Association of serum levels of perfluoroalkyl substances with gestational diabetes mellitus and postpartum blood glucose
Graphical abstract
Introduction
Perfluoroalkyl substances (PFASs) are high-volume synthetic chemicals that have been extensively used as surfactants, repellents, paper and textile coatings, non-stick frying pan coatings and food packaging, resulting in ubiquitous contamination and human exposure worldwide (Lau et al., 2007, Lindstrom et al., 2011, Shi et al., 2010, Wang et al., 2017, Zhao et al., 2014). Potential routs of human exposure include ingestion of diet, water, and indoor dust as well as inhalation, although the exposure pathways remain unclear (Lau et al., 2007). Detectable PFAS compounds in biological matrix from non-occupational populations in various countries/regions have been heavily reported (Choi et al., 2017). Due to their persistence, the elimination in human body is very slow, and the estimated half-life is 3–5 years for some well-known PFAS compounds, like perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) (Olsen et al., 2007).
PFAS compounds are structurally homologous with fatty acids and plausibly have endocrine-disrupting properties, and these chemicals may be involved in the development of energy metabolism dysfunction (Audouze et al., 2013, Lau et al., 2007, Lv et al., 2013, White et al., 2011). Exposure to PFASs could up-regulate the fatty acid oxidation pathways and increase oxidative stress that were associated with diabetes (Guruge et al., 2006, Hu et al., 2005, Karpe et al., 2011). However, on the other hand, PFASs have also shown the ability to bind peroxisome proliferator-activate receptors (PPARs) as agonist that are critical to improve insulin resistance (Staels and Fruchart, 2005, Vanden Heuvel et al., 2006). Thus, the potential mechanisms underlying disrupted glucose and lipid metabolism by PFAS exposure remain unclear and controversial. And some studies have statistically linked specific PFAS congeners exposure with insulin resistance (Fleisch et al., 2017, Lin et al., 2009, Lind et al., 2014, Timmermann et al., 2014), β-cell function (Conway et al., 2016), impaired glucose homeostasis and risk of type 2 diabetes (T2D) (Lind et al., 2014, Su et al., 2016).
Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy, is a growing health concern and related to the increased risk of T2D and cardiovascular diseases for both mother and offspring as well as other adverse outcomes like preeclampsia and fetal macrosomia (Metzger et al., 2007). The GDM incidence is escalating in parallel with dramatically increasing rates of T2D as well as obesity worldwide. Some risk factors for GDM, including maternal characteristics as well as lifestyle, and dietary habits, have been well documented and emerging data indicate a possible environmental etiology for GDM (Smarr et al., 2016, Vafeiadi et al., 2017, Zhang et al., 2016). So far, there is very scarce literature on investigating the correlation between PFASs exposure and the risk of GDM as well as maternal glucose metabolism (Zhang et al., 2015). In the present study, we conducted a 1:2 matched case–control study with a study population including 84 GDM subjects and 168 healthy pregnant women that were age-matched, and various PFASs were measured in maternal serum to evaluate the association of PFAS exposure with GDM and postpartum fasting blood glucose levels.
Section snippets
Study population
This study was designed as a 1:2 pair-matching case–control study. 84 GDM subjects were recruited from pregnant women diagnosed as GDM from January to March, 2013 at Haidian Maternal & Child Health Hospital in Beijing, China. The diagnoses of GDM follow the Diagnostic Criteria for Gestational Diabetes Mellitus (WS311-2011) released by Ministry of Health of China. Briefly, 75 g oral glucose test (OGTT) is applied, and GDM was diagnosed if one or more cut-off values were equal or exceed, which
Results
Among 22 PFASs determined in this study, six linear PFASs (n-PFOA, PFNA, PFDA, PFUnDA, n-PFOS, and PFHxS) and five branched PFOS isomers (1m-PFOS, 3m-PFOS, 4m-PFOS, 5m-PFOS, and 6m-PFOS) were detected in almost all serum samples, and values are listed in Table 1. The median of the summation of detectable PFASs (∑11PFASs) was 4.24 ng/mL and the interquartile range (IQR) was 2.82–6.54 ng/mL. For individual chemicals, n-PFOS was the predominant compound with a median of 2.78 ng/mL (IQR: 1.91–4.41
Discussion
Similar with T2D, GDM is characterized by hyperglycemia and insulin levels that are insufficient to meet insulin demands (Metzger et al., 2007). Some studies support the hypothesis that GDM and T2D may be two manifestations of the same entity (Lauenborg et al., 2009). While a number of epidemiological studies focusing on the association of PFAS exposure with diabetes have been conducted, the diabetogenic effect of these chemicals remains unclear. General information of these studies is
Conclusion
We found no evidence for the association between maternal exposure of pregnant women to various linear and branched PFASs and risk of GDM. After adjusting for some potential confounders, maternal exposure to some PFASs like 1m-PFOS, 3m + 4m-PFOS, 5m-PFOS, and PFHxS was significantly associated with postpartum blood glucose, suggesting negative effect of maternal exposure to PFASs on blood glucose. It is worthy to conduct further research to replicate the present findings in a large sample size
Acknowledgment
We would like to express our gratitude to all volunteering mothers in this study. This work was supported by the National Natural Science Foundation of China (Nos. 21537001 and 21477030) and the National Key Research and Development Program of China (No. 2017YFC1600502), the Strategic Priority Research Program of the Chinese Academy of Sciences (No. XDB14010100).
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