Environment/Climate Change
Per- and Polyfluoroalkyl Substances (PFAS), Perceived Stress, and Miscarriage in a Cohort of U.S. Black Women Samantha Schildroth* Samantha Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Schildroth Boston University School of Public Health
Background: Per- and polyfluoroalkyl substances (PFAS) can dysregulate hormonal and metabolic processes supporting healthy pregnancies. PFAS exposure has been associated with miscarriage risk but less is known about co-exposure to multiple PFAS and psychosocial stressors, especially among Black women.
Methods: We used prospective data from 538 participants from the Study of Environment, Lifestyle, and Fibroids who self-identified as Black/African American. We measured concentrations of six PFAS in baseline plasma samples and participants completed the Perceived Stress Scale-4 (PSS-4) at baseline. Participants reported pregnancy outcomes (miscarriage, induced abortion, ectopic/tubal pregnancy, live birth, stillbirth) at follow-up study visits (~20, 40, and 60 months). We used Cox proportional hazards models, using gestational week as the time scale, to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) characterizing miscarriage risk associated with PFAS concentrations and PSS-4 scores. We also used the survival extension of quantile-based g-computation to estimate associations of the mixture (PFAS and PSS-4 scores) with miscarriage risk.
Results: Ninety-five miscarriages were reported in the study. In Cox models, perfluorohexanesulfonic acid (PFHxS) was associated with 99% (95% CI=1.10, 3.58) and 52% (95% CI=0.73, 3.17) higher risk for miscarriage at the 50th-74th and ≥75th percentiles (vs. <50th percentile), respectively. Other PFAS were not strongly associated with miscarriage. PSS-4 scores (per 1-standard deviation increase) were associated with 23% (95% CI=0.98, 1.53) higher risk for miscarriage. The mixture (PFAS and PSS-4 scores) was non-linearly associated with higher miscarriage risk, but associations were imprecise.
Conclusions: PFHxS and experience of perceived stress were associated with higher risk of miscarriage in a cohort of Black women.