Gestational hypertension, preeclampsia, and gestational diabetes mellitus after high exposure to perfluoroalkyl substances from drinking water in Ronneby, Sweden

Environ Res. 2023 Dec 15;239(Pt 1):117316. doi: 10.1016/j.envres.2023.117316. Epub 2023 Oct 5.


Background: Leakage of fire-fighting foam from an airfield caused contamination of the drinking water supplied to a third of the population in Ronneby, resulting in very high serum levels of predominantly perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). The results of studies investigating the association between exposure to perfluorinated alkyl substances (PFAS) and pregnancy complications are inconsistent, and studies at high exposures of PFOS and PFHxS are lacking.

Objectives: To investigate the association between exposure to high levels of PFAS and gestational hypertension and preeclampsia, and gestational diabetes mellitus.

Methods: We retrieved data on 27 292 childbirths between 1995 and 2013 from the National Medical Birth Register for women that had a residential address in Blekinge county for at least one year before delivery. Residential history was used as a proxy for exposure by categorizing women into high-, intermediate-, or background exposed based on their residential address during the five-year period before childbirth. Data on confounders were retrieved from administrative registers. The outcomes were defined based on International Classification of Diseases codes. We used logistic regression to estimate odds ratios (OR) for gestational hypertension and preeclampsia, and gestational diabetes mellitus. We also investigated effect modification by fetal sex.

Results: We found no evidence of increased risk of gestational hypertension and preeclampsia (OR 0.80; CI 0.63-1.03), nor gestational diabetes (OR 1.03; CI 0.67-1.58) after high PFAS exposure. There was no effect modification by fetal sex.

Discussion: This was the first study to investigate the association between high exposure to PFOS and PFHxS and pregnancy complications. The results from this study add important knowledge to public health management as new hotspots with high levels of PFAS are continuously discovered.

Keywords: Contaminated drinking water; Endocrine disruptors; PFAS; Pregnancy complications; Register-based cohort study.

MeSH terms

  • Alkanesulfonates
  • Diabetes, Gestational* / chemically induced
  • Diabetes, Gestational* / epidemiology
  • Drinking Water*
  • Female
  • Fluorocarbons* / toxicity
  • Humans
  • Hypertension, Pregnancy-Induced* / chemically induced
  • Hypertension, Pregnancy-Induced* / epidemiology
  • Pre-Eclampsia* / chemically induced
  • Pre-Eclampsia* / epidemiology
  • Pregnancy
  • Sweden / epidemiology


  • Drinking Water
  • perflexane
  • perfluorooctane sulfonic acid
  • Alkanesulfonates
  • Fluorocarbons