Pregnancy-Related Hemodynamic Biomarkers in Relation to Trimester-Specific Maternal per- and Polyfluoroalkyl Substances Exposures and Adverse Birth Outcomes
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The fate of environmental chemicals in maternal and fetal tissues might be affected by pregnancy-related hemodynamic changes that occur across gestation. Specifically, hemodilution and renal function are hypothesized to confound associations between per- and polyfluoroalkyl substances (PFAS) exposure measures in late pregnancy with gestational length and fetal growth. We sought to analyze two pregnancy-related hemodynamic biomarkers, creatinine and estimated glomerular filtration rate (eGFR), as confounders of the trimester-specific relationships between maternal serum PFAS concentrations and adverse birth outcomes. Participants were enrolled in the Atlanta African American Maternal-Child Cohort between 2014 and 2020. Biospecimens were collected at up to two timepoints, which were categorized into the 1st trimester (N = 278; 11 mean weeks gestation), 2nd trimester (N = 162; 24 mean weeks gestation), and 3rd trimester (N = 110; 29 mean weeks gestation). We quantified six PFAS in serum, creatinine in serum and urine, and eGFR using the Cockroft-Gault equation. Multivariable regression models estimated the associations between single PFAS and their sum with gestational age at delivery (weeks), preterm birth (PTB, <37 gestational weeks), birthweight z-scores, and small for gestational age (SGA). Primary models were adjusted for sociodemographics. We additionally adjusted for serum creatinine, urinary creatinine, or eGFR in the confounding assessments. An interquartile range increase in perfluorooctanoic acid (PFOA) produced a non-significant reduction in birthweight z-score during the 1st and 2nd trimesters (β = -0.01 g [95% CI = -0.14, 0.12] and β = -0.07 g [95% CI = -0.19, 0.06], respectively) whereas the relationship was significant and positive during the 3rd trimester (β = 0.15 g; 95% CI = 0.01, 0.29). Trimester-specific effects were similar for the other PFAS and adverse birth outcomes, which persisted after adjusting for creatinine or eGFR. The relationships between prenatal PFAS exposure and adverse birth outcomes were not strongly confounded by renal function or hemodilution. However, 3rd trimester samples consistently exhibited different effects than those collected during the 1st and 2nd trimesters.
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Exposure during sensitive developmental periods is associated with altered puberty timing, impaired fertility, and adverse pregnancy outcomes.
“Exposure during sensitive developmental periods has been associated with altered puberty timing, impaired fertility, and adverse pregnancy outcomes [88].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [88]
The Introduction (page unavailable) reports an association between increased prenatal PFAS exposure and reduced gestational length and birthweight, supporting the adverse-birth-outcomes portion. The paper does not report an association with altered puberty timing or impaired fertility; those topics appear only in reference titles, not as findings discussed in the text. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPFAS are well-documented endocrine disruptors that interfere with thyroid, adrenal, and reproductive hormonal pathways.
“PFAS are well-documented endocrine disruptors that interfere with critical hormonal pathways—including thyroid, adrenal, and reproductive systems.”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [88]
The Introduction describes PFAS exposure and associations with adverse health outcomes, while the Discussion focuses on pregnancy-related hemodynamics. Searches for endocrine disruption and thyroid, adrenal, and reproductive hormonal pathways found no passage in our copy addressing the claimed interference. (LLM, conf=0.77)
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PFAS exposure during pregnancy is associated with maternal cardiometabolic and birth outcomes
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Self-citation
- Authors
- Taibl, K. R., Liang, D., Dunlop, A. L., Barr, D. B., Smith, M. R., Steenland, K., Tan, Y., Ryan, P. B., Panuwet, P., Everson, T., Marsit, C. J., Kannan, K., Jones, D. P., & Eick, S. M.
- Affiliations
- Emory University (US)
- New York University (US)
- Corresponding author
- Eick, Stephanie M.
- ORCID
- Venue
- Environmental Pollution
- Publisher
- Elsevier BV
- Published
- 2023-04
- Volume
- 323
- Pages
- 121331
- ISSN
- 0269-7491 (ISSN-L)
- PMC
- PMC10023492
- OpenAlex
- W4321370931
- Cited by
- 28
- References
- 63
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 6 · 2023: 5
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 329 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Environmental Pollution (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- USEPA (83615301)
- NIH (5U2COD023375-05/A03-3824, P50ES02607, R24ES029490, R01NR014800, P30ES019776, R21ES032117, R01MD009746, U2CES026560, R01MD009064, U2CES026542, UH3OD023318)
- National Institute of Environmental Health Sciences (1U2CES030857-01, 1990/01)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- per- and polyfluoroalkyl substances, trimester-specific exposure, hemodilution, renal function, estimated glomerular filtration rate, creatinine, confounding, preterm birth, small for gestational age, birth weight, gestational age at delivery, perfluorooctanoic acid, African American women
- MeSH terms
- Birth Weight, Creatinine, Environmental Pollutants, Female, Fluorocarbons, Hemodynamics, Humans, Infant, Newborn, Pregnancy, Maternal Exposure, Premature Birth
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