Prenatal and Peripubertal Exposure to Per- and Polyfluoroalkyl Substances and Pubertal Development in Boys and Girls in the HOME Study

Abstract

Background/Aim: Per- and polyfluoroalkyl substances (PFAS) exposures in pregnancy and childhood have been associated with lower sex hormones levels in children, but few prospective studies have estimated the effect of PFAS on secondary sex characteristics. We examined the associations of prenatal and peripubertal exposure to PFAS with sexual maturation. Methods: We used data from a prospective pregnancy and birth cohort study in Cincinnati, OH (the HOME Study, enrolled: 2003-2006). We quantified serum concentrations of four PFAS—perfluorooctane sulfonate, perfluorooctanoate (PFOA), perfluorononanoate, and perfluorohexane sulfonate—in mothers at ~16 weeks gestation and their children at age ~12 years (120 girls and 96 boys). At age ~12 years, we collected pubertal data by self-reported Tanner staging of pubic hair growth (boys and girls) and breast growth (girls), as well as age at menarche in girls. We estimated covariate-adjusted associations between PFAS and stages of breast and pubic hair growth (stage 1 to 5) using ordinal regression models. We evaluated age at menarche using Cox proportional-hazard models that account for censored data. Results: Mean age at menarche was 11.6 years; 82% and 97% of boys and girls, respectively, were stage 2+ for pubic hair development; and 96% of girls were stage 2+ for breast growth. We observed that higher peripubertal serum concentrations of all PFAS were associated with later puberty among girls. For example, one IQR increase in PFOA (3.5 ng/mL) was inversely associated with breast (OR=0.47, 95%CI:0.22-0.98) and pubic hair (OR=0.84, 95%CI:0.45-1.58) growth, and age at menarche (HR=0.66, 95%CI:0.37-1.18). We found no clear pattern in males or for prenatal concentrations. Conclusions: These data suggest that higher peripubertal PFAS concentrations may be associated with later pubertal development in girls, but not boys.