Association between prenatal exposure to perfluorinated compounds and symptoms of infections at age 1-4years among 359 children in the Odense Child Cohort.
Perfluorinated alkylated substances (PFAS) are persistent industrial chemicals that have resulted in global environmental exposures. Previous epidemiological studies have reported possible effects on the immune system after developmental PFAS exposure, but the possible impact on childhood infectious disease is unclear.



To investigate the association between prenatal exposure to PFAS and symptoms of infections at age 1-4years.



The Odense Child Cohort is an on-going prospective study on children's health, where serum concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorodecanoic acid (PFDA) and perfluorononanoic acid (PFNA) were measured in 649 pregnant women before gestational week 16. Of these women, 359 reported on symptoms of infection in their child every two weeks for a one-year period. The association between prenatal exposure to PFAS and the symptoms was estimated using a logistic regression model and a negative binomial regression model. For the latter, the outcome was reported as an incidence rate-ratio (IRR), and all models were adjusted for maternal age, educational level, parity and child age.



On average, the children experienced symptoms of infection 23% of the time during one year. PFOS exposure in the high tertile compared to the low tertile was associated with a statistically significant increased proportion of days with fever (IRR: 1.65 (95% CI: 1.24, 2.18), P-trend<0.001) and an increased odds of experiencing days with fever above the median (OR: 2.35 (95% CI: 1.31, 4.11). The latter tendency was also apparent for PFOA (OR: 1.97 (95% CI: 1.07, 3.62). Further, higher concentrations of PFOS and PFOA tended to increase the number of episodes of co-occurrence of fever and coughing and fever and nasal discharge during the one-year study period.



We found a positive association between prenatal exposure to PFOS and PFOA and the prevalence of fever, which may be a sensitive marker of infection. This finding is in agreement with an immunotoxic effect of prenatal exposure to PFAS. The wider implications for childhood infectious disease deserve attention.
Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address: ldalsager@health.sdu.dk.
Louise
L
Dalsager
Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Nikolas
N
Christensen
Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
Steffen
S
Husby
Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Odense Patient data Exploratory Network (OPEN), Odense, Denmark.
Henriette
H
Kyhl
Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark.
Flemming
F
Nielsen
Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
Arne
A
Høst
Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Philippe
P
Grandjean
Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, J.B. Winsløwsvej 17A, 5000 Odense, Denmark; Rigshospitalet, Copenhagen University Hospital, Department of Growth and Reproduction, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Tina Kold
TK
Jensen
D000328:Adult; D017738:Alkanesulfonic Acids; D002210:Caprylates; D002675:Child, Preschool; D003652:Decanoic Acids; D003718:Denmark / Q000453:epidemiology; D004781:Environmental Exposure; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D005466:Fluorocarbons / Q000097:blood / Q000633:toxicity*; D006801:Humans; D007223:Infant; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D010298:Parity; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D013451:Sulfonic Acids; D055815:Young Adult
D017738:Alkanesulfonic Acids; D002210:Caprylates; D003652:Decanoic Acids; D005466:Fluorocarbons; D013451:Sulfonic Acids; C036567:perfluorodecanoic acid; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid; C078626:perflexane
Childhood infections; Cohort study; Immunotoxicity; Perfluorinated compounds; Prenatal exposure