Q&A: PFAS exposure linked to late-onset preeclampsia

Maternal exposure to perfluoroalkyl substances, or PFAS, was associated with a higher risk for late-onset preeclampsia, according to findings published in Environmental Health Perspectives.

“PFAS are ubiquitous in the environment and are commonly detected in humans,” David Cantonwine, PhD, MPH, an assistant professor in the division of maternal-fetal medicine at Brigham and Women’s Hospital, said in a press release. “Exposure to PFAS has been linked to a wide array of adverse health outcomes, including reproductive ones. In our study, we focused on the effects of exposure to PFAS chemicals during early pregnancy and preeclampsia.”

Previously, PFAS exposure has been linked to reduced executive function in school-aged children and endocrine disruption that may drive cancer, diabetes, infertility, obesity and osteoporosis. In October, the White House announced efforts to address exposure to PFAS and help prevent the chemicals from being released into the air, food supply and drinking systems.

Cantonwine and colleagues examined associations between PFAS and preeclampsia in a case control study of 150 pregnant women from the LIFECODES data bank at Brigham and Women’s Hospital. Among them, 75 participants were diagnosed with preeclampsia.

Women who developed preeclampsia were more often Black (31% vs. 12%), had a higher BMI before pregnancy, were nulliparous (52% vs. 40%), had a previous chronic hypertension diagnosis (19% vs. 5%) and had preeclampsia in a previous pregnancy (13% vs. 1%), according to the researchers.

They observed associations between PFAS exposure and late-onset preeclampsia, but not early-onset preeclampsia. Specifically, perfluorodecanoic acid (OR = 1.64; 95% CI, 1.08-2.47) and perfluorooctanesulfonic acid concentrations (OR = 1.6; 95% CI, 1.06, 2.43) were associated with greater odds of late-onset preeclampsia.

“PFAS exposure may be more closely related to late-onset preeclampsia and, therefore, to mechanisms aside from aberrant placentation,” Cantonwine and colleagues wrote.

Healio Primary Care spoke with Cantonwine to learn more about how these “forever chemicals” can impact pregnancy.

Healio Primary Care: Is this link between PFAS exposure and preeclampsia new?

Cantonwine: No. One of the first large scale studies was the C8 Health Project conducted in the Ohio River Valley. Since then, a number of large research studies have looked at the associations between PFAS and preeclampsia with inconsistent results. We are just the first to consider preeclampsia as a complex syndrome.

Healio Primary Care: Why do you think PFAS exposure was linked with higher odds of late-onset compared with early-onset preeclampsia?

Cantonwine: Supportive evidence from our associations with the angiogenic factors indicates that these nine PFAS chemicals may not impact mechanisms that have been shown to be associated with early-onset preeclampsia. We did not expect this initially, but it is not surprising given other research has shown that these PFAS chemicals can impact hormone regulation during pregnancy and immune system function, which is more often related to later-onset preeclampsia.

Healio Primary Care: The FDA recently announced that it has found no evidence of dangerous PFAS levels in processed foods. What levels of PFAS influence preeclampsia?

Cantonwine: There is no established level. In our study, we looked at a one interquartile range increase in exposure in a population with levels that were slightly lower than what was found in the National Health and Nutrition Examination Survey for the same year range. All the existing human studies have slightly different study designs and concentrations they have found in the participants and verification for preeclampsia. It would be premature to say that a certain concentration of a particular PFAS chemical would influence preeclampsia.

Healio Primary Care: What were common sources of exposure to PFAS?

Cantonwine: Current thinking (beyond specific industrial and legacy from military and commercial airports, due to aqueous film-forming foam) is from water, food, food packaging and handling and a vast number of common consumer products.

Healio Primary Care: Should pregnant women be monitored for their PFAS levels

Cantonwine: Personally? Yes, I think they should, but relevant policy and guidelines need to happen before we do. Otherwise, women and clinicians get data without context. The White House announcement was a step in the right direction. I need to add that I do think we need to screen and monitor pregnant women for a wide range of environmental chemicals, not just PFAS.

References:

Bommarito PA, et al. Environ. 2021;doi:10.1289/EHP9091.

FACT SHEET: Biden-Harris Administration launches plan to combat PFAS pollution. https://www.whitehouse.gov/briefing-room/statements-releases/2021/10/18/fact-sheet-biden-harris-administration-launches-plan-to-combat-pfas-pollution/. Published Oct. 18, 2021. Accessed Nov. 12, 2021.

Frisbee SJ, et al. Environ. 2009;doi:10.1289/ehp.0800379.

Study finds link between certain ‘forever chemicals’ and preeclampsia. https://www.eurekalert.org/news-releases/933316. Published Nov. 1, 2021. Accessed Nov. 12, 2021.