Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China.
Chemosphere. 2022 Feb;288(Pt 1):132468. doi: 10.1016/j.chemosphere.2021.132468. Epub 2021 Oct 5.
Previous epidemiological studies have examined the associations between exposure to perfluoroalkyl substances (PFASs) and the risk of hypertensive disorders of pregnancy (HDP). However, these studies have drawn discrepant conclusions and have some limitations.
A nested case-control study was conducted with the Guangxi Zhuang Birth Cohort (GZBC), a prospective, ongoing birth cohort that was implemented in Guangxi, China, in June 2015. Maternal serum concentrations of nine PFASs were measured using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS). The associations between PFAS exposure and the risk of HDP were assessed using logistic regression (single-exposure), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models.
A total of 136 HDP cases and 408 controls were enrolled in this study. In logistic regression models, perfluoroundecanoic acid (PFUnA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA) and perfluorobutanesulfonic acid (PFBS) were positively associated with HDP, while perfluorohexane sulfonate (PFHxS) was inversely associated with HDP. In the BKMR analysis, the joint effect of PFASs was positively associated with HDP. PFOS and PFBS showed positive trends, while PFHxS and PFHpA showed inverse trends. In WQS regression analysis, we calculated two WQS indices that were estimated using constraints in both the positive and negative directions of effects. Both WQS indices were significantly associated with HDP (OR: 2.663, 95% CI: 1.795-3.951; OR: 0.338, 95% CI: 0.229-0.499, respectively). PFBS, PFOS and PFUnA had significant weights in the positive effect direction; PFHxS, perfluoroheptanoic acid (PFHpA) and perfluorododecanoic acid (PFDoA) had significant weights in the negative effect direction.
Considering all model results, we found that combined exposure to nine PFASs had a positive effect on the development of HDP. Moreover, PFOS and PFBS were positively associated with the HDP risk, while PFHxS and PFHpA were negatively associated with the HDP risk in women in Guangxi, China.
先前的流行病学研究已经检验了全氟烷基物质（PFASs）暴露与妊娠高血压疾病（HDP）风险之间的关联。然而，这些研究得出了不一致的结论，并存在一些局限性。
本研究采用嵌套病例对照研究设计，使用超高效液相色谱-串联质谱法（UPLC-MS）检测 9 种 PFASs 的浓度。病例组为 136 例妊娠高血压疾病患者，对照组为 408 例正常妊娠孕妇。采用逻辑回归（单暴露）、加权分位数和（WQS）回归和贝叶斯核机器回归（BKMR）模型评估 PFAS 暴露与 HDP 风险之间的关系。
共纳入 136 例 HDP 病例和 408 例对照。在逻辑回归模型中，PFUnA、PFOS、PFNA 和 PFBS 与 HDP 呈正相关，而 PFHxS 与 HDP 呈负相关。在 BKMR 分析中，PFASs 的联合效应与 HDP 呈正相关。PFOS 和 PFBS 呈正相关趋势，而 PFHxS 和 PFHpA 呈负相关趋势。在 WQS 回归分析中，我们计算了两种 WQS 指数，这两种指数均是基于正向和负向效应的约束进行估计的。这两种 WQS 指数均与 HDP 显著相关（OR：2.663，95%CI：1.795-3.951；OR：0.338，95%CI：0.229-0.499）。PFBS、PFOS 和 PFUnA 在正向效应方向上的权重较大；PFHxS、PFHpA 和 PFDoA 在负向效应方向上的权重较大。
综合所有模型结果，我们发现九种 PFASs 的联合暴露对 HDP 的发生有正向影响。此外，在中国广西，PFOS 和 PFBS 与 HDP 风险呈正相关，而 PFHxS 和 PFHpA 与 HDP 风险呈负相关。
