(839) High Rural Water Per- and Polyfluorinated Alkyl Substances (PFAS) Levels and Preeclampsia

Per- and Polyfluorinated Alkyl Substances (PFAS) are synthetic chemicals used in pesticides. PFAS are found in humans with drinking water as the key route of entry. PFAS exposure in human and preclinical models is associated with preeclampsia (PreE). Yet, adequate control for covariates are limited in previous studies. The objective of this study to estimate the effect of PFAS levels in rural populations on the development of PreE.

Study Design:

This retrospective cohort study uses a dataset from the Intergenerational Health Knowledgebase (N=78,726 pregnancies, IRB#20101369) an integrated datamart of all EHR data of maternal, pediatric, and pregnancy care at the University of Iowa Health Care system. Pregnancies from high PFAS (hiP) areas (N=1880) were identified by zip codes in which the municipal water tested higher than the maximum contaminant level (MCL) for one PFAS chemical as determined by the Iowa Department of Natural Resources. Low PFAS (loP) pregnancies (N=1602) were identified by zip codes in which the MCL for any PFAS was not exceeded. Baseline characteristics were compared for both groups (alpha=0.05).  Logistic regression models were constructed to evaluate the association of municipal water PFOS levels and PreE.

Results:

Pregnancies from hiP areas in comparison to loP were significantly more rural by RUCA code (36% vs 3%, p< 0.001), had higher obesity rates (48% vs. 35%, p< 0.001), and higher PreE rates (12% vs. 9%, p=0.014). Rates of diabetes, racial distribution, and rates of adverse neonatal outcomes were similar between the two groups.  After controlling for obesity, race, and diabetes diagnosis, hiP pregnancies were associated with higher odds of developing PreE in comparison to loP pregnancies (aOR=1.4 [1.1-1.8], p=0.020).

Conclusion:

High rural municipal water PFAS levels are associated with a higher odds of developing PreE even after controlling significant covariates. Future studies should investigate PFAS level exposure at the participant level to determine a more granular association with PFAS levels and PreE development.