area were eligible to participate in ACHS II. Diabetes status (type-2) was determined by a doctor's diagnosis, fasting glucose ≥125 mg/dL, or being on any glycemic control medication. Incident diabetes cases were identified in ACHS II among those who did not have diabetes in ACHS I, using the same criteria. Thirty-five ortho-substituted PCBs, 6 pesticides, 7 polychlorinated dibenzo-p-dioxins (PCDD), 10 furans (PCDF), and 3 non-ortho PCBs were measured in 338 ACHS II participants. Dioxin toxic equivalents (TEQs) were calculated for all dioxin-like compounds. Main analyses used logistic regression models to calculate odds ratios (OR) and 95 % confidence intervals (CI). In models adjusted for age, race, sex, BMI, total lipids, family history of diabetes, and taking lipid lowering medication, the highest ORs for diabetes were observed for PCDD TEQ: 3.61 (95 % CI: 1.04, 12.46), dichloro-diphenyl dichloroethylene (p,p'-DDE): 2.07 (95 % CI 1.08, 3.97), and trans-Nonachlor: 2.55 (95 % CI 0.93, 7.02). The OR for sum 35 PCBs was 1.22 (95 % CI: 0.58-2.57). To complement the main analyses, we used BKMR and g-computation models to evaluate 12 mixture components including 4 TEQs, 2 PCB subsets and 6 pesticides; suggestive positive associations for the joint effect of the mixture analyses resulted in ORs of 1.40 (95% CI: -1.13, 3.93) for BKMR and 1.32 (95% CI: -1.12, 3.76) for g-computation. The mixture analyses provide further support to previously observed associations of trans-Nonachlor, p,p'- DDE, PCDD TEQ and some PCB groups with diabetes.
Collapse
Affiliation(s)
- M Pavuk
- Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - P F Rosenbaum
- SUNY Upstate Medical University, Syracuse, NY, United States of America.
| | - M D Lewin
- Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - T C Serio
- Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America; ATSDR/CDC, Atlanta, GA, United States of America
| | - P Rago
- ATSDR/CDC, Atlanta, GA, United States of America
| | - M C Cave
- University of Louisville, Louisville, KY, United States of America
| | - L S Birnbaum
- NIEHS, Research Triangle Park, NC, United States of America
| |
Collapse
|
23
|
Xavier IM, Simões ACZ, Oliveira RD, Barros YE, Sarmento ACA, Medeiros KSD, Costa APF, Korkes H, Gonçalves AK. Maternal-fetal outcomes of women with hypertensive disorders of pregnancy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230060. [PMID: 37283361 DOI: 10.1590/1806-9282.20230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386-3,302; p=0.001) and preterm delivery at <34 weeks' gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19-5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.
Collapse
Affiliation(s)
- Ivete Matias Xavier
- Universidade Federal do Rio Grande do Norte, Postgraduate Program in Applied Sciences to Women's Health - Natal (RN), Brazil
| | | | - Ronnier de Oliveira
- Universidade Federal do Rio Grande do Norte, Undergraduate Course in Medicine - Natal (RN), Brazil
| | - Yasha Emerenciano Barros
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology - Natal (RN), Brazil
| | | | - Kleyton Santos de Medeiros
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology - Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Health Sciences Center - Natal (RN), Brazil
| | - Ana Paula Ferreira Costa
- Universidade Federal do Rio Grande do Norte, Health Sciences Center - Natal (RN), Brazil
- League Against Cancer, Institute of Teaching, Research, and Innovation - Natal (RN), Brazil
| | - Henri Korkes
- Pontifícia Universidade Católica de São Paulo - São Paulo (SP), Brazil
| | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology - Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Health Sciences Center - Natal (RN), Brazil
| |
Collapse
|
24
|
Taibl KR, Dunlop AL, Barr DB, Li YY, Eick SM, Kannan K, Ryan PB, Schroder M, Rushing B, Fennell T, Chang CJ, Tan Y, Marsit CJ, Jones DP, Liang D. Newborn metabolomic signatures of maternal per- and polyfluoroalkyl substance exposure and reduced length of gestation. Nat Commun 2023; 14:3120. [PMID: 37253729 DOI: 10.1038/s41467-023-38710-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
Marginalized populations experience disproportionate rates of preterm birth and early term birth. Exposure to per- and polyfluoroalkyl substances (PFAS) has been reported to reduce length of gestation, but the underlying mechanisms are unknown. In the present study, we characterized the molecular signatures of prenatal PFAS exposure and gestational age at birth outcomes in the newborn dried blood spot metabolome among 267 African American dyads in Atlanta, Georgia between 2016 and 2020. Pregnant people with higher serum perfluorooctanoic acid and perfluorohexane sulfonic acid concentrations had increased odds of an early birth. After false discovery rate correction, the effect of prenatal PFAS exposure on reduced length of gestation was associated with 8 metabolomic pathways and 52 metabolites in newborn dried blood spots, which suggested perturbed tissue neogenesis, neuroendocrine function, and redox homeostasis. These mechanisms explain how prenatal PFAS exposure gives rise to the leading cause of infant death in the United States.
