Associations of Exposure to Perfluoroalkyl Substances With Thyroid Hormone Concentrations and Birth Size

Christina Xiao, Philippe Grandjean, Damaskini Valvi, Flemming Nielsen, Tina Kold Jensen, Pal Weihe, Youssef Oulhote

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    42 Citations (Scopus)


    Background: Adequate thyroid function during pregnancy is essential for optimal fetal growth. Gestational exposure to perfluoroalkyl substances (PFAS) can negatively affect birth size and disrupt maternal and neonatal thyroid function, although the interrelationship is unclear.

    Objective: We aimed to quantify the associations between maternal serum-PFAS concentrations and birth weight, birth length, and cranial circumference. We also aimed to estimate associations between PFAS and thyroid hormone (TH) concentrations, thereby elucidating whether THs potentially mediate the associations between PFAS concentrations and birth size.

    Methods: We studied a population-based prospective cohort of 172 mother-singleton pairs from the Faroe Islands. Twelve PFAS were measured in maternal serum obtained at 34 weeks of gestation. THs were measured in maternal and cord serum. Associations between PFAS concentrations and birth size and TH concentrations were estimated using multivariable linear regressions. Sex-stratified analyses along with a mediation analysis were performed to estimate potential mediating effects of THs in the association between PFAS and birth outcomes.

    Results: Several PFASs were negatively associated with birth weight, length, and head circumference, and a general positive association between maternal serum-PFASs and cord serum-thyroid-stimulating hormone (TSH; also known as thyrotropin) was found. For instance, a doubling in perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) was associated with a 53% (95% CI, 18%-99%) and 40% (95% CI, 8%-81%) increases in TSH concentrations, respectively. There was little evidence of sexually dimorphic associations. Overall, THs were not found to mediate associations between PFASs and birth size.

    Conclusion: In this study, several PFASs were negatively associated with birth size and increased THs; however, this did not explain lower birth weight among children exposed to PFAS.
    Original languageEnglish
    Pages (from-to)735-745
    Number of pages11
    JournalJournal of Clinical Endocrinology and Metabolism
    Issue number3
    Early online date29 Oct 2019
    Publication statusPublished - Mar 2020


    • birth outcomes
    • fetal development
    • mediation analysis
    • perfluoroalkyl substances
    • pregnant women
    • thyroid hormones


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