Maternal Plasma Perfluoroalkyl Substances and Miscarriage: A Nested Case-Control Study in the Danish National Birth Cohort
Per- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants and endocrine disruptors. High doses of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) exposure can cause pregnancy loss and infant deaths in animals, but the associations between PFAS expo...
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| Veröffentlicht in: | Environmental health perspectives 2020-04, Vol.128 (4), p.47007 |
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| creator | Liew, Zeyan Luo, Jiajun Nohr, Ellen A Bech, Bodil Hammer Bossi, Rossana Arah, Onyebuchi A Olsen, Jørn |
| description | Per- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants and endocrine disruptors. High doses of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) exposure can cause pregnancy loss and infant deaths in animals, but the associations between PFAS exposures and risk of miscarriage in humans are not well studied.
Using a case-control study nested within the Danish National Birth Cohort (DNBC, 1996-2002), we compared 220 pregnancies ending in miscarriage during weeks 12-22 of gestation, with 218 pregnancies resulting in live births. Levels of seven types of PFAS [PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctanesulfonic acid (PFOSA)] were measured in maternal plasma collected in early gestation (mean gestational week 8). We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage and each PFAS as a continuous variable or in quartiles, controlling for maternal age, parity, socio-occupational status, smoking and alcohol intake, gestational week of blood sampling, and maternal history of miscarriage. Stratification by parity and PFAS mixture analyses using weighted quantile sum (WQS) regression were also conducted.
We observed a monotonic increase in odds for miscarriage associated with increasing PFOA and PFHpS levels. The ORs comparing the highest PFOA or PFHpS quartile to the lowest were 2.2 (95% CI: 1.2, 3.9) and 1.8 (95% CI: 1.0, 3.2). The ORs were also elevated for the second or third quartile of PFHxS or PFOS, but no consistent exposure-outcome pattern emerged. An interquartile range (IQR) increment in the WQS index of seven PFAS was associated with 64% higher odds for miscarriage (95% CI: 1.15, 2.34). The associations were stronger in parous women, while findings were inconsistent among nulliparous women.
Maternal exposures to higher levels of PFOA, PFHpS, and PFAS mixtures were associated with the risk of miscarriage and particularly among parous women. Larger replication studies among nulliparous women are needed to allay concerns about confounding by reproductive history. https://doi.org/10.1289/EHP6202. |
| doi_str_mv | 10.1289/EHP6202 |
| format | Article |
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Using a case-control study nested within the Danish National Birth Cohort (DNBC, 1996-2002), we compared 220 pregnancies ending in miscarriage during weeks 12-22 of gestation, with 218 pregnancies resulting in live births. Levels of seven types of PFAS [PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctanesulfonic acid (PFOSA)] were measured in maternal plasma collected in early gestation (mean gestational week 8). We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage and each PFAS as a continuous variable or in quartiles, controlling for maternal age, parity, socio-occupational status, smoking and alcohol intake, gestational week of blood sampling, and maternal history of miscarriage. Stratification by parity and PFAS mixture analyses using weighted quantile sum (WQS) regression were also conducted.
We observed a monotonic increase in odds for miscarriage associated with increasing PFOA and PFHpS levels. The ORs comparing the highest PFOA or PFHpS quartile to the lowest were 2.2 (95% CI: 1.2, 3.9) and 1.8 (95% CI: 1.0, 3.2). The ORs were also elevated for the second or third quartile of PFHxS or PFOS, but no consistent exposure-outcome pattern emerged. An interquartile range (IQR) increment in the WQS index of seven PFAS was associated with 64% higher odds for miscarriage (95% CI: 1.15, 2.34). The associations were stronger in parous women, while findings were inconsistent among nulliparous women.