Collapse
Affiliation(s)
- Kaitlin R Taibl
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yuan-Yuan Li
- Metabolomics and Exposome Laboratory, Nutrition Research Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - P Barry Ryan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madison Schroder
- Metabolomics and Exposome Laboratory, Nutrition Research Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Blake Rushing
- Metabolomics and Exposome Laboratory, Nutrition Research Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy Fennell
- Analytical Chemistry and Pharmaceuticals, RTI International, Research Triangle Park, Durham, NC, USA
| | - Che-Jung Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Youran Tan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carmen J Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
25
|
McAdam J, Bell EM. Determinants of maternal and neonatal PFAS concentrations: a review. Environ Health 2023; 22:41. [PMID: 37161484 PMCID: PMC10170754 DOI: 10.1186/s12940-023-00992-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are used for their properties such as stain and water resistance. The substances have been associated with adverse health outcomes in both pregnant mothers and infants, including pre-eclampsia and low birthweight. A growing body of research suggests that PFAS are transferred from mother to fetus through the placenta, leading to in utero exposure. A systematic review was performed using the PubMed database to search for studies evaluating determinants of PFAS concentrations in blood matrices of pregnant mothers and neonates shortly after birth. Studies were included in this review if an observational study design was utilized, exposure to at least one PFAS analyte was measured, PFAS were measured in maternal or neonatal matrices, at least one determinant of PFAS concentrations was assessed, and results such as beta estimates were provided. We identified 35 studies for inclusion in the review and evaluated the PFAS and determinant relationships among the factors collected in these studies. Parity, breastfeeding history, maternal race and country of origin, and household income had the strongest and most consistent evidence to support their roles as determinants of certain PFAS concentrations in pregnant mothers. Reported study findings on smoking status, alcohol consumption, and pre-pregnancy body mass index (BMI) suggest that these factors are not important determinants of PFAS concentrations in pregnant mothers or neonates. Further study into informative factors such as consumer product use, detailed dietary information, and consumed water sources as potential determinants of maternal or neonatal PFAS concentrations is needed. Research on determinants of maternal or neonatal PFAS concentrations is critical to estimate past PFAS exposure, build improved exposure models, and further our understanding on dose-response relationships, which can influence epidemiological studies and risk assessment evaluations. Given the potential for adverse outcomes in pregnant mothers and neonates exposed to PFAS, it is important to identify and understand determinants of maternal and neonatal PFAS concentrations to better implement public health interventions in these populations.
Collapse
Affiliation(s)
- Jordan McAdam
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA.
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA.
| |
Collapse
|
26
|
Hall AM, Braun JM. Per- and Polyfluoroalkyl Substances and Outcomes Related to Metabolic Syndrome: A Review of the Literature and Current Recommendations for Clinicians. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231162802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a class of toxic, ubiquitous, anthropogenic chemicals known to bioaccumulate in humans. Substantial concern exists regarding the human health effects of PFAS, particularly metabolic syndrome (MetS), a precursor to cardiovascular disease, the leading cause of mortality worldwide. This narrative review provides an overview of the PFAS literature on 4 specific components of MetS: insulin resistance/glucose dysregulation, central adiposity, dyslipidemia, and blood pressure. We focus on prospective cohort studies as these provide the best body of evidence compared to other study designs. Available evidence suggests potential associations between some PFAS and type-2 diabetes in adults, dyslipidemia in children and adults, and blood pressure in adults. Additionally, some studies found that sex and physical activity may modify these relationships. Future studies should consider modification by sex and lifestyle factors (e.g., diet and physical activity), as well quantifying the impact of PFAS mixtures on MetS features and related clinical disease. Finally, clinicians can follow recently developed clinical guidance to screen for PFAS exposure in patients, measure PFAS levels, conduct additional clinical care based on PFAS levels, and advise on PFAS exposure reduction.
