Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program

Amy M Padula; Xuejuan Ning; Shivani Bakre; Emily S Barrett; Tracy Bastain; Deborah H Bennett; Michael S Bloom; Carrie V Breton; Anne L Dunlop; Stephanie M Eick; Assiamira Ferrara; Abby Fleisch; Sarah Geiger; Dana E Goin; Kurunthachalam Kannan; Margaret R Karagas; Susan Korrick; John D Meeker; Rachel Morello-Frosch; Thomas G O'Connor; Emily Oken; Morgan Robinson; Megan E Romano; Susan L Schantz; Rebecca J Schmidt; Anne P Starling; Yeyi Zhu; Ghassan B Hamra; Tracey J Woodruff; program collaborators for Environmental influences on Child Health Outcomes

doi:10.1289/EHP10723

Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program

Environ Health Perspect. 2023 Mar;131(3):37006. doi: 10.1289/EHP10723. Epub 2023 Mar 15.

Authors

Amy M Padula¹, Xuejuan Ning², Shivani Bakre², Emily S Barrett³, Tracy Bastain⁴, Deborah H Bennett⁵, Michael S Bloom⁶, Carrie V Breton⁴, Anne L Dunlop⁷, Stephanie M Eick¹, Assiamira Ferrara⁸, Abby Fleisch^{9

10}, Sarah Geiger¹¹, Dana E Goin¹, Kurunthachalam Kannan¹², Margaret R Karagas¹³, Susan Korrick^{10

14}, John D Meeker¹⁵, Rachel Morello-Frosch¹⁶, Thomas G O'Connor¹⁷, Emily Oken¹⁸, Morgan Robinson¹², Megan E Romano¹³, Susan L Schantz¹⁹, Rebecca J Schmidt⁵, Anne P Starling^{20

21}, Yeyi Zhu⁸, Ghassan B Hamra², Tracey J Woodruff¹; program collaborators for Environmental influences on Child Health Outcomes

Affiliations

¹ Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.
² Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
³ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁵ Department of Public Health Sciences, University of California, Davis, Davis, California, USA.
⁶ Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA.
⁷ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁹ Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA.
¹⁰ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹¹ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.
¹² Department of Pediatrics and Department of Environmental Medicine, New York University Grossman School of Medicine, New York, New York, USA.
¹³ Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA.
¹⁴ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹⁵ Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.
¹⁶ School of Public Health and Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, California, USA.
¹⁷ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
¹⁸ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
¹⁹ Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.
²⁰ Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²¹ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Abstract

Background: Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress.

Objectives: We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships.

Methods: We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS.

Results: We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of $β = - 0.15$ [95% confidence interval (CI): $- 0.27$ , $- 0.03$ ], $β = - 0.14$ (95% CI: $- 0.28$ , $- 0.002$ ), $β = - 0.22$ (95% CI: $- 0.23$ , $- 0.10$ ), $β = - 0.06$ (95% CI: $- 0.18$ , 0.06), and $β = - 0.25$ (95% CI: $- 0.37$ , $- 0.14$ ), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: ${OR}_{PFNA} = 0.56$ (95% CI: 0.38, 0.83), ${OR}_{PFDA} = 0.52$ (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [ $- 0.28$ ; 95% highest posterior density (HPD): $- 0.44$ , $- 0.14$ ] and decreased odds of large-for-gestational-age ( $OR = 0.49$ ; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress.

Discussion: Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Alkanesulfonic Acids*
Bayes Theorem
Birth Weight
Child
Cohort Studies
Environmental Pollutants* / adverse effects
Female
Fluorocarbons* / adverse effects
Humans
Outcome Assessment, Health Care
Pregnancy
Prenatal Exposure Delayed Effects* / chemically induced
Prenatal Exposure Delayed Effects* / epidemiology
Prospective Studies

Substances

Environmental Pollutants
perfluoro-n-nonanoic acid
Fluorocarbons
perfluorodecanoic acid
Alkanesulfonic Acids

Abstract

Publication types

MeSH terms

Substances

Grants and funding