Early Pregnancy Perfluoroalkyl Substance Plasma Concentrations and Birth Outcomes in Project Viva: Confounded by Pregnancy Hemodynamics?

Abstract

Associations of prenatal exposure to perfluoroalkyl substances (PFASs), ubiquitous chemicals used in stain and water resistant products, with adverse birth outcomes may be confounded by pregnancy hemodynamics. We measured plasma concentrations of four PFASs in early pregnancy (median, 9 weeks) among 1,645 women in Project Viva, a Boston-area cohort recruited 1999–2002. We fit multivariable models to estimate PFAS associations with birth weight-for-gestational age z score and gestation length adjusting for sociodemographic confounders and two hemodynamic markers: 1) plasma albumin, a measure of plasma volume expansion, and 2) plasma creatinine, used to estimate glomerular filtration rate. Perfluorooctane sulfonate (PFOS) and perfluorononanoate (PFNA) were weakly inversely associated with birth weight-for-gestational age z scores (adjusted β = −0.04 (95% confidence interval (CI): −0.08, 0.1) and −0.06 (95% CI: −0.11, −0.01) per interquartile increase, respectively). PFOS and PFNA were also associated with higher odds of preterm birth (e.g., highest vs. lowest PFOS quartile adjusted odds ratio = 2.4 (95% CI: 1.3, 4.4)). Adjusting for markers of pregnancy hemodynamics (glomerular filtration rate and plasma albumin), to the extent that they accurately reflect underlying pregnancy physiology, did not materially impact associations. These results suggest that pregnancy hemodynamics may not confound associations with birth outcomes when PFASs are measured early in pregnancy.