Prenatal exposure to per- and polyfluoroalkyl substances and infancy/child growth trajectories through 2 years

Abstract

BACKGROUND AND AIM: Prenatal exposure to poly- and per-fluoroalkyl substances (PFAS) has been associated with reduced birth weight, but also with excess adiposity and overweight in childhood. These mixed findings warrant investigation of relationships between prenatal PFAS exposure and dynamic offspring growth. This study aims to investigate the association between prenatal PFAS exposure and early life growth trajectories through 2 years. METHODS: In a prospective cohort of women and their children from Shanghai, China, we quantified seven PFAS congeners in pregnant women’s serum during the first trimester. Four anthropometric measures, including weight (n=1346), length/height (n=1140), weight-for-length (n=1134), and head circumference (HC, n=1082), were evaluated among children at birth (3 days), 42 days, 6 months, 12 months, and 24 months, and then standardized into z scores. Trajectory groups were identified using group-based trajectory modeling for each measure. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for trajectory groups according to log2-transformed PFAS concentrations. RESULTS:Five trajectory groups were identified for each anthropometric measure, respectively. In each measure, the trajectory with a stable trend near the null z score was selected as the reference group. Prenatal exposure to PFAS was consistently associated with elevated odds for weight low-rising trajectory characterized by rapid increase from a low birth weight (e.g., perfluorohexane sulfonate (PFHxS): OR=1.54, 95% CI: 1.10-2.14) and length/height high-rising trajectory characterized by increase from a large value (e.g., perfluorononanoic acid (PFNA): OR=1.69, 95% CI: 1.05-2.73). Inverse associations were observed with HC high-stable trajectory characterized by large HC (e.g., perfluoroheptanoic acid (PFHpA): OR=0.75, 95% CI: 0.58-0.96) and HC low-stable trajectory characterized by small HC (e.g., PFHxS: OR=0.70, 95% CI: 0.50-1.00). No association was observed for weight-for-length trajectories. CONCLUSIONS:We observed associations between prenatal PFAS exposure and unusual growth trajectories in early life, suggesting enduring impact of prenatal PFAS exposure. KEYWORDS: PFAS, Birth outcomes, Endocrine disrupting chemicals, Multi-pollutant, Environmental epidemiology