Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, ME, USA.
Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California at Berkeley, Berkeley, CA, USA; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Sci Total Environ. 2023 Sep 15;891:164724. doi: 10.1016/j.scitotenv.2023.164724. Epub 2023 Jun 7.
Per- and polyfluoroalkyl substances (PFAS) may disrupt mammary gland development and function; thereby inhibiting milk supply and breastfeeding duration. However, conclusions on the potential effects of PFAS and breastfeeding duration are limited by prior epidemiologic studies that inconsistently adjusted for past cumulative breastfeeding duration and by a lack of examination of the joint effects of PFAS mixtures.
In Project Viva, a longitudinal cohort that enrolled pregnant participants from 1999 to 2002 in the greater Boston, MA area, we studied 1079 women who ever attempted to lactate. We investigated associations of plasma concentrations of select PFAS in early pregnancy (mean: 10.1 weeks gestation) with breastfeeding termination by 9 months, after which women typically cite self-weaning as the reason for terminating breastfeeding. We used Cox regression for single-PFAS models and quantile g-computation for mixture models, adjusting for sociodemographics, prior breastfeeding duration, and weeks of gestation at the time of blood draw.
We detected 6 PFAS [perfluorooctane sulfonate; perfluorooctanoate (PFOA); perfluorohexane sulfonate; perfluorononanoate; 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EtFOSAA); 2-(N-methyl-perfluorooctane sulfonamide) acetate (MeFOSAA)] in >98 % of samples. Sixty percent of lactating women terminated breastfeeding by 9 months postpartum. Women with higher plasma concentrations of PFOA, EtFOSAA, and MeFOSAA had a greater hazard of terminating breastfeeding in the first 9 months postpartum [HR (95 % CI) per doubling concentration: 1.20 (1.04, 1.38) for PFOA; 1.10 (1.01, 1.20) for EtFOSAA; 1.18 (1.08, 1.30) for MeFOSAA]. In the quantile g-computation model, simultaneously increasing all PFAS in the mixture by one quartile was associated with 1.17 (95 % CI: 1.05, 1.31) greater hazard of terminating breastfeeding in the first 9 months.
Our findings suggest that exposure to PFAS may be associated with reduced breastfeeding duration and draw further attention to environmental chemicals that may dysregulate human lactation.
全氟和多氟烷基物质 (PFAS) 可能会干扰乳腺发育和功能；从而抑制乳汁供应和母乳喂养时间。然而，由于先前的流行病学研究不一致地调整了过去的累积母乳喂养时间，并且缺乏对 PFAS 混合物联合效应的研究，因此关于 PFAS 和母乳喂养时间潜在影响的结论受到限制。
在 Viva 项目中，这是一项纵向队列研究，于 1999 年至 2002 年在马萨诸塞州波士顿地区招募了孕妇参与者，我们研究了 1079 名曾经试图哺乳的女性。我们研究了早期妊娠（平均：10.1 周妊娠）时选择的 PFAS 血浆浓度与 9 个月时母乳喂养终止之间的关系，此后女性通常以自我断奶为由终止母乳喂养。我们使用 Cox 回归进行单 PFAS 模型分析和分位数 g 计算进行混合物模型分析，调整了社会人口统计学因素、先前的母乳喂养时间和采血时的妊娠周数。
我们在 >98%的样本中检测到 6 种 PFAS [全氟辛烷磺酸；全氟辛酸 (PFOA)；全氟己烷磺酸；全氟壬酸；2-(N-乙基全氟辛烷磺酰胺基)乙酸 (EtFOSAA)；2-(N-甲基全氟辛烷磺酰胺基)乙酸 (MeFOSAA)]。60%的哺乳期妇女在产后 9 个月内终止母乳喂养。PFOA、EtFOSAA 和 MeFOSAA 血浆浓度较高的女性在产后前 9 个月内母乳喂养终止的风险更高 [风险比 (95%置信区间) 每增加一倍浓度：PFOA 为 1.20(1.04, 1.38)；EtFOSAA 为 1.10(1.01, 1.20)；MeFOSAA 为 1.18(1.08, 1.30)]。在分位数 g 计算模型中，混合物中所有 PFAS 同时增加一个四分位数与前 9 个月母乳喂养终止的风险增加 1.17(95%CI：1.05, 1.31)相关。
我们的研究结果表明，接触 PFAS 可能与母乳喂养时间缩短有关，并进一步引起对可能扰乱人类泌乳的环境化学物质的关注。
