Per- and Polyfluoroalkyl Substances in Early Pregnancy and Risk for Preeclampsia: A Case-Control Study in Southern Sweden.

Lars Rylander,Stefan R Hansson,Karin Källén,Christian H Lindh,Karin Broberg

doi:10.3390/toxics8020043

Lars Rylander, Stefan R Hansson + Show 3 more

Open Access

https://doi.org/10.3390/toxics8020043

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Journal: Toxics	Publication Date: Jun 16, 2020
Citations: 29	License type: CC BY 4.0

Affiliation: Lund University, Karolinska Institutet

Abstract

Preeclampsia is one of the most common causes of perinatal and maternal morbidity/mortality. One suggested environmental risk factor is exposure to endocrine-disrupting pollutants such as per- and polyfluoroalkyl substances (PFAS). The present case-control study in southern Sweden aims to investigate the hypothesized association between serum concentrations of PFAS in early pregnancy and the risk of developing preeclampsia. The study included 296 women diagnosed with preeclampsia (cases) and 580 healthy pregnant women (controls). Maternal serum samples were obtained from a biobank of samples collected in early pregnancy in connection with screening for infections. Serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS) were analyzed using liquid chromatography-tandem-mass-spectrometry (LC/MS/MS). Among primiparous women, there were no differences in PFAS concentrations in early pregnancy between the cases and the controls whereas among multipara women, the cases had significantly higher concentrations of PFNA (median concentrations were 0.44 and 0.38 ng/mL, p = 0.04). When individual PFAS were categorized into quartiles and adjustment for potential confounders was performed, the women in the highest quartiles had no significant increased risks of developing preeclampsia as compared with women in the lowest category. In conclusion, the present study provides limited support for the hypothesized association between PFAS and preeclampsia in a population with relatively low exposure levels.

Highlights

Preeclampsia affects 3–7 percent of all pregnancies each year and is one of the most common causes of perinatal and maternal morbidity and mortality [1,2]
With one exception, pairwise correlations showed that the different polyfluoroalkyl substances (PFAS) were significantly correlated in the cases as well as among the controls (Table 2)
The significant correlation coefficients varied from 0.14 to 0.68, with the strongest correlation observed between perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS)

Summary

Introduction

Preeclampsia affects 3–7 percent of all pregnancies each year and is one of the most common causes of perinatal and maternal morbidity and mortality [1,2]. Preeclampsia has been called “the disease of theories” because so much is unknown, and many different explanations for the disease have been proposed over the years [3]. There are some factors which increase the risk for preeclampsia, such as being primipara, having a history of preeclampsia, high maternal body mass index (BMI), presence of certain systemic diseases such as diabetes and hypertension, African ethnicity, increased maternal age, and long inter-pregnancy interval, whereas smoking has been observed to decrease the risk [3]. Overall, these factors only explain a relatively small portion of the preeclampsia cases and any “new” risk factor that can be identified and eliminated/reduced is of great importance.

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