Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the risk of hypertensive disorders of pregnancy

Environ Health. 2019 Jan 9;18(1):5. doi: 10.1186/s12940-018-0445-3.


Background: Perfluoroalkyl and polyfluoroalkyl substances (PFAS) have been reported to disrupt endocrine system and reproduction. However, epidemiological evidence on the association between PFAS and preeclampsia is inconsistent. We aimed to investigate the association between prenatal PFAS exposure and hypertensive disorders of pregnancy (HDP) in humans.

Methods: PFAS were measured by liquid chromatography system coupled with tandem mass spectrometry in 687 umbilical cord plasma samples collected between 2011 and 2012 in Shanghai, China. Information on HDP including gestational hypertension and preeclampsia was abstracted from medical records. Multiple logistic regression was used to examine the association of each PFAS with gestational hypertension, preeclampsia, and overall HDP in separate models. Elastic net regression with logit link was used to identify independent associations between exposures and outcomes. Logistic regression was used to obtain the unpenalized estimates of the selected PFAS components for the associations with outcomes, adjusting for age, education level, pre-pregnancy BMI, parity, and mutual adjustment of selected PFAS.

Results: The risk of gestational hypertension and preeclampsia was 3.3% and 2.8% in our subjects, respectively. Perfluorobutane sulfonate (PFBS), perfluorohexane sulfonate (PFHxS), perfluoroundecanoic acid (PFUA) were associated with preeclampsia based on elastic net penalty regression. In the fully adjusted statistical model, women with a higher level of standardized ln-transformed PFBS had an increased odds of preeclampsia [adjusted odds ratio (AOR): 1.81, 95% confidence interval (CI): 1.03-3.17], and overall HDP (AOR: 1.64, 95% CI: 1.09-2.47).

Conclusions: Prenatal exposure to PFBS was positively associated with the risk of preeclampsia and overall HDP.

Keywords: Cord blood; Gestational hypertension; PFAS; Preeclampsia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alkanesulfonic Acids / blood*
  • China
  • Environmental Monitoring
  • Environmental Pollutants / blood*
  • Fatty Acids / blood*
  • Female
  • Fetal Blood / chemistry*
  • Fluorocarbons / blood*
  • Humans
  • Hypertension, Pregnancy-Induced / epidemiology*
  • Maternal Exposure*
  • Pregnancy
  • Risk


  • Alkanesulfonic Acids
  • Environmental Pollutants
  • Fatty Acids
  • Fluorocarbons