Maternal Exposure to Per- and Polyfluoroalkyl Substances: Implications for Intrahepatic Cholestasis of Pregnancy and Adverse Birth Outcomes

• Published in: Exposure and health 2024-10, Vol.16 (5), p.1209-1223
• Main Authors: Tian, Yonghong, Xu, Chenye, Zhang, Long, Shi, Dake, Cappelli, Francesca, Yin, Shanshan
• Format: Article
• Language: English
• Subjects: 17β-Estradiol; Acids; Aquatic Pollution; Biomarkers; Birth; Cholestasis; Earth and Environmental Science; Environment; Environmental Health; Epidemiology; Exposure; Fetuses; Gallbladder diseases; Hospitals; Hypoxia; Intrauterine exposure; Liver; Original Paper; Pathogenesis; Perfluoro compounds; Perfluoroalkyl & polyfluoroalkyl substances; Perfluorochemicals; Perfluorodecanoic acid; Perfluorooctane sulfonic acid; Perfluorooctanoic acid; Placenta; Pollution; Pregnancy; Pregnancy complications; Propionic acid; Public health; Sex hormones; Sulfonates; Toxicity; Waste Water Technology; Water and Health; Water Management; Water Pollution Control; Water Quality/Water Pollution; Womens health
• ISSN: 2451-9766; 2451-9685
• DOI: 10.1007/s12403-023-00620-6

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy has been linked to maternal complications and exerts a long-term impact on fetal growth. However, information regarding the effects of PFAS on intrahepatic cholestasis of pregnancy (ICP) with hepatic biomarkers underlying the association is nascent. By analyzing 15 PFAS compounds in maternal serum from 78 women with a diagnosis of ICP and 164 healthy participants, this study provided epidemiological associations between PFAS exposure and ICP risks, liver function, and their potential influence on birth outcomes. As a result, the main contributors were perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), which accounted for 21% and 23% of the total PFAS exposure, respectively. Results revealed that each logarithmic increase in serum PFOA was associated with nearly tripled risk of ICP during pregnancy. In contrast, perfluorohexanesulfonic acid (PFHxS), 4:2 fluorotelomer sulfonate (4:2 FTS), and 3H-perfluoro-3-[(3-methoxy-propoxy) propanoic acid] (ADONA) showed negative associations on liver toxicity. In addition, increased estradiol and estriol levels in the serum were observed significantly associated with higher exposure of PFOA, perfluorodecanoic acid (PFDA), and 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA). Concerning the birth outcomes, increased risks for small-for-gestational-age and intrauterine development were found for the higher PFOA, PFOS, and 6:2-Cl-PFESA exposure. Notably, higher levels of PFOA exposure may be linked to an increased risk of intrauterine hypoxia due to impaired transfer of oxygen across the placenta. These findings provide valuable insights for environmental and public health considerations, highlighting the importance of considering maternal PFAS exposure to ICP and birth outcomes.