孕期暴露于高水平的全氟和多氟烷基物质与妊娠糖尿病风险增加有关：来自中国上海的一项巢式病例对照研究。
Exposure to elevated per- and polyfluoroalkyl substances in early pregnancy is related to increased risk of gestational diabetes mellitus: A nested case-control study in Shanghai, China.
机构信息
Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
出版信息
Environ Int. 2020 Oct;143:105952. doi: 10.1016/j.envint.2020.105952. Epub 2020 Jul 24.
BACKGROUND
Long-chain per- and polyfluoroalkyl substances (PFASs) and their short-chain alternatives have been produced and used extensively in China. However, it is unclear whether these compounds contribute to the risk of gestational diabetes mellitus (GDM) in women residing in contaminated areas.
OBJECTIVE
The study was performed to explore the association between PFASs varying in chain length and the risk of developing GDM.
METHOD
A nested case-control study was conducted in a prospective cohort of 2,460 pregnant women between July 1, 2017, and January 31, 2019 in Shanghai, China. Twelve PFASs of interest were measured using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF MS) in the sera of pregnant women at 16-20 weeks. GDM was diagnosed by an oral glucose tolerance test administered over 24-28 gestational weeks. The cases and controls were matched by maternal age. The relationship between maternal serum PFAS level and GDM risk was determined by conditional logistic and linear regression analyses.
RESULTS
A total of 165 GDM cases and 330 controls were enrolled in the study cohort. The frequencies of detection of PFHpA, PFDS, and PFOSA were all ≤80%. Hence, they were excluded from any further risk analysis. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected at relatively high serum levels (medians 6.57 ng/mL and 8.07 ng/mL, respectively). The serum levels of perfluorobutanesulfonic acid (PFBS) and perfluorododecanoic acid (PFDoA) were significantly higher in the GDM group than they were in the control group (P = 0.02 and P < 0.01, respectively) according to a nonparametric Wilcoxon rank sum test. A quartile analysis showed that the odds ratio of GDM would significantly increase at the highest PFBS and PFDoA levels. In the core model, the adjusted ORs were 2.02 (95% CI = 1.04-3.79) and 13.00 (95% CI = 4.74-24.59), respectively, after adjusting for maternal age, sampling time, parity and body mass index [BMI]).
CONCLUSION
Elevated maternal serum PFBS and PFDoA levels in early pregnancy may be associated with a substantially higher GDM risk.
背景
长链全氟和多氟烷基物质（PFAS）及其短链替代品在中国已被广泛生产和使用。然而，目前尚不清楚这些化合物是否会增加居住在污染地区的女性患妊娠糖尿病（GDM）的风险。
目的
本研究旨在探讨不同链长的 PFAS 与 GDM 发病风险之间的关系。
方法
采用嵌套病例对照研究，纳入 2017 年 7 月 1 日至 2019 年 1 月 31 日期间在上海市进行的一项前瞻性队列研究中的 2460 名孕妇。采用超高效液相色谱/四极杆飞行时间质谱（UPLC-Q/TOF MS）检测孕妇 16-20 周血清中 12 种目标 PFAS。通过 24-28 孕周口服葡萄糖耐量试验诊断 GDM。采用条件 logistic 和线性回归分析确定母体血清 PFAS 水平与 GDM 风险之间的关系。
结果
本研究共纳入 165 例 GDM 病例和 330 例对照。PFHpA、PFDS 和 PFOSA 的检出率均≤80%，因此未纳入进一步的风险分析。全氟辛烷磺酸（PFOS）和全氟辛酸（PFOA）在血清中检测到较高的浓度（中位数分别为 6.57ng/mL 和 8.07ng/mL）。非参数 Wilcoxon 秩和检验显示，GDM 组血清中全氟丁烷磺酸（PFBS）和全氟十二烷酸（PFDoA）的水平显著高于对照组（P=0.02 和 P<0.01）。四分位分析显示，PFBS 和 PFDoA 水平最高时，GDM 的比值比会显著增加。在核心模型中，经母体年龄、采样时间、产次和体重指数（BMI）调整后，PFBS 和 PFDoA 的调整比值比（OR）分别为 2.02（95%CI=1.04-3.79）和 13.00（95%CI=4.74-24.59）。
结论
妊娠早期母体血清中 PFBS 和 PFDoA 水平升高与 GDM 风险显著增加有关。
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