Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
Environ Health. 2021 May 22;20(1):63. doi: 10.1186/s12940-021-00740-z.
Per- and polyfluoroalkyl substances (PFAS) have been found to be associated with gestational diabetes mellitus (GDM) development, a maternal health disorder in pregnancy with negative effects that can extend beyond pregnancy. Studies that report on this association are difficult to summarize due to weak associations and wide confidence intervals. One way to advance this field is to sharpen the biologic theory on a causal pathway behind this association, and to measure it directly by way of molecular biomarkers. The aim of this review is to summarize the literature that supports a novel pathway between PFAS exposure and GDM development. Epidemiological studies demonstrate a clear association of biomarkers of thyroid hormones and glucose metabolism with GDM development. We report biologic plausibility and epidemiologic evidence that PFAS dysregulation of maternal thyroid hormones and thyrotropin (TSH) may disrupt glucose homeostasis, increasing the risk of GDM. Overall, epidemiological studies demonstrate that PFAS were positively associated with TSH and negatively with triiodothyronine (T3) and thyroxine (T4). PFAS were generally positively associated with glucose and insulin levels in pregnancy. We propose dysregulation of thyroid function and glucose metabolism may be a critical and missing component in the accurate estimation of PFAS on the risk of GDM.
全氟和多氟烷基物质（PFAS）已被发现与妊娠糖尿病（GDM）的发展有关，这是一种妊娠期间的母体健康障碍，其影响可能会超出妊娠期。由于关联较弱且置信区间较宽，因此报告这种关联的研究很难进行总结。推进这一领域的一种方法是通过分子生物标志物，深入研究该关联背后的生物学理论，并直接对其进行测量。本综述的目的是总结支持 PFAS 暴露与 GDM 发展之间存在新途径的文献。流行病学研究表明，甲状腺激素和葡萄糖代谢的生物标志物与 GDM 的发展之间存在明确的关联。我们报告了生物学上的合理性和流行病学证据，表明 PFAS 对母体甲状腺激素和促甲状腺激素（TSH）的失调可能会破坏葡萄糖稳态，增加 GDM 的风险。总体而言，流行病学研究表明，PFAS 与 TSH 呈正相关，与三碘甲状腺原氨酸（T3）和甲状腺素（T4）呈负相关。PFAS 通常与妊娠期间的血糖和胰岛素水平呈正相关。我们提出，甲状腺功能和葡萄糖代谢的失调可能是准确估计 PFAS 对 GDM 风险的一个关键且缺失的因素。
