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孕妇孕早期血清中全氟化合物暴露水平与妊娠期糖尿病发生风险关系

Association of serum concentrations of per- and polyfluoroalkyl substances in early pregnancy with risk of gestational diabetes mellitus: a prospective nested case-control study

    摘要
  • 摘要:
    目的 分析天津市孕妇孕早期血清中全氟及多氟化合物（PFASs）暴露水平与妊娠期糖尿病（GDM）发生风险的关系，为GDM的防治及相关环境卫生政策的制定提供参考依据。
    方法 对2010 — 2012年天津市480名孕早期孕妇进行前瞻性巢式病例对照研究，使用在线SPE – 超高效液相色谱 – 高分辨质谱法，检测240例GDM孕妇和240名经过年龄进行1 : 1匹配的非GDM孕妇孕早期血清样品中的35种PFASs浓度水平，运用logistic回归模型分析孕早期PFASs暴露水平与GDM发生风险的关系。
    结果 在35种PFASs中，16种PFASs的检出率均 > 60%，平均浓度最高的是6 : 2氯代多氟烷基醚磺酸盐（6 : 2 Cl-PFESA），浓度为5.208 9 ng/mL。Mann-Whitney U检验结果显示，GDM组全氟壬酸（PFNA）、全氟辛酸（PFOA）、全氟戊烷磺酸（PFPeS）浓度中位数高于非GDM组，8 : 2氯代多氟烷基醚磺酸盐（8 : 2 Cl-PFESA）浓度中位数低于非GDM组（P < 0.05）。多因素logistic回归结果显示，检出率 > 60%的16种PFASs中，PFNA（OR = 1.655，95%CI = 1.023～2.679）、PFOA（OR = 1.277，95%CI = 1.090～1.496）、PFPeS（OR = 1.218，95%CI = 1.032～1.434）3种物质水平与GDM发生风险存在正向关联（P < 0.05）；8 : 2 Cl-PFESA（OR = 0.427，95%CI = 0.227～0.802）与GDM发生风险存在负向关联（P < 0.05）。将上述4种PFASs的浓度水平分别按三分位数分组，与低浓度组相比，PFNA、PFOA和PFPeS 3种物质的高浓度组GDM的发生风险增加（P < 0.05）。
    结论 孕早期PFASs暴露水平与GDM发生相关，PFNA、PFOA和PFPeS是GDM发生的危险因素。

     

    Abstract:
    Objective To analyze the association between serum concentrations of per- and polyfluoroalkyl substances (PFASs) in early pregnancy and the risk of gestational diabetes mellitus (GDM) among pregnant women in Tianjin, and to provide guidance for the prevention and control of GDM and the establishment of related environmental health policies.
    Methods A prospective nested case-control study was conducted among 480 early pregnant women (gestational age 8 – 13 weeks and plus 6 days) in Tianjin between 2010 and 2012. Online solid-phase extraction (SPE) – ultra-performance liquid chromatography (UPLC)-high resolution mass spectrometry (HRMS) was used to measure the concentrations of 35 types of PFASs in serum samples from 240 GDM patients and 240 age-matched non-GDM pregnant women. Logistic regression models were used to analyze the association between PFAS exposure in early pregnancy and the risk of developing GDM.
    Results Of the 35 PFASs analyzed, 16 had a detection rate greater than 60% among all participants, with the highest mean concentration of 5.2089 ng/mL for 6 : 2 chlorinated polyfluorinated ether sulfonate (6 : 2 Cl-PFESA). The Mann-Whitney U test showed that the median concentrations of perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), and perfluoropentane sulfonate (PFPeS) were higher in the GDM group than in the non-GDM group, whereas the concentration of 8 : 2 chlorinated polyfluorinated ether sulfonate (8 : 2 Cl-PFESA) was lower (P < 0.05 for all). The results of multivariate logistic regression showed that among the 16 PFASs with a detection rate greater than 60%, the levels of PFNA, PFOA, and PFPeS were positively correlated with the risk of GDM, with odds ratios (OR) (95% confidence interval CI) of 1.655 (1.023 – 2.679), 1.277 (1.090 – 1.496), and 1.218 (1.032 – 1.434), respectively (all P < 0.05), whereas 8 : 2 Cl-PFESA (OR = 0.427, 95%CI: 0.227 – 0.802) was inversely correlated with the risk of GDM. When the concentration levels of the four PFASs mentioned above were grouped into tertiles, participants with PFNA, PFOA, and PFPeS concentrations in the third tertile had an increased risk of GDM compared to those with concentrations in the first tertile (P < 0.05 for all).
    Conclusion Exposure to PFAS in early pregnancy is associated with the occurrence of GDM, and PFNA, PFOA, and PFPeS are risk factors for GDM.

     

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