PFAS Exposure and Cardiometabolic Health in U.S. Women

Abstract

Americans are exposed to multiple per- and polyfluoroalkyl substances (PFAS), chemicals used in consumer products including stain-resistant treatment and food packaging. Strong evidence of health effects from high exposures to these chemicals has recently emerged, but there is less information about the health effects of typical exposure levels. In Chapter 1, we tested the extent to which early pregnancy PFAS concentrations were associated with gestational weight gain and postpartum weight changes, using 1614 women in the Project Viva pre-birth cohort. Women gained more weight during pregnancy per doubling of 2-(N-ethyl-perfluorooctane sulfonamide) acetic acid (EtFOSAA), retained more weight at one year postpartum per doubling of perfluorooctanoic acid (PFOA), and gained more weight at three years postpartum per doubling in PFOA. We concluded that concentrations of certain PFAS in pregnancy were associated with greater gestational weight gain, weight retention, and weight gain after pregnancy. In Chapter 2, we examined the extent to which PFAS plasma concentrations during pregnancy were associated with postpartum anthropometry and biomarkers, again using participants in Project Viva. Higher pregnancy concentrations of EtFOSAA, PFOA, and perfluorooctanesulfonic acid (PFOS) were associated with greater adiposity, and higher PFOS was associated with higher systolic blood pressure at three years postpartum. We also reported that EtFOSAA concentrations were associated with biomarkers of inflammation and worse cardiovascular health at three years postpartum. We concluded that higher concentrations of PFOS, PFOA, and EtFOSAA were associated with a shift towards a higher-risk postpartum profile across measures of anthropometry, blood pressure, and biomarkers of cardiometabolic health. In Chapter 3, we tested whether PFAS concentrations were associated with metabolites previously shown to predict incident type 2 diabetes, using participants in the Diabetes Prevention Program. Higher concentrations of Sb-PFOA (branched isomer of PFOA) were associated with higher leucine and lower glycine, while higher total PFOA and n-PFOA (linear isomer of PFOA) were associated with lower glycine. Several PFAS were positively associated with multiple triacylglycerols, diacylglycerols, and glycerophospholipids. Our results suggest that PFAS may increase risk of type 2 diabetes through alterations in amino acid, glycerolipid and glycerophospholipid metabolism. Further research is needed to elucidate mechanisms.