Association of perfluoroalkyl substances with gestational hypertension and preeclampsia in the MIREC study

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DOI

https://doi.org/10.1016/j.envint.2020.105789

Language of the publication
English
Date
2020-05-11
Type
Article
Author(s)
  • Borghese, Michael M.
  • Walker, Mark
  • Helewa, Michael E.
  • Fraser, William D.
  • Arbuckle, Tye E.
Publisher
Elsevier

Abstract

Background Perfluoroalkyl substances (PFAS) have been linked with a number of developmental, reproductive, hepatic, and cardiovascular health outcomes. However, the evidence for an association between PFAS and hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia) is equivocal and warrants further investigation. Objectives To examine the relationship between background levels of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorohexane sulfonate (PFHxS) and the development of gestational hypertension or preeclampsia in a Canadian pregnancy cohort. We also explored the potential for effect modification according to fetal sex. Methods Maternal plasma samples were collected in the first trimester from participants in the MIREC study and were analyzed for PFOA, PFOS, and PFHxS. Blood pressure was measured during each trimester. Gestational hypertension and preeclampsia were defined using the Society of Obstetricians and Gynaecologists of Canada guidelines. Logistic regression models were used to derive adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations between PFAS concentrations (per doubling of concentration as well as according to tertiles) and gestational hypertension or preeclampsia. Linear mixed models were used to examine the association between PFAS concentrations and changes in blood pressure throughout pregnancy. Results Data from 1739 participants were analyzed. 90% of women were normotensive throughout pregnancy, 7% developed gestational hypertension without preeclampsia, and 3% developed preeclampsia. In the full analyses, neither PFOA nor PFOS were associated with gestational hypertension or preeclampsia. However, each doubling of PFHxS plasma concentration was associated with higher odds of developing preeclampsia (OR = 1.32; 95% CI: 1.03, 1.70). In addition, participants in the highest PFHxS tertile (1.4–40.0 μg/L) had higher odds of developing preeclampsia relative to those in the lowest tertile (OR = 3.06; 95% CI: 1.27, 7.39). In stratified analyses, this effect was only apparent among women carrying a female fetus (OR = 4.90; 95% CI: 1.02, 22.3). However, among women carrying a male fetus, both PFOS and PFHxS were associated with gestational hypertension, but not preeclampsia. Higher plasma concentrations of all three PFAS were associated with increases in diastolic blood pressure throughout pregnancy, and PFOA and PFHxS were also associated with systolic blood pressure. Discrepant findings were similarly revealed in analyses stratified by fetal sex. Conclusions Higher levels of PFHxS were associated with the development of preeclampsia, but not gestational hypertension. Neither PFOA nor PFOS were associated with either outcome. However, we show, for the first time, that fetal sex may modify these associations, a finding which warrants replication and further study.

Plain language summary

"Health Canada helps to protect the health of Canadians by assessing and managing the risks associated with exposure to environmental chemicals. Perfluoroalkyl substances (PFAS) are persistent chemicals found in the environment that are suspected of contributing to gestational hypertension and preeclampsia. Gestational hypertension refers to high blood pressure with new onset in pregnancy, and preeclampsia is defined as additionally involving at least one of several maternal complications. The epidemiological evidence for associations between PFAS and these conditions is limited and equivocal. The objective of this paper was to examine the relationship of three PFASs (PFOA, PFOS, and PFHxS) with the development of gestational hypertension and preeclampsia in the Maternal-Infant Research on Environmental Chemicals (MIREC) Study. PFAS concentrations were measured in plasma of pregnant women. Blood pressure measurements and clinical lab tests were used to diagnose gestational hypertension and preeclampsia according to standard Canadian clinical guidelines. Statistical models were fit to examine the relationship between the PFAS and gestational hypertension/preeclampsia, stratified by infant sex, while controlling for potential confounders. Data from 1739 participants were analyzed. 90% of women had normal blood pressure, 7% developed gestational hypertension, and 3% developed preeclampsia. PFHxS, but not PFOA nor PFOS, was associated with higher odds of developing preeclampsia and this effect was strongest among women giving birth to females. Effects were observed for PFOS and PFHxS and gestational hypertension among boys only. Higher levels of PFAS were positively associated with diastolic blood pressure, and PFOA and PFHxS were also associated with systolic blood pressure. In conclusion, higher levels of PFHxS were associated with the development of preeclampsia, but not gestational hypertension. Neither PFOA nor PFOS were consistently associated with either outcome. However, we show, for the first time, that fetal sex can modify these effects, a finding which warrants replication and further study."

Subject

  • Health,
  • Health and safety

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Healthy environments, consumer safety and consumer products

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