Maternal perfluoroalkyl and polyfluoroalkyl substances (PFAS) exposure and preeclampsia: a systematic review and meta-analysis

Polyfluoroalkyl and perfluoroalkyl substances (PFAS) are persistent organic pollutants and exposure have been suggested with the risk of developing preeclampsia. Yet, evidence on the associations of PFAS with preeclampsia is still conflicting. Thus, the current study conducted a systematic review and meta-analysis of the epidemiological evidence linking maternal PFAS exposure to preeclampsia. This research methodology involved searching three electronic databases for epidemiological studies, and then conducting a meta-analysis using a random-effects model to analyse the heterogeneity between the studies. The quality and strength of evidence for each exposure-outcome pair was also evaluated, as well as the risk of bias. The search identified 10 potentially eligible studies related to maternal PFAS blood level with preeclampsia, which 7 were ultimately selected. Meta-analysis demonstrated evidence of association between combined PFAS compounds in pregnant mother with preeclampsia with zero heterogeneity (I2=0.0%, Q= 3.09, df= 6, p=0.798). Preeclampsia was found to have moderate association with maternal perfluorooctanoic acid (PFOA) exposure (Test for overall effect: z=2.2, p=0.03; Test for heterogeneity: I2=0.0%, Q= 3.49, df= 6, p=0.745) as well as maternal perfluorooctane sulfonate (PFOS) exposure (Test for overall effect: z=2.5, p=0.01; Test for heterogeneity: I2=0.0%, Q= 3.70, df= 6, p=0.718). This study showed significant associations between PFOA and PFOS exposure with the risk of preeclampsia. However, in-depth investigation is imperative to elucidate the impact of the different concentration and types of PFAS on preeclampsia risk.