Cord-blood PFBS linked to preeclampsia in Shanghai

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Among Shanghai births, higher standardized cord PFBS associated with preeclampsia (AOR 1.81) and overall hypertensive disorders of pregnancy (AOR 1.64) in a dose-response pattern.

Source

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the risk of hypertensive disorders of pregnancy

Huang R, Chen Q, Zhang L, et al. · Environmental health : a global access science source · 2019

doi.org/10.1186/s12940-018-0445-3 Read the full paper ↗112 citationscc by

Study at a glance

Design: Cohort — Shanghai delivery cohort with cord-blood PFAS and recorded hypertensive disorders of pregnancy
N: N=687 · 687 women delivering singletons at two Shanghai hospitals (13 excluded for missing covariates in some models)
Population: Women delivering at two Shanghai hospitals, 2011–2012
Outcome: Hypertensive disorders of pregnancy and preeclampsia related to cord PFAS (esp. PFBS)

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What they did

Authors recruited women delivering at two Shanghai hospitals, quantified eight PFAS in cord blood, classified HDP/preeclampsia from records, and used elastic-net then unpenalized logistic models with confounder adjustment.

What they found

HDP, preeclampsia, and gestational hypertension rates were 6.1%, 2.8%, and 3.3%. PFOA was the highest median PFAS (6.98 ng/ml) but PFBS (median 0.047 ng/ml) was selected for HDP/preeclampsia. AOR 1.64 for HDP and 1.81 for preeclampsia per standardized PFBS unit.

The limits

What it doesn't show

Cord blood is not a full pregnancy-long exposure history, and observational AORs cannot prove PFBS causes preeclampsia.

Key terms

PFBS: Short-chain perfluorobutane sulfonate, a PFOS replacement found in cord blood.
Hypertensive disorders of pregnancy (HDP): Gestational hypertension, preeclampsia, chronic hypertension, or superimposed preeclampsia.
Preeclampsia: New hypertension with organ injury in pregnancy; major cause of maternal/perinatal morbidity.
Elastic net: Penalized regression that selects among correlated PFAS while shrinking noise.
Cord-blood PFAS: PFAS measured at delivery in umbilical cord plasma as a prenatal exposure marker.

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PFAS linked to preeclampsia here:

Common questions

Which PFAS associated with preeclampsia?

PFBS, despite low median concentration.

Preeclampsia AOR per standardized PFBS?

1.81 (95% CI 1.03–3.17).

HDP rate in the sample?

6.1%.

Highest-concentration PFAS?

PFOA (median 6.98 ng/ml).