Date of Award


Document Type

Thesis (Ph.D.)

Department or Program

Quantitative Biomedical Sciences

First Advisor

Megan E. Romano

Second Advisor

Caitlin G. Howe

Third Advisor

Jiang Gui


Food is a common exposure pathway to per- and polyfluoroalkyl substances (PFAS) but dietary factors related to PFAS concentrations in pregnant people have not been adequately evaluated. PFAS have been linked to the increased risk of gestational hypertension, preeclampsia, and adiposity. However, less is known regarding the effect of PFAS mixtures on blood pressure (BP) trajectories in normotensive pregnancies or weight retention postpartum. We used data from the New Hampshire Birth Cohort Study (NHBCS) to examine dietary intake and PFAS concentrations and associations of PFAS with BP trajectories and postpartum weight retention. PFAS concentrations were measured in plasma collected at ~28 weeks gestation and human milk collected at ~6 weeks postpartum. Information on maternal diet was collected using a validated food frequency questionnaire at ~24-28 weeks gestation. BP measurements during pregnancy and pre-pregnancy weight were abstracted from maternal medical records. Self-reported pre-pregnancy weight was used if medical records were unavailable. We calculated the difference between self-reported postpartum weight collected in 2020 and pre-pregnancy weight. Adaptive elastic net was used to identify dietary variables associated with plasma and milk PFAS concentrations while accounting for correlations between dietary variables. Latent class trajectory modeling was used to identify BP trajectory groups among normotensive pregnant people. We used mixture modeling approaches to assess the effect of PFAS mixtures on BP trajectories among normotensive pregnancies and weight change pre-pregnancy to postpartum. We also evaluated whether the PFAS mixtures-weight retention association was modified by pre-pregnancy body mass index. Higher intake of fish/seafood, eggs, coffee, or white rice during pregnancy was associated with higher plasma or milk PFAS concentrations. Plasma PFAS concentrations were associated with greater increases in BP during pregnancy among normotensive people and greater weight retention at ~7 years postpartum for individuals who were obese/overweight pre-pregnancy. Our findings suggest that certain dietary factors during pregnancy influence PFAS concentrations in pregnant people, which can inform interventions to reduce PFAS exposure. Moreover, PFAS may impact BP trajectories among normotensive pregnancies and have a long-term effect on postpartum weight retention. Thus, reducing PFAS exposure may contribute to improving cardiovascular health for pregnant individuals and their offspring.

Original Citation

Wang Y, Howe C, Gallagher LG, Botelho JC, Calafat AM, Karagas MR, Romano ME. Per- and Polyfluoroalkyl Substances (PFAS) Mixture during Pregnancy and Postpartum Weight Retention in the New Hampshire Birth Cohort Study (NHBCS). Toxics. 2023; 11(5):450.

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