Prenatal exposure to chlorinated polyfluoroalkyl ether sulfonic acids and perfluoroalkyl acids: Potential role of maternal determinants and associations with birth outcomes.

Transplacental exposure to per/polyfluoroalkyl substances (PFASs) may impact fetal growth, but published evidence are still sparse and not in agreement. Moreover, little is known on the occurrence of emerging chlorinated polyfluorinated ether sulfonates (Cl-PFESAs, 6:2 and 8:2) in maternal-neonatal population. This study investigated eleven PFASs by analyzing 98 cord samples from Hangzhou, China. All target compounds can be transported across placenta, with highest median concentrations of 4.07, 1.05 and 0.731 ng/mL for PFOS, PFOA, and 6:2 Cl-PFESA. Older ages and higher pre-pregnancy BMI were associated with higher cord PFASs concentration; being primiparous was also significantly associated. Notably, after adjusting for potential confounders, PFOS was negatively associated with birth weight (β = -417.3 g, 95% CI: -742.1, -92.4, p = 0.011, per a log10 unit increase in exposure) and ponderal index (β = -0.005 g/cm3, 95% CI: -0.008, -0.002, p = 0.000). PFOS and PFHxS were also indicated to be associated with small for gestational age birth (SGA) (p <  0.05). Although no evidence of association was observed between Cl-PFESAs and birth outcomes in this study, the bioaccumulative properties and development toxicity of Cl-PFESAs deserve continuous concern.