Prenatal Exposure to Per- and Polyfluoroalkyl Substances (PFAS) and Risk of Astigmatism in Preschool-Aged Children: A Prospective Birth Cohort Study

Astigmatism is a common refractive error in early childhood that can affect visual function and potentially cause amblyopia if not treated. Although environmental factors are gaining recognition as influences on eye development, the impact of prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) remains uncertain. In this prospective birth cohort study that included 248 mother–child pairs enrolled from the Maternal and Child Health Hospital in Maoming, Guangdong Province, China, between 2015 and 2018, we aimed to examine the association between maternal serum PFAS concentrations during pregnancy and the risk of astigmatism in preschool-aged children aged 3–6 years. After adjusting for covariates, each interquartile range (IQR) increase in total PFAS concentration was associated with 1.29-fold higher odds of astigmatism (95% CI: 1.02, 1.65; p = 0.033) and more negative cylindrical power. The associations were significantly stronger among children born preterm and those with a smaller head circumference at birth. Our findings suggest that prenatal PFAS exposure may disrupt early ocular development, underscoring the need to incorporate gestational environmental chemical exposure into strategies for preventing childhood refractive errors and their long-term visual consequences.