Gestational Perfluoroalkyl Substance Exposure and Body Mass Index Trajectories over the First 12 Years of Life

BACKGROUND/OBJECTIVES: Gestational exposure to perfluoroalkyl substances (PFAS), a ubiquitous class of persistent endocrine disrupting chemicals, is associated with increased risk of obesity and cardiometabolic disease. However, it is unclear if gestational PFAS exposure is associated with adiposity trajectories related to adult obesity and cardiometabolic health. SUBJECTS/METHODS: We measured perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononaoic acid, and perfluorohexanesulfonic acid (PFHxS) concentrations in maternal serum collected between 16-weeks gestation and delivery in a cohort of 345 mother-child pairs in Cincinnati, OH (enrolled 2003–06). From age 4-weeks to 12 years, we measured weight and length or height up to eight times and calculated child BMI (1,865 repeated measures). Using covariate-adjusted linear mixed models and splines to account for repeated BMI measures and non-linear BMI patterns, respectively, we estimated the age/magnitude of infancy BMI zenith (~1 year) and childhood BMI nadir (~5 years), BMI accrual from 8–12 years, and BMI at age 12 years by PFAS terciles. RESULTS: BMI trajectories varied by PFOA concentrations (age × PFOA interaction p-value=0.03). Children born to women with higher PFOA concentrations had lower infancy and early childhood BMI, earlier BMI nadir, accelerating BMI gains in mid-childhood and adolescence, and higher BMI at age 12 years. Some of these associations were non-monotonic. PFOS and PFHxS were not associated with alterations in BMI trajectories, but were monotonically associated with lower BMI across infancy, childhood, and adolescence. Compared to children in the 1(st) PFOS tercile, those in the 2(nd) (β:-0.83; 95%CI:-2.11, 0.51 kg/m(2)) and 3(rd) (β:-1.41; 95%CI:-2.65, -0.14 kg/m(2)) had lower BMI at age 12 years. CONCLUSIONS: These results suggest that gestational PFOA exposure may be associated with BMI trajectories related to adult obesity and cardiometabolic disease, while PFOS and PFHxS exposure is associated with lower BMI in the first 12 years of life.