Influence of prenatal exposure to per- and polyfluoroalkyl substances under gestational diabetes mellitus on birth and child growth

Per- and polyfluoroalkyl substances (PFAS) have been recently identified as contaminants of concern for human health, yet their influence of birth and child growth is not well understood, notably under gestational diabetes mellitus. Here we measured PFAS concentrations in cord blood serum of 532 mother-child pairs under gestational diabetes mellitus and in 532 pairs without gestational diabetes mellitus, by high-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. We analyzed birth outcomes and child growth up to two years of age using generalized linear models, generalized estimation equations, and quantile g-computation models. Results show that PFAS, including perfluorooctanoic acid, perfluorooctanesulfonic acid, perfluorohexanesulfonic acid, perfluorodecanoic acid, and 6:2 chlorinated polyfluorinated ether sulfonate, adversely affected birth outcomes. Both individual and mixed PFAS exposure delayed early child growth. Under gestational diabetes mellitus, prenatal PFAS exposure was highly associated with weight-for-length Z-scores and body mass index-for-age Z-scores.