Association between gestational PFAS exposure biomarkers and risk of preeclampsia in the ECHO Cohort

Preeclampsia represents a major public health problem and contributes to maternal and child morbidity and mortality. Environmental exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of preeclampsia. We investigated associations between 6 gestational PFAS exposure biomarkers and odds of preeclampsia among 2,343 women in the Environmental influences on Child Health Outcomes (ECHO) Cohort. We evaluated effect modification by race and fetal sex, and mixture effects with quantile g-computation and BKMR. Odds ratios (ORs) were elevated for perfluorooctanoic acid (PFOA; OR: 1.27 [0.73-2.23]), perfluorononanoic acid (PFNA; OR: 1.13 [0.85-1.49]), and perfluorodecanoic acid (PFDA; OR: 1.24 [0.92-1.65]) but reduced for perfluorohexane-1-sulfonic acid (PFHXS; OR: 0.78 [0.57-1.06]) and N-methyl perfluorooctane sulfonamido acetic acid (FOSAA; OR: 0.65 [0.24-1.76]). An interquartile range increase in PFDA was associated with 1.40 (95 % CI: 0.95-2.05) times greater odds of preeclampsia among pregnancies carrying female fetuses (OR: 1.09, 95 % CI: 0.73-1.62) and 2.28 (95 % CI: 1.26-4.12) times greater odds among those of Hispanic ethnicity compared with non-Hispanic White (OR: 0.96, 95 % CI: 0.62-1.48). Mixture analyses detected interactions between several PFAS chemicals. Our findings indicate suggestive trends of elevated susceptibility to preeclampsia with increasing PFAS exposure among pregnancies with a female fetus and races and ethnicities other than non-Hispanic White.