Maternal exposures to higher levels of PFOA, PFHpS, and PFAS mixtures were associated with the risk of miscarriage and particularly among parous women. Larger replication studies among nulliparous women are needed to allay concerns about confounding by reproductive history. https://doi.org/10.1289/EHP6202.</description><identifier>ISSN: 0091-6765</identifier><identifier>EISSN: 1552-9924</identifier><identifier>DOI: 10.1289/EHP6202</identifier><identifier>PMID: 32319790</identifier><language>eng</language><publisher>United States: National Institute of Environmental Health Sciences</publisher><subject>Abortion, Spontaneous - chemically induced ; Abortion, Spontaneous - epidemiology ; Acids ; Adult ; Alcohol use ; Ammonium perfluorooctanoate ; Analysis ; Blood tests ; Case studies ; Case-Control Studies ; Confidence intervals ; Continuity (mathematics) ; Control methods ; Denmark - epidemiology ; Drinking (Alcoholic beverages) ; Drinking water ; Endocrine disruptors ; Endocrine Disruptors - adverse effects ; Endocrine Disruptors - blood ; Environmental Pollutants - adverse effects ; Environmental Pollutants - blood ; Exposure ; Female ; Fluorine compounds ; Fluorocarbons - adverse effects ; Fluorocarbons - blood ; Gestation ; Gestational age ; Humans ; Infant mortality ; Infants ; Maternal Exposure - adverse effects ; Miscarriage ; Parity ; Perfluoro compounds ; Perfluoroalkyl & polyfluoroalkyl substances ; Perfluorodecanoic acid ; Perfluorohexane ; Perfluorooctane sulfonic acid ; Perfluorooctanoic acid ; Persistent organic pollutants ; Pollutants ; Pregnancy ; Quartiles ; Regression analysis ; Sample size ; Statistical analysis ; Studies ; Sulfonates ; Womens health ; Young Adult</subject><ispartof>Environmental health perspectives, 2020-04, Vol.128 (4), p.47007</ispartof><rights>COPYRIGHT 2020 National Institute of Environmental Health Sciences</rights><rights>Reproduced from Environmental Health Perspectives. This article is published under https://ehp.niehs.nih.gov/about-ehp/copyright-permissions (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c601t-8cd8d75837cea38b975723a2e8e64ecfd810276365ee657ee9d7c3b2f53019873</citedby><cites>FETCH-LOGICAL-c601t-8cd8d75837cea38b975723a2e8e64ecfd810276365ee657ee9d7c3b2f53019873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228130/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228130/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32319790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liew, Zeyan</creatorcontrib><creatorcontrib>Luo, Jiajun</creatorcontrib><creatorcontrib>Nohr, Ellen A</creatorcontrib><creatorcontrib>Bech, Bodil Hammer</creatorcontrib><creatorcontrib>Bossi, Rossana</creatorcontrib><creatorcontrib>Arah, Onyebuchi A</creatorcontrib><creatorcontrib>Olsen, Jørn</creatorcontrib><title>Maternal Plasma Perfluoroalkyl Substances and Miscarriage: A Nested Case-Control Study in the Danish National Birth Cohort</title><title>Environmental health perspectives</title><addtitle>Environ Health Perspect</addtitle><description>Per- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants and endocrine disruptors. High doses of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) exposure can cause pregnancy loss and infant deaths in animals, but the associations between PFAS exposures and risk of miscarriage in humans are not well studied.
Using a case-control study nested within the Danish National Birth Cohort (DNBC, 1996-2002), we compared 220 pregnancies ending in miscarriage during weeks 12-22 of gestation, with 218 pregnancies resulting in live births. Levels of seven types of PFAS [PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctanesulfonic acid (PFOSA)] were measured in maternal plasma collected in early gestation (mean gestational week 8). We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage and each PFAS as a continuous variable or in quartiles, controlling for maternal age, parity, socio-occupational status, smoking and alcohol intake, gestational week of blood sampling, and maternal history of miscarriage. Stratification by parity and PFAS mixture analyses using weighted quantile sum (WQS) regression were also conducted.
