BACKGROUND AND AIM: Exposure to environmental chemicals may increase the risk of cardiovascular disease. However, data on associations between per- and polyfluoroalkyl substances (PFASs) and hypertensive disorders of pregnancy (HDP) are limited and inconsistent. We sought to determine the extent to which early-pregnancy PFAS concentrations are prospectively associated with HDP risk in a large cohort. METHODS: We studied 1,537 pregnant women from the Project Viva cohort in Boston, Massachusetts, USA. Using maternal plasma samples collected from 1999-2002 at a median of 9.7 gestational weeks, we quantified concentrations of eight PFAS [perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), perfluorononanoate (PFNA), 2-(N-ethyl-perfluorooctane sulfonamide) acetate (EtFOSAA), 2-(N-methyl-perfluorooctane sulfonamide) acetate (MeFOSAA), perfluorodecanoate (PFDeA), perfluorooctane sulfonamide (FOSA)]. PFDeA and FOSA were detected in 50% of samples and were not included in further analyses. We assessed HDP using clinical data and defined preeclampsia and gestational hypertension according to the National High Blood Pressure Education Program recommendations. We used multinomial logistic regression to estimate associations of log2-transformed continuous PFAS concentrations with categories of HDP [gestational hypertension, preeclampsia, normotensive (ref)], adjusting for age, race/ethnicity, education, smoking, marital status, and parity. RESULTS:A total of 56 (4%) of women developed preeclampsia and 106 (7%) developed gestational hypertension. We observed higher risk of gestational hypertension per doubling of concentrations of PFOS (odds ratio [OR] 1.28, 95% confidence interval [CI]: 0.96, 1.70), PFOA (OR 1.36, 95% CI: 0.99, 1.86), and PFHxS (OR 1.22, 95% CI: 1.01, 1.48). Associations with other PFAS were consistent in direction but smaller in magnitude (e.g., EtFOSAA: OR 1.14, 95% CI: 0.95, 1.38). We did not observe associations between PFAS concentrations and preeclampsia. CONCLUSIONS:Our results support the hypothesis that PFAS exposure during pregnancy may increase the risk of gestational hypertension. However, we did not observe associations between PFAS exposure and preeclampsia. KEYWORDS: PFAS, hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, pregnancy
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