title: Variability of perfluoroalkyl substance concentrations in pregnant women by socio-demographic and dietary factors in a Spanish birth cohort.
abstract: Prenatal exposure to perfluoroalkyl substances (PFAS) might affect child health; but maternal determinants of PFAS exposure are unclear. We evaluated the socio-demographic and dietary factors of prenatal PFAS concentrations in a Spanish birth cohort.
  
  
  
  We analyzed perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in 1216 plasma samples collected during the 1(ST) trimester of pregnancy (2003-2008). We used multivariable linear regressions to assess the geometric mean (GM) ratios of PFAS concentrations by socio-demographic and dietary factors. We used analysis of variance (ANOVA) to assess the variability of PFAS concentrations by maternal factors.
  
  
  
  GM PFAS concentrations ranged from 0.55ng/mL for PFHxS to 5.77ng/mL for PFOS. Women born outside of Spain had lower PFAS concentrations (e.g. GM ratio for PFHxS 0.53[95%CI: 0.46, 0.60] than Spanish women. PFHxS and PFOA concentrations were higher in mothers from the regions of Sabadell (2.13[1.93, 2.35] and 1.73[1.60, 1.88], respectively) and Valencia (1.40[1.28, 1.54] and 1.42[1.31, 1.53], respectively) than Gipuzkoa. PFOA and PFNA concentrations decreased with parity (≥2 children: 0.79[0.67, 0.94] and 0.82[0.68, 0.99], respectively). Younger women (i.e. <25years) had lower PFHxS (0.73[0.62, 0.86]) and PFOS (0.85[0.75, 0.96]) concentrations than older women. PFHxS and PFOA concentrations were lower in women who previously breastfed for >6months compared to those who never breastfed (0.79[0.67, 0.94] and 0.82[0.71, 0.95], respectively). High intake of fish and shellfish during pregnancy (i.e. ≥5.6 servings/week) was associated with 11% (1.11[1.04, 1.18]) higher PFOS concentrations than the lowest intake group. Our ANOVA models explained 26% to 40% of PFAS concentrations variability.
  
  
  
  Prenatal PFAS concentrations were mainly determined by maternal country of birth, region of residence, previous breastfeeding and age. Fish and shellfish intake also contributed to PFOS and PFOA concentrations.
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address: cmanzano@creal.cat.
authors.forename: Cyntia B
authors.initials: CB
authors.lastname: Manzano-Salgado
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Maribel
authors.initials: M
authors.lastname: Casas
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; FISABIO Universitat de València-Universitat Jaume I Joint Research Unit, Valencia, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Lopez-Espinosa
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; FISABIO Universitat de València-Universitat Jaume I Joint Research Unit, Valencia, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Ballester
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martinez
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Subdirección de Salud Pública y Adicciones de Gipuzkoa, Donostia-San Sebastián, Spain; Instituto de Investigación Sanitaria BIODONOSTIA, Donostia-San Sebastián, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Ibarluzea
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Subdirección de Salud Pública y Adicciones de Gipuzkoa, Donostia-San Sebastián, Spain; Instituto de Investigación Sanitaria BIODONOSTIA, Donostia-San Sebastián, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Santa-Marina
authors.affiliation: Institute for Occupational Medicine, RWTH Aachen University, Aachen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schettgen
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universidad Miguel Hernandez, San Juan de Alicante, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Vioque
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Martine
authors.initials: M
authors.lastname: Vrijheid
mesh_terms: D001942:Breast Feeding; D002648:Child; D000067576:Child Health; D015331:Cohort Studies; D004032:Diet; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D005466:Fluorocarbons / Q000097:blood*; D005506:Food Contamination; D006801:Humans; D016014:Linear Models; D009035:Mothers; D010298:Parity; D011247:Pregnancy; D013030:Spain; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D005466:Fluorocarbons
keywords: Birth cohort; Maternal-fetal exposure; Perfluoroalkyl substances (PFAS); Perfluorohexanesulfonic acid (PFHxS); Perfluorononanoic acid (PFNA); Perfluorooctanesulfonic acid (PFOS); Perfluorooctanoic acid (PFOA); Spain