Associations between the chemical exposome and pregnancy induced hypertension

Munawar Hussain Soomro; Gillian England-Mason; Jiaying Liu; Anthony J F Reardon; Amy M MacDonald; David W Kinniburgh; Jonathan W Martin; Deborah Dewey; APrON Study Team

doi:10.1016/j.envres.2023.116838

Associations between the chemical exposome and pregnancy induced hypertension

Environ Res. 2023 Nov 15;237(Pt 1):116838. doi: 10.1016/j.envres.2023.116838. Epub 2023 Aug 5.

Authors

Munawar Hussain Soomro¹, Gillian England-Mason¹, Jiaying Liu², Anthony J F Reardon², Amy M MacDonald³, David W Kinniburgh⁴, Jonathan W Martin⁵, Deborah Dewey⁶; APrON Study Team⁷

Affiliations

¹ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
² Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
³ Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada.
⁵ Science for Life Laboratory, Department of Analytical Chemistry and Environmental Sciences, Stockholm University, Stockholm, Sweden.
⁶ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Electronic address: dmdewey@ucalgary.ca.
⁷ University of Calgary, Calgary, Alberta Canada; University of Alberta, Edmonton, Alberta Canada.

PMID: 37544468
DOI: 10.1016/j.envres.2023.116838

Abstract

Exposure to environmental chemicals has been linked to an increased risk of pregnancy-induced hypertension (PIH). This prospective cohort study examined the associations between PIH and maternal chemical exposure to four classes of chemicals (i.e., phthalates, bisphenols, perfluoroalkyl acids, non-essential metals and trace minerals). Participants included 420 pregnant women from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort who had data available on diagnosed PIH and environmental chemical exposure. Twelve phthalate metabolites, two bisphenols, eight perfluoroalkyl acids and eleven non-essential metals or trace minerals were quantified in maternal urine or blood samples collected in the second trimester of pregnancy. Associations between the urinary and blood concentrations of these chemicals and PIH were assessed using multiple logistic and LASSO regression analyses in single- and multi-chemical exposure models, respectively. Thirty-five (8.3%) participants were diagnosed with PIH. In single chemical exposure models, two phthalate metabolites, mono-methyl phthalate (MMP) and monoethyl phthalate (MEP), three perfluoroalkyl acids, perfluoroheptanoic acid (PFHpA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA), and one metal, manganese, were associated with increased odds of PIH. The metabolites of di (2-ethylhexyl) phthalate (DEHP) and the molar sum of these metabolites, as well as antimony, displayed trend associations (p < 0.10). In multi-chemical exposure models using LASSO penalized regressions and double-LASSO regressions, MEP (AOR: 1.43, 95% CI: 1.09-1.88, p = 0.009) and PFNA (AOR: 2.03, 95% CI: 1.01-4.07, p = 0.04) were selected as the chemicals most highly associated with PIH. These findings suggest that maternal levels of phthalates and perfluoroalkyl acids may be associated with the diagnosis on PIH. Future research should consider both individual and multi-chemical exposures when examining predictors of PIH and other maternal cardiometabolic health disorders, such as preeclampsia, eclampsia, HELLP syndrome, and gestational diabetes.

Keywords: APrON study; Environmental chemical exposures; LASSO regression; Pregnancy; Pregnancy-induced hypertension.