与环境对儿童健康结果的影响（ECHO）计划中孕期暴露于全氟和多氟烷基物质和应激相关的出生结局。
Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program.
机构信息
Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
Environ Health Perspect. 2023 Mar;131(3):37006. doi: 10.1289/EHP10723. Epub 2023 Mar 15.
BACKGROUND
Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress.
OBJECTIVES
We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships.
METHODS
We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS.
RESULTS
We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of [95% confidence interval (CI): , ], (95% CI: , ), (95% CI: , ), (95% CI: , 0.06), and (95% CI: , ), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: (95% CI: 0.38, 0.83), (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [; 95% highest posterior density (HPD): , ] and decreased odds of large-for-gestational-age (; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress.
DISCUSSION
Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723.
背景
全氟和多氟烷基物质（PFAS）是持久性和普遍存在的化学物质，与不良出生结果的风险有关。先前的研究结果不一致。PFAS 与出生结果之间的关联可能受到心理社会压力的影响。
目的
我们估计了与产前 PFAS 浓度相关的不良出生结果的风险，并评估了母体应激是否会改变这些关系。
方法
我们纳入了 ECHO 计划中 11 个前瞻性产前队列的 3339 名参与者，以估计五种 PFAS 与出生结果的关系。我们按感知压力量表评分进行分层，以检查效应修饰，并使用贝叶斯加权和来估计 PFAS 的混合物。
结果
我们观察到随着所有 PFAS 浓度的增加，出生规模减小。对于每单位更高的对数正态化全氟辛酸（PFOA）、全氟辛烷磺酸（PFOS）、全氟壬酸（PFNA）和全氟己烷磺酸（PFHxS）暴露，我们观察到较低的出生体重与胎龄 Z 分数为 [95%置信区间（CI）：，]、[95% CI：，]、[95% CI：，]、[95% CI：，0.06] 和 [95% CI：，]，分别。我们观察到巨大儿的比值比（OR）较低：[95% CI：0.38，0.83]，[95% CI：0.35，0.77]。对于对数正态化浓度总和增加 1 个单位，我们观察到出生体重与胎龄 Z 分数较低[；95%最高后验密度（HPD）：，]，巨大儿的几率降低[；95% HPD：0.29，0.82]。全氟癸酸（PFDA）在这两个模型中解释了总和效应的最高百分比（40%）。在高感知压力组和低感知压力组中，这些关联没有差异。
讨论
我们对 PFAS 和不良出生结果的大型多队列研究发现，产前 PFAS 与出生体重与胎龄呈负相关，且在高感知压力组和低感知压力组中，这些关联没有差异。这项研究可以帮助制定政策，以减少环境和人类中的暴露。https://doi.org/10.1289/EHP10723.
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