Friedman Chloe, Dabelea Dana, Keil Alexander P, Adgate John L, Glueck Deborah H, Calafat Antonia M, Starling Anne P
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Environ Epidemiol. 2023 Jun 16;7(4):e260. doi: 10.1097/EE9.0000000000000260. eCollection 2023 Aug.
Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals that may affect breastfeeding duration. We examined associations between maternal PFAS concentrations during pregnancy and breastfeeding cessation. We investigated potential effect modification by parity status.
Among 555 women enrolled in the Healthy Start study (2009-2014), we quantified maternal serum concentrations of 5 PFAS during mid- to late-pregnancy (mean 27 weeks of gestation). Participants self-reported their breastfeeding practices through 18-24 months postnatally. Among all participants and stratified by parity, we estimated associations between maternal PFAS concentrations and breastfeeding discontinuation by 3 and 6 months, using Poisson regression, and breastfeeding duration, using Cox regression.
Median PFAS concentrations were similar to those in the general US population. Associations between PFAS and breastfeeding duration differed by parity status. After adjusting for covariates, among primiparous women, associations between PFAS and breastfeeding cessation by 3 and 6 months were generally null, with some inverse associations. Among multiparous women, there were positive associations between perfluorohexane sulfonate, perfluorooctane sulfonate, perfluorooctanoate (PFOA), and perfluorononanoate and breastfeeding cessation by 3 and 6 months. For example, per ln-ng/mL increase in PFOA, the risk ratio for breastfeeding discontinuation by 6 months was 1.45 (95% confidence interval, 1.18, 1.78). Hazard ratios reflected similar patterns between PFAS and breastfeeding duration.
Among primiparous women, we did not find evidence for associations between PFAS concentrations and breastfeeding duration. In contrast, among multiparous women, PFAS serum concentrations were generally inversely associated with breastfeeding duration, though estimates may be biased due to confounding by unmeasured previous breastfeeding.
全氟和多氟烷基物质（PFAS）是可能影响母乳喂养持续时间的内分泌干扰化学物质。我们研究了孕期母亲PFAS浓度与母乳喂养停止之间的关联。我们调查了产次状态对潜在效应的修饰作用。
在参与“健康起步”研究（2009 - 2014年）的555名女性中，我们对孕中期至晚期（平均妊娠27周）母亲血清中5种PFAS的浓度进行了定量。参与者在产后18 - 24个月自我报告其母乳喂养情况。在所有参与者中并按产次分层，我们使用泊松回归估计母亲PFAS浓度与3个月和6个月时母乳喂养中断之间的关联，使用Cox回归估计母乳喂养持续时间。
PFAS浓度中位数与美国普通人群相似。PFAS与母乳喂养持续时间之间的关联因产次状态而异。在调整协变量后，在初产妇中，PFAS与3个月和6个月时母乳喂养停止之间的关联通常无统计学意义，有一些负相关。在经产妇中，全氟己烷磺酸、全氟辛烷磺酸、全氟辛酸（PFOA）和全氟壬酸与3个月和6个月时母乳喂养停止之间存在正相关。例如，PFOA每增加ln - ng/mL，6个月时母乳喂养中断的风险比为1.45（95%置信区间，1.18，1.78）。风险比反映了PFAS与母乳喂养持续时间之间的相似模式。
在初产妇中，我们未发现PFAS浓度与母乳喂养持续时间之间存在关联的证据。相比之下，在经产妇中，PFAS血清浓度通常与母乳喂养持续时间呈负相关，尽管由于未测量的既往母乳喂养造成的混杂，估计值可能存在偏差。