We observed a monotonic increase in odds for miscarriage associated with increasing PFOA and PFHpS levels. The ORs comparing the highest PFOA or PFHpS quartile to the lowest were 2.2 (95% CI: 1.2, 3.9) and 1.8 (95% CI: 1.0, 3.2). The ORs were also elevated for the second or third quartile of PFHxS or PFOS, but no consistent exposure-outcome pattern emerged. An interquartile range (IQR) increment in the WQS index of seven PFAS was associated with 64% higher odds for miscarriage (95% CI: 1.15, 2.34). The associations were stronger in parous women, while findings were inconsistent among nulliparous women.
Maternal exposures to higher levels of PFOA, PFHpS, and PFAS mixtures were associated with the risk of miscarriage and particularly among parous women. Larger replication studies among nulliparous women are needed to allay concerns about confounding by reproductive history. https://doi.org/10.1289/EHP6202.</description><subject>Abortion, Spontaneous - chemically induced</subject><subject>Abortion, Spontaneous - epidemiology</subject><subject>Acids</subject><subject>Adult</subject><subject>Alcohol use</subject><subject>Ammonium perfluorooctanoate</subject><subject>Analysis</subject><subject>Blood tests</subject><subject>Case studies</subject><subject>Case-Control Studies</subject><subject>Confidence intervals</subject><subject>Continuity (mathematics)</subject><subject>Control methods</subject><subject>Denmark - epidemiology</subject><subject>Drinking (Alcoholic beverages)</subject><subject>Drinking water</subject><subject>Endocrine disruptors</subject><subject>Endocrine Disruptors - adverse effects</subject><subject>Endocrine Disruptors - blood</subject><subject>Environmental Pollutants - adverse effects</subject><subject>Environmental Pollutants - blood</subject><subject>Exposure</subject><subject>Female</subject><subject>Fluorine compounds</subject><subject>Fluorocarbons - adverse effects</subject><subject>Fluorocarbons - blood</subject><subject>Gestation</subject><subject>Gestational age</subject><subject>Humans</subject><subject>Infant mortality</subject><subject>Infants</subject><subject>Maternal Exposure - adverse effects</subject><subject>Miscarriage</subject><subject>Parity</subject><subject>Perfluoro compounds</subject><subject>Perfluoroalkyl & polyfluoroalkyl substances</subject><subject>Perfluorodecanoic acid</subject><subject>Perfluorohexane</subject><subject>Perfluorooctane sulfonic acid</subject><subject>Perfluorooctanoic acid</subject><subject>Persistent organic pollutants</subject><subject>Pollutants</subject><subject>Pregnancy</subject><subject>Quartiles</subject><subject>Regression analysis</subject><subject>Sample size</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Sulfonates</subject><subject>Womens health</subject><subject>Young 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Plasma Perfluoroalkyl Substances and Miscarriage: A Nested Case-Control Study in the Danish National Birth Cohort</title><author>Liew, Zeyan ; Luo, Jiajun ; Nohr, Ellen A ; Bech, Bodil Hammer ; Bossi, Rossana ; Arah, Onyebuchi A ; Olsen, Jørn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c601t-8cd8d75837cea38b975723a2e8e64ecfd810276365ee657ee9d7c3b2f53019873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abortion, Spontaneous - chemically induced</topic><topic>Abortion, Spontaneous - epidemiology</topic><topic>Acids</topic><topic>Adult</topic><topic>Alcohol use</topic><topic>Ammonium perfluorooctanoate</topic><topic>Analysis</topic><topic>Blood tests</topic><topic>Case studies</topic><topic>Case-Control Studies</topic><topic>Confidence intervals</topic><topic>Continuity (mathematics)</topic><topic>Control methods</topic><topic>Denmark - 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Collection</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>Environment Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Environmental health perspectives</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liew, Zeyan</au><au>Luo, Jiajun</au><au>Nohr, Ellen A</au><au>Bech, Bodil Hammer</au><au>Bossi, Rossana</au><au>Arah, Onyebuchi A</au><au>Olsen, Jørn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maternal Plasma Perfluoroalkyl Substances and Miscarriage: A Nested Case-Control Study in the Danish National Birth Cohort</atitle><jtitle>Environmental health perspectives</jtitle><addtitle>Environ Health Perspect</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>128</volume><issue>4</issue><spage>47007</spage><pages>47007-</pages><issn>0091-6765</issn><eissn>1552-9924</eissn><abstract>Per- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants and endocrine disruptors. High doses of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) exposure can cause pregnancy loss and infant deaths in animals, but the associations between PFAS exposures and risk of miscarriage in humans are not well studied.
