Fetal growth in relation to prenatal per- and polyfluoroalkyl substances exposure: A prospective birth cohort study

Background Prenatal per- and polyfluoroalkyl substances (PFAS) exposure has been linked to adverse birth outcomes, yet evidence on fetal growth remains limited. Methods A total of 2856 pregnant women-fetus dyads were included from Henan Maternal and Child Health Hospital. Sixteen PFAS concentrations were detected. Five fetal ultrasound measurements (biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], femur length [FL], estimated fetal weight [EFW]) were collected at 18, 24, 32, 35 and 38 weeks, and standardized into gestational age-adjusted standard deviation scores (SDS). Generalized linear models, linear mixed models, and multinomial logistic regression were applied to evaluate associations of PFAS with single-time-point, repeated, and trajectory-based measures. Results Higher perfluoropentane sulfonate (PFPeS) were associated with reduced BPD-SDS at 24 weeks (β = -13.72%, 95% CI: –22.03%, −5.41%), and lower BPD-SDS and HC-SDS (β range: −6.21% to −6.19%) longitudinally. Elevated perfluorohexane sulfonate (PFHxS) was related to reduced FL-SDS and EFW-SDS (β range: −5.84% to −5.64%) at 32 weeks, and lower FL-SDS longitudinally (β = -3.56%, 95% CI: −5.56%, −1.57%), as well as higher odds of FL‑SDS “lower growth” trajectory (OR = 1.27, 95% CI: 1.06, 1.51). Higher 6:2 chlorinated polyfluorinated ether sulfonate (6:2Cl‑PFESA) were inversely associated with BPD-SDS, HC-SDS, FL-SDS, and EFW-SDS at 32 weeks (β range: −11.01% to −9.74%), and HC-SDS and EFW-SDS in repeated-measures analyses (β range: −6.94 to −4.84%), while positively associated with EFW-SDS “slow growth” trajectory (OR = 1.36, 95% CI: 1.00, 1.85). These trajectory-based findings were attenuated after multiple testing correction. Conclusion Our findings indicated that prenatal exposure to PFPeS, PFHxS, and 6:2Cl-PFESA may retard fetal growth.