In a recent study, prenatal PFAS exposure was linked to higher adolescent blood pressure, with stronger effects in boys and children born to non-Hispanic Black mothers.
Prenatal exposure to PFAS linked to higher adolescent blood pressure in diverse birth cohort | Image Credit: © Francesco Scatena - stock.adobe.com.
Children exposed in utero to certain synthetic chemicals known as PFAS had higher blood pressure in adolescence, according to findings published in the Journal of the American Heart Association and presented at the Society for Epidemiologic Research (SER) Conference. The study analyzed longitudinal data from the Boston Birth Cohort and is among the first to examine the relationship between prenatal exposure to “forever chemicals” and blood pressure across childhood and adolescence in a racially and ethnically diverse population.1,2
PFAS, or per- and polyfluoroalkyl substances, are a group of man-made chemicals commonly found in products such as nonstick cookware, water-resistant fabrics, and food packaging. These compounds do not degrade easily and can persist in the environment and human body for years. Prenatal exposure occurs when PFAS cross the placental barrier, potentially affecting fetal development.
“Our study shows that prenatal PFAS exposure is associated with higher blood pressure later in childhood, especially during adolescence,” said lead author Zeyu Li, MSPH, a graduate student researcher at Johns Hopkins Bloomberg School of Public Health. “This suggests these forever chemicals can have long-lasting and potentially harmful effects that may only become apparent years after birth.”
The study followed 1,094 children from the Boston Birth Cohort for a median of 12 years, encompassing more than 13,000 blood pressure measurements taken during routine pediatric visits. Researchers measured levels of eight PFAS in maternal blood samples collected within 72 hours of delivery. The analysis focused on the association between these exposures and children's systolic and diastolic blood pressure percentiles from ages 3 to 18.
The results indicated that children whose mothers had higher concentrations of PFDeA, PFNA, and PFUnA had higher systolic and diastolic blood pressure percentiles during adolescence. A doubling in these PFAS levels was associated with a 1.39 to 2.78 percentile increase in systolic blood pressure and a 1.22 to 2.54 percentile increase in diastolic blood pressure among adolescents.
The associations were strongest in male children and those born to non-Hispanic Black mothers. Each doubling of PFAS levels was linked to a 6% to 8% increased risk of elevated blood pressure in these groups. In contrast, some PFAS—such as Me-PFOSA-AcOH, PFHpS, PFHxS, PFOA, and PFOS—were associated with lower diastolic blood pressure in early childhood, but these effects did not persist into adolescence.
“Many past studies stopped at early or mid-childhood; however, our study shows that the health effects of prenatal PFAS exposure may not appear until the teen years,” Li said.
The study's senior author, Mingyu Zhang, PhD, MHS, FAHA, assistant professor at Beth Israel Deaconess Medical Center and Harvard Medical School, emphasized the need for broader public health measures. “Reducing PFAS exposure—especially during pregnancy and in children—requires policy-level action to limit and phase out PFAS in consumer products and industrial uses, and to strengthen monitoring and regulation of PFAS in water systems. This is not something individuals can solve on their own,” Zhang said.
The Boston Birth Cohort study population was predominantly composed of non-Hispanic Black and Hispanic families and included mothers with a median age of 29 at delivery. Researchers used statistical models that adjusted for maternal health conditions, socioeconomic variables, delivery mode, and fish consumption during pregnancy.
Children had a median of 9 blood pressure measurements between the ages of 3 and 18 years. Researchers defined elevated blood pressure based on the 2017 AAP Clinical Practice Guidelines. The findings revealed a dose-dependent increase in systolic blood pressure among children with higher prenatal PFAS levels, particularly evident starting around age 13.
Justin Zachariah, MD, MPH, FAHA, chair of the American Heart Association’s scientific statement on environmental exposures and pediatric cardiology, commented on the study’s implications. “We must remember that these chemicals last in our bodies for years, suggesting that perhaps prenatal exposure may have occurred before conception, and these chemicals may cause changes that can carry forward for generations.”
He added that socioeconomic disparities may exacerbate exposure, particularly among families reliant on processed foods and products containing PFAS. “In addition, the children may have lifestyles that expose them to everyday items heavily burdened with these chemicals, such as toys they may chew on, rain jackets, camping tents, and more,” he said.
Study limitations included reliance on a single maternal blood sample for PFAS measurement shortly after delivery and fewer blood pressure readings available during adolescence compared to early childhood.
Despite these limitations, the findings support the need for long-term surveillance and preventive strategies aimed at reducing prenatal PFAS exposure. As Zachariah noted, “Improvements we make could echo for generations to come.”
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