Using a case-control study nested within the Danish National Birth Cohort (DNBC, 1996-2002), we compared 220 pregnancies ending in miscarriage during weeks 12-22 of gestation, with 218 pregnancies resulting in live births. Levels of seven types of PFAS [PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctanesulfonic acid (PFOSA)] were measured in maternal plasma collected in early gestation (mean gestational week 8). We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage and each PFAS as a continuous variable or in quartiles, controlling for maternal age, parity, socio-occupational status, smoking and alcohol intake, gestational week of blood sampling, and maternal history of miscarriage. Stratification by parity and PFAS mixture analyses using weighted quantile sum (WQS) regression were also conducted.
We observed a monotonic increase in odds for miscarriage associated with increasing PFOA and PFHpS levels. The ORs comparing the highest PFOA or PFHpS quartile to the lowest were 2.2 (95% CI: 1.2, 3.9) and 1.8 (95% CI: 1.0, 3.2). The ORs were also elevated for the second or third quartile of PFHxS or PFOS, but no consistent exposure-outcome pattern emerged. An interquartile range (IQR) increment in the WQS index of seven PFAS was associated with 64% higher odds for miscarriage (95% CI: 1.15, 2.34). The associations were stronger in parous women, while findings were inconsistent among nulliparous women.
Maternal exposures to higher levels of PFOA, PFHpS, and PFAS mixtures were associated with the risk of miscarriage and particularly among parous women. Larger replication studies among nulliparous women are needed to allay concerns about confounding by reproductive history. https://doi.org/10.1289/EHP6202.</abstract><cop>United States</cop><pub>National Institute of Environmental Health Sciences</pub><pmid>32319790</pmid><doi>10.1289/EHP6202</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0091-6765 |
| ispartof | Environmental health perspectives, 2020-04, Vol.128 (4), p.47007 |
| issn | 0091-6765 1552-9924 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7228130 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; Jstor Complete Legacy; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Abortion, Spontaneous - chemically induced Abortion, Spontaneous - epidemiology Acids Adult Alcohol use Ammonium perfluorooctanoate Analysis Blood tests Case studies Case-Control Studies Confidence intervals Continuity (mathematics) Control methods Denmark - epidemiology Drinking (Alcoholic beverages) Drinking water Endocrine disruptors Endocrine Disruptors - adverse effects Endocrine Disruptors - blood Environmental Pollutants - adverse effects Environmental Pollutants - blood Exposure Female Fluorine compounds Fluorocarbons - adverse effects Fluorocarbons - blood Gestation Gestational age Humans Infant mortality Infants Maternal Exposure - adverse effects Miscarriage Parity Perfluoro compounds Perfluoroalkyl & polyfluoroalkyl substances Perfluorodecanoic acid Perfluorohexane Perfluorooctane sulfonic acid Perfluorooctanoic acid Persistent organic pollutants Pollutants Pregnancy Quartiles Regression analysis Sample size Statistical analysis Studies Sulfonates Womens health Young Adult |
| title | Maternal Plasma Perfluoroalkyl Substances and Miscarriage: A Nested Case-Control Study in the Danish National Birth Cohort |
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