Zhu Yachen, Bartell Scott M
Program in Public Health, University of California, Irvine, California.
Department of Environmental and Occupational Health, University of California, Irvine, California.
Environ Epidemiol. 2022 May 4;6(3):e209. doi: 10.1097/EE9.0000000000000209. eCollection 2022 Jun.
Per- and polyfluoroalkyl substances (PFAS) widely exist in the environment and human bodies. Contaminated drinking water is one of the major exposure pathways for humans. Previous studies found weak or moderate associations between PFAS and hypertensive disorders of pregnancy (HDP).
We obtained the number of births and counts of HDP cases for singleton births multiply stratified by county, maternal age, race, education, smoking status, and parity from CDC WONDER, and PFAS water concentrations from EPA UCMR3 data in the United States during 2013-2015. We used binomial regression on the multiply stratified HDP data to produce equal effect estimates and standard errors to those that would be derived from using individual-level data on binary HDP status and demographic covariates in logistic regression.
After adjusting for demographic covariates, we found small but statistically significant positive associations between HDP and population-weighted average water concentrations (ng/L) of all four PFAS: Odds ratio (OR) = 1.009, 95% CI = (1.001, 1.016) per IQR increase in perfluorooctanoic acid (PFOA); 1.030, 95% CI = (1.021, 1.040) per IQR increase in perfluorooctane sulfonate (PFOS); 1.008, 95% CI = (1.005, 1.011) per IQR increase in perfluoroheptanoic acid (PFHpA); 1.007, 95% CI = (1.004, 1.010) per IQR increase in perfluorohexane sulfonic acid (PFHxS), and 1.032, 95% CI = (1.022, 1.042) per IQR increase in the sum of four PFAS. Further adjustment for coexposures reversed the effect of PFOA from positive to inverse, and attenuated the effects of PFOS and PFHxS toward the null. After drinking water to serum concentration conversions, our effect estimates for PFOA, PFOS, and PFHxS are similar to previous studies.
We found a weak positive association between the PFAS mixture and HDP, although the generalizability is subject to inherent limitations of the public-available datasets.
全氟和多氟烷基物质（PFAS）广泛存在于环境和人体中。受污染的饮用水是人类主要的暴露途径之一。先前的研究发现PFAS与妊娠高血压疾病（HDP）之间存在弱或中度关联。
我们从美国疾病控制与预防中心（CDC）的WONDER数据库中获取了2013 - 2015年期间按县、产妇年龄、种族、教育程度、吸烟状况和产次进行多重分层的单胎出生数量及HDP病例数，以及来自美国环境保护局（EPA）统一监测信息报告3（UCMR3）数据中的PFAS水浓度。我们对多重分层的HDP数据使用二项式回归，以得出与使用逻辑回归中关于二元HDP状态和人口统计学协变量的个体水平数据所得到的效应估计值和标准误差相等的结果。
在对人口统计学协变量进行调整后，我们发现HDP与所有四种PFAS的人口加权平均水浓度（纳克/升）之间存在虽小但具有统计学意义的正相关：全氟辛酸（PFOA）每增加一个四分位间距（IQR），优势比（OR）= 1.009，95%置信区间（CI）=（1.001，1.016）；全氟辛烷磺酸（PFOS）每增加一个IQR，OR = 1.030，95% CI =（1.021，1.040）；全氟庚酸（PFHpA）每增加一个IQR，OR = 1.008，95% CI =（1.005，1.011）；全氟己烷磺酸（PFHxS）每增加一个IQR，OR = 1.007，95% CI =（1.004，1.010）；四种PFAS总和每增加一个IQR，OR = 1.032，95% CI =（1.022，1.042）。对共暴露因素进行进一步调整后，PFOA的效应从正向转为负向，PFOS和PFHxS的效应向无效方向减弱。在将饮用水浓度转换为血清浓度后，我们对PFOA、PFOS和PFHxS的效应估计与先前的研究相似。
我们发现PFAS混合物与HDP之间存在弱正相关，尽管由于公开可用数据集的固有局限性，其普遍性受到影响。
