Adverse Birth Outcome Linked to Forever Chemical Exposure in Pregnancy

On May 31, 2023, JAMA Network Open published an article detailing the impacts of perfluoroalkyl and polyfluoroalkyl substance (PFAS) exposure on birth outcomes. Researchers determined that exposure to forever chemicals in early pregnancy is linked to adverse birth outcomes for mothers with low folate status.

The researchers used data from pregnant individuals in eastern Massachusetts between April 1999 and November 2002. Project Viva originally collected the data for a previous study; however, the JAMA investigators reevaluated the data in this prospective cohort study.

For each participant, researchers evaluated the concentration of six PFAS compounds, including perfluorooctanoic acid, perfluorooctane sulfonic acid, perfluorohexane sulfonic acid, perfluorononanoate, 2-(N-ethyl-perfluorooctane sulfonamido) acetate, 2-(N-methyl-perfluorooctane sulfonamido) acetate, perfluorodecanoic acid, and perfluorooctane sulfonamide, during early pregnancy at around 9.6 gestational weeks. In addition, folate status was evaluated using plasma samples and patient questionnaires.

In addition to evaluating the pregnant individuals, the researchers also collected information on the infant’s birth weight, gestational age, birth weight z-score, low birth weight, and preterm birth.

The participant pool includes 1,400 pairs of pregnant individuals and infants, evaluating only singleton pregnancies.

Researchers concluded that, in pregnant people with low folate intake, based on patient questionnaires, exposure to PFAS was associated with lower birth weights, an average of 89.13 grams lower. Furthermore, these patients’ birth weight z-score was roughly 0.13 points lower.

Similarly, low plasma folate concentrations were linked to an average birth weight decline of 87.03 grams and a 0.14-point lower z-score. On the other hand, the researchers noted that pregnant individuals with high folate levels did not have a significant increase in adverse birth outcomes when exposed to PFAS during early pregnancy.

“Findings suggest mothers with the lowest folate status were more susceptible to PFAS-related adverse birth outcomes. Folate might be used as a PFAS prevention measure during preconception and pregnancy. If confirmed in other settings, the findings may have important implications for identifying vulnerable populations and implementing intervention studies,” concluded the researchers in the publication.