title: Perfluoroalkyl substances and lipid concentrations in plasma during pregnancy among women in the Norwegian Mother and Child Cohort Study.
abstract: BACKGROUND
  Perfluoroalkyl substances (PFASs) are widespread and persistent environmental pollutants. Previous studies, primarily among non-pregnant individuals, suggest positive associations between PFAS levels and certain blood lipids. If there is a causal link between PFAS concentrations and elevated lipids during pregnancy, this may suggest a mechanism by which PFAS exposure leads to certain adverse pregnancy outcomes, including preeclampsia.
  
  
  METHODS
  This cross-sectional analysis included 891 pregnant women enrolled in the Norwegian Mother and Child (MoBa) Cohort Study in 2003-2004. Non-fasting plasma samples were obtained at mid-pregnancy and analyzed for nineteen PFASs. Total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured in plasma. Linear regression was used to quantify associations between each PFAS exposure and each lipid outcome. A multiple PFAS model was also fitted.
  
  
  RESULTS
  Seven PFASs were quantifiable in >50% of samples. Perfluorooctane sulfonate (PFOS) concentration was associated with total cholesterol, which increased 4.2mg/dL per inter-quartile shift (95% CI=0.8, 7.7) in adjusted models. Five of the seven PFASs studied were positively associated with HDL cholesterol, and all seven had elevated HDL associated with the highest quartile of exposure. Perfluoroundecanoic acid showed the strongest association with HDL: HDL increased 3.7 mg/dL per inter-quartile shift (95% CI=2.5, 4.9).
  
  
  CONCLUSIONS
  Plasma concentrations of PFASs were positively associated with HDL cholesterol, and PFOS was positively associated with total cholesterol in this sample of pregnant Norwegian women. While elevated HDL is not an adverse outcome per se, elevated total cholesterol associated with PFASs during pregnancy could be of concern if causal.
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Starling
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Engel
authors.forename: Kristina W
authors.initials: KW
authors.lastname: Whitworth
authors.forename: David B
authors.initials: DB
authors.lastname: Richardson
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
authors.forename: Julie L
authors.initials: JL
authors.lastname: Daniels
authors.forename: Line Småstuen
authors.initials: LS
authors.lastname: Haug
authors.forename: Merete
authors.initials: M
authors.lastname: Eggesbø
authors.forename: Georg
authors.initials: G
authors.lastname: Becher
authors.forename: Azemira
authors.initials: A
authors.lastname: Sabaredzovic
authors.forename: Cathrine
authors.initials: C
authors.lastname: Thomsen
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Wilson
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Travlos
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
authors.forename: Donna D
authors.initials: DD
authors.lastname: Baird
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Longnecker
mesh_terms: D000328:Adult; D017738:Alkanesulfonic Acids / Q000097:blood; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D005466:Fluorocarbons / Q000097:blood; D006801:Humans; D016014:Linear Models; D008055:Lipids / Q000097:blood*; D009035:Mothers; D009664:Norway
chemical_list: D017738:Alkanesulfonic Acids; D004785:Environmental Pollutants; D005466:Fluorocarbons; D008055:Lipids; D002784:Cholesterol; C076994:perfluorooctane sulfonic acid
keywords: BMI; CI; DAG; HDL; IQR; LDL; LOQ; MBRN; Medical Birth Registry of Norway; MoBa; Norwegian Mother and Child Cohort Study; PFASs; PFDA; PFHpS; PFHxS; PFNA; PFOA; PFOS; PFUnDA; Perfluoroalkyl substances; Perfluorooctane sulfonate; Perfluorooctanoic acid; The Norwegian Mother and Child Cohort Study; body mass index; confidence interval; directed acyclic graph; high-density lipoprotein; inter-quartile range; limit of quantification; low-density lipoprotein; perfluoroalkyl substances; perfluorodecanoic acid; perfluoroheptane sulfonate; perfluorohexane sulfonate; perfluorononanoic acid; perfluorooctane sulfonate; perfluorooctanoic acid; perfluoroundecanoic acid