Jørgensen Kristian T, Specht Ina O, Lenters Virissa, Bach Cathrine C, Rylander Lars, Jönsson Bo A G, Lindh Christian H, Giwercman Aleksander, Heederik Dick, Toft Gunnar, Bonde Jens Peter
Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Environ Health. 2014 Dec 22;13:116. doi: 10.1186/1476-069X-13-116.
Perfluoroalkyl substances (PFAS) are suggested to affect human fecundity through longer time to pregnancy (TTP). We studied the relationship between four abundant PFAS and TTP in pregnant women from Greenland, Poland and Ukraine representing varying PFAS exposures and pregnancy planning behaviors.
We measured serum levels of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) in 938 women from Greenland (448 women), Poland (203 women) and Ukraine (287 women). PFAS exposure was assessed on a continuous logarithm transformed scale and in country-specific tertiles. We used Cox discrete-time models and logistic regression to estimate fecundability ratios (FRs) and infertility (TTP >13 months) odds ratios (ORs), respectively, and 95% confidence intervals (CI) according to PFAS levels. Adjusted analyses of the association between PFAS and TTP were done for each study population and in a pooled sample.
Higher PFNA levels were associated with longer TTP in the pooled sample (log-scale FR = 0.80; 95% CI 0.69-0.94) and specifically in women from Greenland (log-scale FR = 0.72; 95% CI 0.58-0.89). ORs for infertility were also increased in the pooled sample (log-scale OR = 1.53; 95% CI 1.08-2.15) and in women from Greenland (log-scale OR = 1.97; 95% CI 1.22-3.19). However, in a sensitivity analysis of primiparous women these associations could not be replicated. Associations with PFNA were weaker for women from Poland and Ukraine. PFOS, PFOA and PFHxS were not consistently associated with TTP.
Findings do not provide consistent evidence that environmental exposure to PFAS is impairing female fecundity by delaying time taken to conceive.
全氟烷基物质（PFAS）被认为会通过延长受孕时间（TTP）来影响人类生育能力。我们研究了四种常见PFAS与格陵兰、波兰和乌克兰孕妇TTP之间的关系，这些地区代表了不同的PFAS暴露水平和怀孕计划行为。
我们测量了来自格陵兰（448名女性）、波兰（203名女性）和乌克兰（287名女性）的938名女性血清中全氟辛酸（PFOA）、全氟辛烷磺酸（PFOS）、全氟己烷磺酸（PFHxS）和全氟壬酸（PFNA）的水平。PFAS暴露通过连续对数转换尺度和特定国家的三分位数进行评估。我们使用Cox离散时间模型和逻辑回归分别估计受孕能力比（FRs）和不孕（TTP>13个月）比值比（ORs）以及根据PFAS水平的95%置信区间（CI）。对每个研究人群和合并样本进行了PFAS与TTP之间关联的调整分析。
在合并样本中，较高的PFNA水平与较长的TTP相关（对数尺度FR = 0.80；95% CI 0.69 - 0.94），特别是在格陵兰女性中（对数尺度FR = 0.72；95% CI 0.58 - 0.89）。合并样本中不孕的ORs也增加了（对数尺度OR = 1.53；95% CI 1.08 - 2.15），格陵兰女性中也是如此（对数尺度OR = 1.97；95% CI 1.22 - 3.19）。然而，在初产妇的敏感性分析中，这些关联无法重现。波兰和乌克兰女性与PFNA的关联较弱。PFOS、PFOA和PFHxS与TTP的关联并不一致。
研究结果没有提供一致的证据表明环境暴露于PFAS会通过延迟受孕时间来损害女性生育能力。
