Association between urinary levels of six per- and poly-fluoroalkyl substances in early pregnancy and risk of gestational diabetes mellitus

Ziyi LIU; Luming YAN; Tingting JIANG; Yaling LI; Chao ZHANG; Jiahu HAO

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Association between urinary levels of six per- and poly-fluoroalkyl substances in early pregnancy and risk of gestational diabetes mellitus

VernacularTitle:孕早期六种全氟及多氟烷基物质尿液水平与妊娠期糖尿病风险关联
Author: Ziyi LIU ¹ ; Luming YAN ¹ ; Tingting JIANG ¹ ; Yaling LI ² ; Chao ZHANG ² ; Jiahu HAO ³
Author Information

1. Department of Maternal, Child and Adolescent Health.
2. Department of Health Promotion and Behavioral Science.
3. Department of Maternal, Child and Adolescent Health;Key Laboratory of Population Health Across Life Cycle, Ministry of Education/National Health Commission Key Laboratory of Gamete and Reproductive Tract Abnormalities/Anhui Provincial Key Laboratory of Population Health and Eugenics (Anhui Medical University), School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
Publication Type:Selectedarticle
Keywords: pregnant woman; per- and poly-fluoroalkyl substance; gestational diabetes mellitus; urine; first trimester
From: Journal of Environmental and Occupational Medicine 2026;43(2):174-181
CountryChina
Language:Chinese
Abstract: Background Per- and poly-fluoroalkyl substances (PFAS) can influence gestational diabetes mellitus (GDM); however, current studies on their association are limited and have yielded inconsistent findings. Objective To investigate the association between maternal exposure to PFAS, as measured by urinary concentrations in early pregnancy, and the risk of developing GDM. Methods Based on the Wuhu Birth Cohort in Anhui Province conducted between 2020 and 2023, this study included 1910 pregnant women. Urine samples were collected during the first trimester, and a 75 g oral glucose tolerance test (OGTT) was completed at 24–28 gestational weeks. The concentrations of six PFAS in urine were measured using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Participants were categorized into low, medium, and high exposure groups according to tertiles of individual PFAS concentrations. Logistic regression analysis was employed to assess the potential impact of early-pregnancy PFAS exposure levels on the risk of GDM, with stratified analyses by maternal age and fetal sex. A generalized weighted quantile sum regression (gWQS) model was applied to evaluate the relative weight distribution of the six PFAS in their mixture effect. Results The logistic regression results revealed that both medium exposure to perfluorohexane sulfonate (PFHxS) (OR=1.475, 95%CI: 1.040, 2.093) and high exposure to perfluorononanoic acid (PFNA) (OR=1.430, 95%CI: 1.013, 2.018) were positively associated with diagnosed GDM. This association was more pronounced among women older than 28 years. Among pregnant women carrying male fetuses, high-level exposures to per fluorohexanoic acid (PFHxA) (OR=1.708, 95%CI: 1.006, 2.899) and PFHxS (OR=2.116, 95%CI: 1.247, 3.584) showed positive associations with diagnosed GDM. In contrast, among those carrying female fetuses, moderate perfluorooctanesulfonic acid (PFOS) exposure was associated with a lower risk of GDM (OR=0.542, 95%CI: 0.311, 0.946). The gWQS results demonstrated that PFOS (0.48) and perfluorobutane sulfonate (PFBS) (0.34) contributed the most to the mixture effect. Conclusion Early-pregnancy exposure to PFAS (particularly PFHxS and PFNA) may be an etiological factor for GDM, with maternal age and fetal sex potentially acting as effect modifiers in this association.