Cardiovascular
Prenatal per- and polyfluoroalkyl substances (PFAS) exposures and longitudinal blood pressure measurements in children aged 3-18 years: Findings from a racially and ethnically diverse U.S. prospective birth cohort Zeyu Li* Zeyu Li Guoying Wang Xiumei Hong Tammy M. Brady Colleen Pearson Jessie P. Buckley Xiaobin Wang Mingyu Zhang
Background: Prenatal PFAS exposures may increase offspring blood pressure (BP), but long-term studies in diverse populations are limited.
Methods: Participants were from the Boston Birth Cohort, a predominantly Black and Hispanic, low-income, and urban cohort. We measured PFAS in maternal plasma collected at delivery and extracted offspring BP from medical records. We derived age-, sex-, and height-specific BP percentiles and defined elevated BP as systolic/diastolic BP ≥90th percentile (ages 3-<13y) or ≥120/80 mmHg (ages 13-<18y). We used linear and modified Poisson mixed-effects models to examine associations of PFAS with BP percentiles and elevated BP. We used linear spline mixed-effects models to predict BP trajectories at ages 3-18y by PFAS levels. We adjusted for covariates listed in the Figure footnote.
Results: We analyzed 13,404 BP measures from 1,094 children (median follow-up: 12y [IQR: 9-15y]), with 61% Black and 22% Hispanic participants. Overall, each doubling of PFDeA, PFNA, and PFUnA was associated with a 1.02 (95% CI: 0.16-1.88), 1.15 (95% CI: 0.10-2.19), and 0.76 (95% CI: 0.14-1.39) percentile higher systolic BP, respectively. There were age-, sex-, and race/ethnicity-specific associations for PFDeA, PFHpS, PFNA, and PFUnA. For example, associations of PFDeA with systolic BP percentile were stronger in older (β3-5y=0.40; β6-12y=1.06; β13-18y=2.55), male (βmale=1.51; βfemale=0.52), and Black (βBlack=1.75; βHispanic=0.45) participants (Panel A). In males, each doubling of PFHpS was associated with a 1.09 times risk of elevated BP at ages 6-12y and a 1.17 times risk at ages 13-18y, with no increased risk at ages 3-5y (Panel B). PFHpS was associated with dose-dependent divergence in BP trajectories beginning at 13y (Panel C).
Conclusions: Prenatal PFAS exposures are associated with higher offspring BP, with stronger associations in adolescents, males, and Black children. Prenatal PFAS may have intergenerational, long-term, and latent hypertensive effects.
