目的:全氟烷基和多氟烷基物质(PFAS)已被证明具有持久性和生物蓄积性。妊娠并发症的危险升高可能与暴露于PFAS有关,但是潜在的影响仍然难以捉摸。这项研究的目的是调查PFASs暴露与妊娠并发症之间的可能关联,利用现有证据。
方法:PubMed的电子数据库,QvidMedline,Embase,和WebofScience进行了彻底搜索,以确定2023年11月28日之前发表的符合条件的研究,研究了PFASs与妊娠相关并发症之间的关系.为了评估纳入本文的观察性研究的质量,使用了加强流行病学观察研究报告(STROBE)工具。本研究评估的主要结局包括妊娠期糖尿病(GDM),妊娠高血压疾病(HDP),妊娠期高血压(GH),和先兆子痫(PE)。
结果:最终从4个数据库中选择了25项相关研究,涉及30079名参与者。综合估计表明,产前暴露于全氟辛酸(PFOA),全氟己烷磺酸(PFHxS),全氟丁烷磺酸(PFBS),和全氟庚酸(PFHpA)与妊娠期糖尿病(GDM)相关(PFOA:OR=1.45,95CI:1.07~1.94,P=0.015;PFHxS:OR=1.16,95CI:1.00~1.36,P=0.055;PFBS:OR=1.44,95CI:1.16~1.79,P=0.001;PFHpA:OR=1.9541,PFBS暴露与HDP呈正相关(OR=1.27,95CI:1.14~1.41,P<0.001),而PFOA和PFHpA均与GH呈统计学正相关(PFOA:OR=1.09,95CI:1.00-1.19,P=0.049;PFHpA:OR=1.43,95CI:1.15-1.78,P=0.001)。产前全氟十二烷酸(PFDoA)暴露与GH呈负相关(OR=0.71,95CI:0.57-0.87,P=0.001)。然而,没有令人信服的证据表明PFASs暴露与PE风险相关.
结论:根据荟萃分析结果,暴露于PFAS可能与GDM有关,HDP,GH,但它并不显著增加单独PE的风险。需要更大样本量的进一步研究来验证这种潜在的关联并探索生物学机制。
OBJECTIVE: Per- and polyfluoroalkyl substances (PFASs) have been shown to be persistent and bioaccumulative. An elevated danger of pregnancy complications perhaps connected with exposure to PFASs, but the potential effects remain elusive. The objective of this study is to investigate the possible association between PFASs exposure and pregnancy complications, drawing upon existing evidence.
METHODS: Electronic databases of PubMed, Qvid Medline, Embase, and Web of Science were searched thoroughly to identify eligible research published prior to November 28, 2023, examining the relationship between PFASs and pregnancy-related complications. To evaluate the quality of observational studies incorporated into the article, the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) tool was utilized. The main outcomes assessed in this study included gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), gestational hypertension (GH), and preeclampsia (PE).
RESULTS: Twenty-five relevant studies involving 30079 participants were finally selected from four databases. The combined estimates indicate that prenatal exposure to perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorobutane sulfonic acid (PFBS), and perfluoroenanthic acid (PFHpA) is associated with gestational diabetes mellitus (GDM) (PFOA: OR = 1.45, 95%CI: 1.07-1.94, P = 0.015; PFHxS: OR = 1.16, 95%CI: 1.00-1.36, P = 0.055; PFBS: OR = 1.44, 95%CI: 1.16-1.79, P = 0.001; PFHpA: OR = 1.41, 95%CI: 1.10-1.82, P = 0.008). The exposure to PFBS is positively associated with HDP (OR = 1.27, 95%CI: 1.14-1.41, P < 0.001), while both PFOA and PFHpA demonstrate statistically significant positive correlations with GH (PFOA: OR = 1.09, 95%CI: 1.00-1.19, P = 0.049; PFHpA: OR = 1.43, 95%CI: 1.15-1.78, P = 0.001). Negative correlations were observed for prenatal perfluorododecanoic acid (PFDoA) exposure and GH (OR = 0.71, 95%CI: 0.57-0.87, P = 0.001). However, no compelling evidence was identified to link PFASs exposure with the risk of PE.
CONCLUSIONS: According to the meta-analysis findings, exposure to PFASs may be linked to GDM, HDP, and GH, but it does not significantly raise the risk of PE alone. Further research with larger sample size is required to verify this potential association and explore the biological mechanisms.