Perinatal & Pediatric
Associations of early-to-mid-pregnancy per- and polyfluoroalkyl substances with maternal gestational weight gain Maria Cinzori* Maria Cinzori Diana Pacyga Libeth Rosas Sabrina Smith June-Soo Park Joseph Gardiner Joseph Braun Susan Schantz Rita Strakovsky
Background: Per- and polyfluoroalkyl substances (PFAS) are metabolic disruptors, but their impact on gestational weight gain (GWG) is unknown. Thus, we evaluated overall and pre-pregnancy body mass index (ppBMI)-specific associations of PFAS with GWG.
Methods: Pregnant Illinois women (n=486) reported weights pre-pregnancy and at their last obstetric appointment before delivery, which we used to calculate gestational age- and ppBMI-specific GWG z-scores (GWGz) using an international reference. We quantified serum perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS) and perfluorodecanoic acid (PFDeA) levels. We calculated ppBMI and categorized women as having under/normal weight (BMI<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI≥30 kg/m2). Using linear regression adjusting for potential confounders (e.g. age, race, employment, income, parity, smoking, alcohol use, stress), we evaluated associations of ln-transformed maternal PFAS levels with GWGz. We also explored differences by ppBMI using a multiplicative interaction term.
Results: In a sample of healthy women with low PFAS levels, the median (25th, 75th percentiles) GWGz was 0.4 (-0.3, 1.1). Overall, only PFNA and PFOS were associated with lower GWGz, but associations differed by ppBMI. In under/normal weight women, each 10% increase in PFNA (β: -0.8, 95% confidence interval (CI): -1.4, -0.2), PFOA (β: -0.3, 95%CI: -0.6, 0.0), PFOS (β: -0.3, 95%CI: -0.5, -0.1), and PFHxS (β: -0.2, 95%CI: -0.5, 0.0) was associated with lower GWGz. However, in women with obesity, each 10% increase in PFNA (β: 1.0, 95%CI: -0.1, 2.0), PFOA (β: 0.5, 95%CI: -0.1, 1.0), and PFDeA (β: 3.2, 95%CI: 0.4, 5.9) was associated with higher GWGz. We observed no associations in women with overweight.
Conclusions: Associations of PFAS with GWG may differ by ppBMI. Studies could consider implications of these findings for maternal and fetal health.