Collapse
Affiliation(s)
- Amber M. Hall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
27
|
Ao Y, Nian M, Tang W, Zhang J, Zhang Q, Ao J. A sensitive and robust method for the simultaneous determination of thirty-three legacy and emerging per- and polyfluoroalkyl substances in human plasma and serum. Anal Bioanal Chem 2023; 415:457-470. [PMID: 36383228 DOI: 10.1007/s00216-022-04426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Legacy and emerging per- and polyfluoroalkyl substances (PFAS) have attracted growing attention due to their potential adverse effects on humans. We developed a method to simultaneously determine thirty-three PFAS (legacy PFAS, precursors, and alternatives) in human plasma and serum using solid phase extraction coupled to ultra-performance liquid chromatography-tandem mass spectrometry (SPE-UPLC-MS/MS). The method yielded good linearity (>0.995) and excellent limits of detection (LODs) (0.0005~0.012 ng mL-1 in plasma and 0.002~0.016 ng mL-1 in serum). The relative recoveries ranged from 80.1 to 116%, with intra- and inter-day precision less than 14.3%. The robustness of this method has been tested continuously for 10 months (coefficients of variation <14.9%). Our method was successfully applied to the PFAS analysis of 42 real human plasma and serum samples collected from women. The proposed method is attractive for the biomonitoring of multi-class PFAS in human health risk assessment and epidemiological studies.
Collapse
Affiliation(s)
- Yan Ao
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Min Nian
- Department of Environmental Science and Engineering, Fudan University, Shanghai, 200082, China
| | - Weifeng Tang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.,School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Qianlong Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Junjie Ao
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| |
Collapse
|
28
|
Yang L, Ji H, Liang H, Yuan W, Song X, Li X, Niu J, Shi H, Wen S, Miao M. Associations of perfluoroalkyl and polyfluoroalkyl substances with gestational hypertension and blood pressure during pregnancy: A cohort study. ENVIRONMENTAL RESEARCH 2022; 215:114284. [PMID: 36088993 DOI: 10.1016/j.envres.2022.114284] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
Previous studies have reported inconsistent associations between perfluoroalkyl and polyfluoroalkyl substances (PFAS) and gestational hypertension (GH) and blood pressure (BP) during pregnancy. Herein, we aimed to evaluate individual and overall effects of PFAS on GH and longitudinal BP measures during pregnancy. We included 826 pregnant women from the Jiashan Birth Cohort established between 2016 and 2018. Concentrations of thirteen PFAS were quantified using plasma samples collected within 16 weeks of gestation. Longitudinal BP measures were obtained from medical records, and more than nine measurements were available for 85.60% of participants. GH was defined as new-onset hypertension occurring after 20 weeks of gestation. Logistic regression models were used to examine the effect of PFAS on GH, while generalized estimating equation models evaluated the average effect of PFAS on BP in each trimester. The potential effect modification by fetal sex was also examined. Bayesian kernel machine regression (BKMR) and quantile g-computation (QgC) were implemented to explore the overall effect of the PFAS mixture. PFOA, PFOS, and PFHxS presented the highest median concentrations of 11.99, 8.81 and 5.43 ng/mL, respectively. Overall, 5.57% of subjects developed GH. PFOS, PFDA, PFUdA, and PFDoA were significantly associated with lower GH odds, and odds ratios ranged between 0.62 and 0.68. We noted associations between PFAS and lower systolic BP and diastolic BP in the third trimester, with PFDA and PFUdA exhibiting the effect on systolic BP only in pregnant women carrying a female fetus. These associations were further confirmed by BKMR and QgC, showing an inverse overall effect of the PFAS mixture. Higher concentrations of PFAS during early pregnancy were associated with lower GH risk and longitudinal BP measures in the third trimester in a population with relatively high exposure levels. Fetal sex might modify the effects of PFDA and PFUdA on systolic BP in the third trimester.
