Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America.
Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore.
Sci Total Environ. 2023 May 15;873:162267. doi: 10.1016/j.scitotenv.2023.162267. Epub 2023 Feb 17.
Experimental models have demonstrated a link between exposure to perfluoroalkyl substances (PFAS) and decreased fertility and fecundability; however, human studies are scarce. We assessed the associations between preconception plasma PFAS concentrations and fertility outcomes in women.
In a case-control study nested within the population-based Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO), we measured PFAS in plasma collected in 2015-2017 from 382 women of reproductive age trying to conceive. Using Cox proportional hazards regression (fecundability ratios [FRs]) and logistic regression (odds ratios [ORs]) models, we assessed the associations of individual PFAS with time-to-pregnancy (TTP), and the likelihoods of clinical pregnancy and live birth, respectively, over one year of follow-up, adjusting for analytical batch, age, education, ethnicity, and parity. We used Bayesian weighted quantile sum (BWQS) regression to assess the associations of the PFAS mixture with fertility outcomes.
We found a 5-10 % reduction in fecundability per quartile increase of exposure to individual PFAS (FRs [95 % CIs] for clinical pregnancy = 0.90 [0.82, 0.98] for PFDA; 0.88 [0.79, 0.99] for PFOS; 0.95 [0.86, 1.06] for PFOA; 0.92 [0.84, 1.00] for PFHpA). We observed similar decreased odds of clinical pregnancy (ORs [95 % CIs] = 0.74 [0.56, 0.98] for PFDA; 0.76 [0.53, 1.09] for PFOS; 0.83 [0.59, 1.17] for PFOA; 0.92 [0.70, 1.22] for PFHpA) and live birth per quartile increases of individual PFAS and the PFAS mixture (ORs [95 % CIs] = 0.61 [0.37, 1.02] for clinical pregnancy, and 0.66 [0.40, 1.07] for live birth). Within the PFAS mixture, PFDA followed by PFOS, PFOA, and PFHpA were the biggest contributors to these associations. We found no evidence of association for PFHxS, PFNA, and PFHpS and the fertility outcomes examined.
Higher PFAS exposures may be associated with decreased fertility in women. The potential impact of ubiquitous PFAS exposures on infertility mechanisms requires further investigation.
实验模型表明，接触全氟烷基物质（PFAS）与生育力和受孕能力下降之间存在关联；然而，人类研究很少。我们评估了女性妊娠前血浆 PFAS 浓度与生育结局之间的关系。
在基于人群的新加坡妊娠前长期母婴结局研究（S-PRESTO）中的病例对照研究中，我们测量了 382 名处于生育年龄且试图怀孕的女性在 2015-2017 年采集的血浆中的 PFAS。使用 Cox 比例风险回归（受孕能力比值 [FRs]）和 logistic 回归（比值比 [ORs]）模型，我们调整了分析批次、年龄、教育程度、种族和产次后，分别评估了个体 PFAS 与妊娠时间（TTP）、临床妊娠和活产的可能性之间的关系，随访时间为一年。我们使用贝叶斯加权和量得分（BWQS）回归来评估 PFAS 混合物与生育结局的关系。
我们发现，随着个体 PFAS 暴露量每增加一个四分位数，受孕能力降低 5-10%（临床妊娠的 FRs[95%CI]为 PFDA 为 0.90[0.82,0.98]；PFOS 为 0.88[0.79,0.99]；PFOA 为 0.95[0.86,1.06]；PFHpA 为 0.92[0.84,1.00]）。我们观察到类似的临床妊娠几率降低（ORs[95%CI]为 PFDA 为 0.74[0.56,0.98]；PFOS 为 0.76[0.53,1.09]；PFOA 为 0.83[0.59,1.17]；PFHpA 为 0.92[0.70,1.22]）和活产几率降低（ORs[95%CI]为临床妊娠为 0.61[0.37,1.02]，活产为 0.66[0.40,1.07]），这与个体 PFAS 和 PFAS 混合物每增加一个四分位数有关。在 PFAS 混合物中，PFDA 其次是 PFOS、PFOA 和 PFHpA，是这些关联的最大贡献者。我们没有发现 PFHxS、PFNA 和 PFHpS 与研究的生育结局之间存在关联的证据。
较高的 PFAS 暴露可能与女性生育能力下降有关。普遍存在的 PFAS 暴露对不孕机制的潜在影响需要进一步研究。
