TY - JOUR
T1 - Birth Outcomes in Relation to Prenatal Exposure to Per-and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program
AU - Environmental influences on Child Health Outcomes
AU - Padula, Amy M.
AU - Ning, Xuejuan
AU - Bakre, Shivani
AU - Barrett, Emily S.
AU - Bastain, Tracy
AU - Bennett, Deborah H.
AU - Bloom, Michael S.
AU - Breton, Carrie V.
AU - Dunlop, Anne L.
AU - Eick, Stephanie M.
AU - Ferrara, Assiamira
AU - Fleisch, Abby
AU - Geiger, Sarah
AU - Goin, Dana E.
AU - Kannan, Kurunthachalam
AU - Karagas, Margaret R.
AU - Korrick, Susan
AU - Meeker, John D.
AU - Morello-Frosch, Rachel
AU - O’connor, Thomas G.
AU - Oken, Emily
AU - Robinson, Morgan
AU - Romano, Megan E.
AU - Schantz, Susan L.
AU - Schmidt, Rebecca J.
AU - Starling, Anne P.
AU - Zhu, Yeyi
AU - Hamra, Ghassan B.
AU - Woodruff, Tracey J.
AU - Smith, P. B.
AU - Newby, K. L.
AU - Benjamin, D. K.
AU - Jacobson, L. P.
AU - Parker, C. B.
AU - Gershonand, R.
AU - Cella, D.
AU - Parsons, P.
AU - Kurunthacalam, K.
N1 - Research reported in this publication was supported by the ECHO program, Office of The Director, National Institutes of Health (NIH), under award nos. U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center, G.B.H., X.N., and S.B.); U24OD023319 (PRO Core); P01ES022841; RD83543301, R01ES027051 (T.J.W.) UH3OD023272 (S.L.S., T.J.W., R.M.-F., S.K., A.M.P., S.G., S.M.E., and D.E.G.); UH3OD023349, R01HD083369, UH3OD023349, P30ES005022 (T.G.O. and E.S.B.); UH3OD023286, UH3OD023318, R01NR014800, R24ESO29490, P50ESO2607, EPA 83615301 (A.L.D.); P30ES007048, P50ES026086, 83615801, P50MD01570, UH3OD023287 (C.V.B. and T.B.), UH3OD02333, UG3OD023316 (M.S.B.), UH3OD023289 (A.F.), UH3OD023275, NIGMS P20GM104416 (M.R.K. and M.E.R.), UH30D023342 (D.H.B. and R.J.S.), U2CES026542 (K.K.), and UH3OD023248 (A.P.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
We acknowledge the contribution of the following Environmental influences on Child Health Outcomes (ECHO) program collaborators: Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: P.B. Smith, K.L. Newby, and D.K. Benjamin; Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: L.P. Jacobson; Research Triangle Institute, Durham, North Carolina: C.B. Parker; Person-Reported Outcomes Core: Northwestern University, Evanston, Illinois: R. Gershon and D. Cella; Children’s Health Exposure Analysis Resource: Wadsworth Center, Albany, New York: P. Parsons and K. Kurunthacalam. G.B.H, X.N., and S.B. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We thank our ECHO colleagues; the medical, nursing, and program staff; as well as the children and families participating in the ECHO cohorts. Research reported in this publication was supported by the ECHO program, Office of The Director, National Institutes of Health (NIH), under award nos. U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center, G.B.H., X.N., and S.B.); U24OD023319 (PRO Core); P01ES022841; RD83543301, R01ES027051 (T.J.W.) UH3OD023272 (S.L.S., T.J.W., R.M.-F., S.K., A.M.P., S.G., S.M.E., and D.E.G.); UH3OD023349, R01HD083369, UH3OD023349, P30ES005022 (T.G.O. and E.S.B.); UH3OD023286, UH3OD023318, R01NR014800, R24ESO29490, P50ESO2607, EPA 83615301 (A.L.D.); P30ES007048, P50ES026086, 83615801, P50MD01570, UH3OD023287 (C.V.B. and T.B.), UH3OD02333, UG3OD023316 (M.S.B.), UH3OD023289 (A.F.), UH3OD023275, NIGMSP20GM104416 (M.R.K. and M.E.R.), UH30D023342 (D.H.B. and R.J.S.), U2CES026542 (K.K.), and UH3OD023248 (A.P.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
PY - 2023/3
Y1 - 2023/3
N2 - BACKGROUND: Per-and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress. OBJECTIVES: We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships. METHODS: We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS. RESULTS: We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of b = − 0:15 [95% confidence interval (CI): −0:27, −0:03], b = − 0:14 (95% CI: −0:28, −0:002), b = − 0:22 (95% CI: −0:23, −0:10), b = − 0:06 (95% CI: −0:18, 0.06), and b = − 0:25 (95% CI: −0:37, −0:14), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: ORPFNA =0:56 (95% CI: 0.38, 0.83), ORPFDA =0:52 (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [−0:28; 95% highest posterior density (HPD): −0:44, −0:14] and decreased odds of large-for-gestational-age (OR = 0:49; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress. DISCUSSION: Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723
AB - BACKGROUND: Per-and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress. OBJECTIVES: We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships. METHODS: We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS. RESULTS: We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of b = − 0:15 [95% confidence interval (CI): −0:27, −0:03], b = − 0:14 (95% CI: −0:28, −0:002), b = − 0:22 (95% CI: −0:23, −0:10), b = − 0:06 (95% CI: −0:18, 0.06), and b = − 0:25 (95% CI: −0:37, −0:14), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: ORPFNA =0:56 (95% CI: 0.38, 0.83), ORPFDA =0:52 (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [−0:28; 95% highest posterior density (HPD): −0:44, −0:14] and decreased odds of large-for-gestational-age (OR = 0:49; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress. DISCUSSION: Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723
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U2 - 10.1289/EHP10723
DO - 10.1289/EHP10723
M3 - Article
C2 - 36920051
AN - SCOPUS:85148738432
SN - 0091-6765
VL - 131
JO - Environmental health perspectives
JF - Environmental health perspectives
IS - 3
M1 - 037006
ER -