Collapse
Affiliation(s)
- Lan Yang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Public Health, Fudan University, Shanghai, 200032, China
| | - Honglei Ji
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Public Health, Fudan University, Shanghai, 200032, China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237, China
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237, China
| | - Xiuxia Song
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237, China
| | - Xiufeng Li
- Jiashan Maternal and Child Health Hospital, Jiaxing, 314199, China
| | - Jinbo Niu
- Jiashan First People's Hospital, Jiaxing, 314199, China
| | - Huijuan Shi
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237, China
| | - Sheng Wen
- Hubei Provincial Key Laboratory of Applied Toxicology, National Reference Laboratory of Dioxin, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), School of Public Health, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
29
|
Li X, Song F, Liu X, Shan A, Huang Y, Yang Z, Li H, Yang Q, Yu Y, Zheng H, Cao XC, Chen D, Chen KX, Chen X, Tang NJ. Perfluoroalkyl substances (PFASs) as risk factors for breast cancer: a case-control study in Chinese population. Environ Health 2022; 21:83. [PMID: 36085159 PMCID: PMC9463854 DOI: 10.1186/s12940-022-00895-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are a large family of synthetic chemicals, some of which are mammary toxicants and endocrine disruptors. Recent studies have implicated exposure to PFASs as a risk factor for breast cancer in Europe and America. Little is known about the role of PFASs with respect to breast cancer in the Chinese population. METHODS Participants who were initially diagnosed with breast cancer at Tianjin Medical University Cancer Institute and Hospital between 2012 and 2016 were recruited as cases. The controls were randomly selected from the participants with available blood samples in the Chinese National Breast Cancer Screening Program (CNBCSP) cohort. Ultimately, we enrolled 373 breast cancer patients and 657 controls. Plasma PFASs were measured by an ultra-performance liquid chromatography (UPLC) system coupled to a 5500 Q-Trap triple quadrupole mass spectrometer. A logistic regression model with least absolute shrinkage and selection operator (LASSO) regularization was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationships between PFASs and breast cancer. The three most predictive variables in the LASSO model were selected from 17 PFASs, which was based on the optimal penalty coefficient (λ = 0.0218) identified with the minimum criterion. Additionally, Bayesian kernel machine regression (BKMR) and quantile g-computation models were applied to evaluate the associations between separate and mixed exposure to PFASs and breast cancer. RESULTS Perfluorooctanesulfonic acid (PFOS) exhibited the highest concentration in both the cases and controls. Perfluorooctanoic acid (PFOA) and perfluoro-n-decanoic acid (PFDA) were positively associated with breast cancer, and perfluoro-n-tridecanoic acid (PFTrDA) was negatively associated with breast cancer according to both the continuous-PFASs and the quartile-PFASs logistic regression models. Of note, PFOA was associated with the occurrence of estrogen receptor (ER)-, progesterone receptor (PR)-, and human epidermal growth factor receptor 2 (HER2)-positive breast cancer (ORER+ = 1.47, 95% CI: 1.19, 1.80; ORPR+ = 1.36, 95% CI: 1.09, 1.69; ORHER2 = 1.62, 95% CI: 1.19, 2.21). CONCLUSIONS Overall, we observed that PFASs were associated with breast cancer in Chinese women. Prospective cohort studies and mechanistic experiments are warranted to elucidate whether these associations are causal.
Collapse
Affiliation(s)
- Xuejun Li
- Department of Occupational and Environmental Health, School of Public Health, Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xiaotu Liu
- School of Environment, Guangzhou Key Laboratory of Environmental Exposure and Health, and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, 510632, China
| | - Anqi Shan
- Department of Occupational and Environmental Health, School of Public Health, Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Zhengjun Yang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Haixin Li
- Department of Epidemiology and Biostatistics, Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Qiaoyun Yang
- Department of Occupational and Environmental Health, School of Public Health, Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Hong Zheng
- Department of Epidemiology and Biostatistics, Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xu-Chen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Da Chen
- School of Environment, Guangzhou Key Laboratory of Environmental Exposure and Health, and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, 510632, China
| | - Ke-Xin Chen
- Department of Epidemiology and Biostatistics, Key Laboratory of Breast Cancer Prevention and Therapy in Ministry of Education, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xi Chen
- Department of Occupational and Environmental Health, School of Public Health, Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
| | - Nai-Jun Tang
- Department of Occupational and Environmental Health, School of Public Health, Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
| |
Collapse
|