Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
J Clin Endocrinol Metab. 2020 Aug 1;105(8):e2864-76. doi: 10.1210/clinem/dgaa328.
Per- and polyfluoroalkyl substances (PFAS) exposure may alter glucose homeostasis. Research on PFAS exposure and glucose tolerance during pregnancy is limited.
The objective of this work is to estimate associations between first-trimester plasma PFAS concentrations and glucose tolerance assessed in late second pregnancy trimester.
DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES: Pregnant women (n = 1540) enrolled in Project Viva in 1999 to 2002 provided first-trimester plasma samples analyzed for 8 PFAS. At approximately 28 weeks' gestation, women completed 1-hour nonfasting, 50-g oral glucose challenge tests (GCTs); if abnormal, women completed subsequent 3-hour oral glucose tolerance tests (OGTTs) to screen for gestational diabetes mellitus (GDM). We assessed both continuous GCT glucose levels and 4 categories of glucose tolerance (normal glycemia [reference], isolated hyperglycemia, impaired glucose tolerance, GDM). We used multinomial logistic regression to estimate associations of PFAS with glucose tolerance categories. We used multivariable linear regression and Bayesian kernel machine regression (BKMR) to assess individual and joint effects of PFAS on continuous GCT glucose levels, respectively. We evaluated effect modification by maternal age and race/ethnicity.
PFAS were not associated with glucose tolerance categories. In BKMR analyses, we observed a positive association between ln-perfluorooctane sulfonate (PFOS) and glucose levels (Δ25th to 75th percentile: 6.2 mg/dL, 95% CI, 1.1-11.3) and an inverse-U shaped association between 2-(N-perfluorooctane sulfonamide) acetate and glucose levels. Individual linear regression results were similar. We found suggestive evidence that associations varied by age and racial/ethnic group.
Certain PFAS may alter glucose homeostasis during pregnancy, but may not be associated with overt GDM.
全氟和多氟烷基物质（PFAS）暴露可能会改变葡萄糖稳态。关于 PFAS 暴露与妊娠期间葡萄糖耐量的研究有限。
本研究旨在评估孕早期血浆 PFAS 浓度与妊娠晚期第 2 孕期葡萄糖耐量之间的关联。
设计、地点、参与者和主要结果：1999 年至 2002 年，孕妇参加了 Viva 项目，共纳入 1540 名孕妇，提供了第 1 孕期的血浆样本，用于分析 8 种 PFAS。大约在 28 周妊娠时，女性完成了 1 小时非禁食、50 克口服葡萄糖挑战试验（GCT）；如果异常，女性将完成随后的 3 小时口服葡萄糖耐量试验（OGTT）以筛查妊娠糖尿病（GDM）。我们评估了 GCT 葡萄糖水平的连续值和葡萄糖耐量的 4 个类别（正常血糖[参考]、孤立性高血糖、糖耐量受损、GDM）。我们使用多变量逻辑回归估计 PFAS 与葡萄糖耐量类别的关联。我们分别使用多变量线性回归和贝叶斯核机器回归（BKMR）评估 PFAS 对 GCT 葡萄糖水平的个体和联合效应。我们评估了母体年龄和种族/民族的效应修饰作用。
PFAS 与葡萄糖耐量类别无关。在 BKMR 分析中，我们观察到 ln-全氟辛烷磺酸（PFOS）与葡萄糖水平呈正相关（25%到 75%分位数的变化：6.2mg/dL，95%CI，1.1-11.3），2-（N-全氟辛烷磺酰胺）乙酸与葡萄糖水平呈反 U 形关联。个体线性回归结果相似。我们发现有迹象表明，关联因年龄和种族/民族群体而异。
某些 PFAS 可能会改变妊娠期间的葡萄糖稳态，但与明显的 GDM 无关。
