Prenatal Per- and Polyfluoroalkyl Substances and Body Mass Index Trajectories in Childhood: Application of Multiphase Growth Mixture Models across the ECHO Cohort

We examined the associations of prenatal per- and polyfluoroalkyl substance (PFAS) exposures with body mass index (BMI) trajectories and growth parameters in the Environmental Influences on Child Health Outcomes Cohort. Maternal PFAS concentrations (perfluorohexanesulfonic acid [PFHxS], perfluorooctanesulfonic acid [PFOS], perfluorooctanoic acid [PFOA], perfluorononanoic acid [PFNA], perfluorodecanoic acid [PFDA], perfluoroundecanoic acid [PFUnDA], and N-methyl perfluorooctane sulfonamidoacetic acid [NMFOSAA]) were measured in serum or plasma during pregnancy. BMI trajectories and growth parameters were estimated using multiphase growth mixture modeling. Among 1,125 children ages 1–9.5 years, we identified a typical BMI trajectory (n = 998, 89%; reference group) and an atypical BMI trajectory characterized by early and rapid BMI increases (n = 127, 11%). Maternal PFOA (adjusted risk ratio [RR] = 1.22 per doubling; 95% CI = 1.05–1.41) and PFOS (adjusted RR = 1.14; 95% CI = 0.99–1.32) concentrations were associated with a higher risk of atypical trajectory membership. A doubling in maternal PFOA concentrations was associated with an earlier age at adiposity rebound by 19 (95% CI = 4–33) days. Other PFAS concentrations were not significantly associated with the atypical trajectory or adiposity rebound. In this pooled cohort study, higher prenatal exposure to certain PFAS was associated with a greater risk of an obesity-related growth trajectory and earlier adiposity rebound.