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      Perfluoroalkyl Acids in Maternal Serum and Indices of Fetal Growth: The Aarhus Birth Cohort

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          Abstract

          Background:

          Previous studies indicated an association between intrauterine exposure to perfluorooctane sulfonate (PFOS) or perfluorooctanoate (PFOA) and lower birth weight. However, these perfluoroalkyl acids (PFAAs) have to some extent been substituted by other compounds on which little is known.

          Objectives:

          We investigated the association between specific PFAAs and birth weight, birth length, and head circumference at birth.

          Methods:

          We studied 1,507 mothers and their children from the Aarhus Birth Cohort (2008–2013). Nulliparous women were included during pregnancy, and serum levels of 16 PFAAs were measured between 9 and 20 completed gestational weeks (96% within 13 weeks). For compounds with quantifiable values in > 50% of samples (7 compounds), we report the associations with birth weight, birth length, and head circumference at birth determined by multivariable linear regression.

          Results:

          Estimated mean birth weights were lower among women with serum perfluorohexane sulfonate, perfluoroheptane sulfonate, and PFOS concentrations above the lowest exposure quartile, but we found no consistent monotonic dose–response patterns. These associations were stronger when the population was restricted to term births (n = 1,426). For PFOS, the birth weight estimates for the highest versus lowest quartile were –50 g (95% CI: –123, 23 g) in all births and –62 g (95% CI: –126, 3 g) in term births. For the other PFAAs, the direction of the associations was inconsistent, and no overall association with birth weight was apparent. No PFAAs were associated with birth length or head circumference at birth.

          Conclusions:

          Overall, we did not find strong or consistent associations between PFAAs and birth weight or other indices of fetal growth, though estimated mean birth weights were lower among those with exposures above the lowest quartile for some compounds.

          Citation:

          Bach CC, Bech BH, Nohr EA, Olsen J, Matthiesen NB, Bonefeld-Jørgensen EC, Bossi R, Henriksen TB. 2016. Perfluoroalkyl acids in maternal serum and indices of fetal growth: the Aarhus Birth Cohort. Environ Health Perspect 124:848–854; http://dx.doi.org/10.1289/ehp.1510046

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          Most cited references45

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          Intrauterine growth curves based on ultrasonically estimated foetal weights.

          H Lilja, Louise J. P. Persson, A Selbing … (1996)
          Available standard intrauterine growth curves based on birthweights underestimate foetal growth in preterm period. New growth curves are presented based on data from four Scandinavian centres for 759 ultrasonically estimated foetal weights in 86 uncomplicated pregnancies. Mean weight of boys exceeded that of girls by 2-3%. A uniform SD value of 12% of the mean weight was adopted for the standard curves as the true SD varied non-systematically between 9.1 and 12.4%. Applied to an unselected population of 8663 singleton births, before 210 days of gestation, 32% of birthweights were classified as small-for-gestational age (SGA; i.e. below mean - 2 SD); the corresponding figures were 11.1% for gestational ages between 210 and 258 days, and 2.6% for ages of 259 days or longer. The new growth curves reveal better the true distribution of SGA foetuses and neonates, and are suggested for use in perinatological practice.
          Article 0 comments Cited 163 times – based on 0 reviews     Review now
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            On the pitfalls of adjusting for gestational age at birth.

            Clarice R. Weinberg, Olga Basso, Allen Wilcox (2011)
            Preterm delivery is a powerful predictor of newborn morbidity and mortality. Such problems are due to not only immaturity but also the pathologic factors (such as infection) that cause early delivery. The understanding of these underlying pathologic factors is incomplete at best. To the extent that unmeasured pathologies triggering preterm delivery also directly harm the fetus, they will confound the association of early delivery with neonatal outcomes. This, in turn, complicates studies of newborn outcomes more generally. When investigators analyze the association of risk factors with neonatal outcomes, adjustment for gestational age as a mediating variable will lead to bias. In the language of directed acyclic graphs, gestational age is a collider. The theoretical basis for colliders has been well described, and gestational age has recently been acknowledged as a possible collider. However, the impact of this problem, as well as its implications for perinatal research, has not been fully appreciated. The authors discuss the evidence for confounding and present simulations to explore how much bias is produced by adjustments for gestational age when estimating direct effects. Under plausible conditions, frank reversal of exposure-outcome associations can occur. When the purpose is causal inference, there are few settings in which adjustment for gestational age can be justified.
            Article 0 comments Cited 118 times – based on 0 reviews     Review now
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              Perfluoroalkyl and polyfluoroalkyl substances and human fetal growth: a systematic review.

              Cathrine Bach, Bodil Hammer Bech, Nis Brix … (2015)
              Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) is ubiquitous in most regions of the world. The most commonly studied PFASs are perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA). Animal studies indicate that maternal PFAS exposure is associated with reduced fetal growth. However, the results of human studies are inconsistent.
              Article 0 comments Cited 82 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Environ Health Perspect
                Journal ID (iso-abbrev): Environ. Health Perspect
                Journal ID (publisher-id): EHP
                Title: Environmental Health Perspectives
                Publisher: National Institute of Environmental Health Sciences
                ISSN (Print): 0091-6765
                ISSN (Electronic): 1552-9924
                Publication date (Electronic): 23 October 2015
                Publication date (Print): June 2016
                Volume: 124
                Issue: 6
                Pages: 848-854
                Affiliations
                [1 ]Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
                [2 ]Horsens Regional Hospital, Horsens, Denmark
                [3 ]Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
                [4 ]Research Unit for Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
                [5 ]Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
                [6 ]Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
                [7 ]Centre for Arctic Health & Unit for Cellular and Molecular Toxicology, Department of Public Health, Aarhus University, Aarhus, Denmark
                [8 ]Department of Environmental Science, Aarhus University, Roskilde, Denmark
                Author notes
                [† ]Address correspondence to C.C. Bach, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark. Telephone: 00 45 61717150. E-mail: ccbach@ 123456clin.au.dk
                Article
                Publisher ID: ehp.1510046
                DOI: 10.1289/ehp.1510046
                PMC ID: 4892925
                PubMed ID: 26495857
                SO-VID: 562c7fca-ee04-4756-b8d4-8e09d0703866
                License:

                Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

                History
                Date received : 7 April 2015
                Date accepted : 9 October 2015
                Categories
                Subject: Children's Health

                ScienceOpen disciplines: Public health
                Data availability:
                ScienceOpen disciplines: Public health

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