Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.
Department of Maternal, Child and Adolescent Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.
Environ Int. 2018 May;114:12-20. doi: 10.1016/j.envint.2018.01.027. Epub 2018 Feb 20.
Exposure to perfluoroalkyl substances (PFASs) can affect glucose homeostasis and has been suggested as a potential risk of diabetes mellitus, but data are limited for pregnant women.
We aimed to explore the associations of exposure to PFASs with glucose homeostasis and gestational diabetes mellitus (GDM) in Chinese pregnant women.
The current study was conducted in Hebei Province of Northern China between 2013 and 2014 and 560 pregnant women were recruited in their early term of pregnancy and two representative serum PFASs, perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS), were measured. In 385 pregnant women who completed oral glucose tolerance test (OGTT), the associations of serum PFOA and PFOS concentrations with fasting blood glucose (FBG), fasting insulin (FIns), and homeostasis model assessment of insulin resistance (HOMA-IR) in the early, middle, and late terms of pregnancy and occurrence of GDM were examined using linear and Cox proportional hazard regression models. The reproducibility of serum PFASs during pregnancy was assessed in 230 pregnant women.
The intraclass correlation coefficients of serum PFASs, covariates, and outcomes based on averaged repeat measurement (0.35-0.96) were higher than those based on single measurement (0.16-0.92). Serum PFOA was positively associated with averaged FIns and HOMA-IR in the early, middle, and late terms of pregnancy and averaged blood glucose level at 1 h and 2 h of OGTT, but serum PFOS tended to be negatively associated with averaged FBG and OGTT blood glucose. The adjusted hazard ratios of GDM associated with serum PFOA and PFOS were 1.98 (95% confidence interval: 0.70-5.57; p-value: 0.197) and 0.71 (0.29-1.75; 0.453), respectively.
Our data raised a possibility that exposure to PFASs might have different influences on glucose homeostasis and GDM in Chinese pregnant women. More lab and human studies are needed to further test the hypothesis and investigate potential mechanisms.
接触全氟烷基物质 (PFASs) 会影响葡萄糖稳态，并且被认为是糖尿病的潜在风险因素，但针对孕妇的相关数据有限。
本研究旨在探索中国孕妇体内 PFASs 暴露与葡萄糖稳态和妊娠期糖尿病 (GDM) 的关系。
本研究于 2013 年至 2014 年在河北省进行，共招募了 560 名处于早孕阶段的孕妇，并检测了两种代表性的血清 PFASs：全氟辛酸 (PFOA) 和全氟辛烷磺酸 (PFOS)。在完成口服葡萄糖耐量试验 (OGTT) 的 385 名孕妇中，采用线性和 Cox 比例风险回归模型，分析了血清 PFOA 和 PFOS 浓度与孕早期、孕中期和孕晚期空腹血糖 (FBG)、空腹胰岛素 (FIns) 和稳态模型评估的胰岛素抵抗 (HOMA-IR) 以及 GDM 发生的关系。在 230 名孕妇中评估了孕期血清 PFASs 的重复性。
基于平均重复测量的血清 PFASs、协变量和结局的组内相关系数（0.35-0.96）高于基于单次测量的组内相关系数（0.16-0.92）。血清 PFOA 与孕早期、孕中期和孕晚期的平均 FIns 和 HOMA-IR 以及 OGTT 1 小时和 2 小时的平均血糖水平呈正相关，而血清 PFOS 与平均 FBG 和 OGTT 血糖呈负相关。与血清 PFOA 和 PFOS 相关的 GDM 的调整后危险比分别为 1.98（95%置信区间：0.70-5.57；p 值：0.197）和 0.71（0.29-1.75；0.453）。
本研究结果提示，PFASs 暴露可能对中国孕妇的葡萄糖稳态和 GDM 产生不同的影响。需要更多的实验室和人体研究来进一步验证这一假设并探讨潜在的机制。
