Association of serum concentrations of per- and polyfluoroalkyl substances in early pregnancy with risk of gestational diabetes mellitus: a prospective nested case-control study

Abstract

ObjectiveTo analyze the association between serum concentrations of per- and polyfluoroalkyl substances (PFASs) in early pregnancy and the risk of gestational diabetes mellitus (GDM) among pregnant women in Tianjin, and to provide guidance for the prevention and control of GDM and the establishment of related environmental health policies. MethodsA prospective nested case-control study was conducted among 480 early pregnant women (gestational age 8 – 13 weeks and plus 6 days) in Tianjin between 2010 and 2012. Online solid-phase extraction (SPE) – ultra-performance liquid chromatography (UPLC)-high resolution mass spectrometry (HRMS) was used to measure the concentrations of 35 types of PFASs in serum samples from 240 GDM patients and 240 age-matched non-GDM pregnant women. Logistic regression models were used to analyze the association between PFAS exposure in early pregnancy and the risk of developing GDM. ResultsOf the 35 PFASs analyzed, 16 had a detection rate greater than 60% among all participants, with the highest mean concentration of 5.2089 ng/mL for 6 : 2 chlorinated polyfluorinated ether sulfonate (6 : 2 Cl-PFESA). The Mann-Whitney U test showed that the median concentrations of perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), and perfluoropentane sulfonate (PFPeS) were higher in the GDM group than in the non-GDM group, whereas the concentration of 8 : 2 chlorinated polyfluorinated ether sulfonate (8 : 2 Cl-PFESA) was lower (P < 0.05 for all). The results of multivariate logistic regression showed that among the 16 PFASs with a detection rate greater than 60%, the levels of PFNA, PFOA, and PFPeS were positively correlated with the risk of GDM, with odds ratios (OR) (95% confidence interval [CI]) of 1.655 (1.023 – 2.679), 1.277 (1.090 – 1.496), and 1.218 (1.032 – 1.434), respectively (all P < 0.05), whereas 8 : 2 Cl-PFESA (OR = 0.427, 95%CI: 0.227 – 0.802) was inversely correlated with the risk of GDM. When the concentration levels of the four PFASs mentioned above were grouped into tertiles, participants with PFNA, PFOA, and PFPeS concentrations in the third tertile had an increased risk of GDM compared to those with concentrations in the first tertile (P < 0.05 for all). ConclusionExposure to PFAS in early pregnancy is associated with the occurrence of GDM, and PFNA, PFOA, and PFPeS are risk factors for GDM.

Keywords

• per- and polyfluoroalkyl substances
• pregnant women
• gestational diabetes mellitus