Early Pregnancy Plasma Per- and Polyfluoroalkyl Substances (PFAS) and Maternal Cardiometabolic Health

Cardiovascular disease, a condition significantly impacted by overall cardiometabolic health, is the leading cause of death for women in the United States. Studying environmental exposures during windows of elevated physiological susceptibility, specifically pregnancy, is critical to manage women’s cardiometabolic health. Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals that humans are regularly exposure to via ingestion of contaminated food, drinking water, and dust. Substantial evidence of effects of PFAS on women’s health is currently growing; however, less information about the associations between PFAS exposure in pregnancy and maternal cardiometabolic health is available. In Chapter 1, unlike previous research that assessed BP in discrete time periods of pregnancy, we used a novel trajectory estimation method to assess first trimester PFAS concentrations with parameters of overall BP trajectories across later stages of pregnancy. In a subset of the Massachusetts-based Project Viva pre-birth cohort (N = 1297), a higher concentration of perfluorooctane sulfonate (PFOS) was associated with higher magnitude of overall systolic BP (SBP) and diastolic BP (DBP) trajectories, as well as faster SBP trajectory velocity. In stratified analyses, participants with parity ≥1 had more pronounced positive associations between PFOS and BP trajectory parameters. In Chapter 2, to supplement published research that assessed individual PFAS, we used multiple recently developed mixtures methods to evaluate the associations between early pregnancy PFAS and parameters of maternal weight trajectory spanning 6 months to 17 years post index pregnancy. Among 1106 Project Viva participants, we observed an increase in trajectory magnitude with higher PFOS concentrations and a decrease in trajectory magnitude with higher perfluorononanoic acid (PFNA) concentrations. In stratified analyses, older participants had more pronounced positive associations between PFOS and weight trajectory velocity. In Chapter 3, to show the potential long-lasting associations with PFAS, we used anthropometrics and dual energy x-ray absorptiometry measurements to assess associations of early pregnancy PFAS with maternal adiposity up to 20 years post index pregnancy. Data from Project Viva participants (N = 546) showed positive relationships between PFOS and weight, trunk fat mass, and total body fat mass at midlife. Conversely, PFNA and perfluorohexane sulfonate were negativ