Background: Per- and polyfluoroalkyl substances (PFAS) can disrupt hormonal and metabolic processes that support healthy pregnancy. PFAS exposure has been associated with miscarriage risk, but less is known about exposure to multiple PFAS and psychosocial stress measured at preconception, especially among Black women. Methods: We used prospective data from 538 participants from the Study of Environment, Lifestyle, and Fibroids who self-identified as Black or African American. At baseline (preconception), we measured six PFAS concentrations in plasma samples, and participants completed the Perceived Stress Scale-4 (PSS-4) (higher scores reflect greater stress). Participants reported pregnancy outcomes at follow-up study visits (~20, 40, and 60 months). We used Cox proportional hazards models, with gestational week as the time scale, to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) characterizing miscarriage risk associated with PFAS concentrations and perceived stress scores. We also used the survival extension of quantile-based g-computation to estimate associations of the mixture (PFAS and perceived stress scores) with miscarriage risk. Results: Ninety-five miscarriages were reported during follow-up. In Cox models, perfluorohexanesulfonic acid was associated with 99% (HR = 1.99, 95% CI = 1.10, 3.58) and 52% (HR = 1.52, 95% CI = 0.73, 3.17) higher miscarriage risk at the 50th–74th and ≥75th percentiles (vs. <50th percentile), respectively. Other PFAS showed little association with miscarriage risk. Perceived stress scores (per 1-standard deviation increase) were associated with 23% (HR = 1.23, 95% CI = 0.98, 1.53) higher miscarriage risk. The mixture was nonlinearly associated with miscarriage risk, but associations were imprecise. Conclusions: Higher perfluorohexanesulfonic acid concentrations and perceived stress scores were associated with miscarriage risk among Black women.
S. Schildroth, Birgit Claus Henn, V. Fruh et al.· Environmental Epidemiology· 0 citations
Sleep health is a critical component of maternal well-being, and poor sleep during pregnancy is associated with adverse maternal-fetal and cardiometabolic outcomes. Although sleep across pregnancy has been examined in several longitudinal studies, fewer studies have included frequent repeated assessments in racially and ethnically diverse populations with a high representation of lower socioeconomic status. We aimed to characterize longitudinal patterns of sleep duration, sleep quality, and sleep midpoint across pregnancy; identify groups with similar sleep profiles; and examine maternal and pregnancy characteristics associated with sleep health.
This secondary analysis included individuals enrolled in the Human Placenta and Phthalates Study in Norfolk, Virginia and Galveston, Texas (2016–2020). Self-reported sleep duration and quality were collected at up to eight visits (13–36 gestational weeks). Sleep midpoint was calculated from reported bedtime and wake time. Generalized estimating equations evaluated associations between participant characteristics and repeated sleep measures. Group-based trajectory modeling identified joint trajectories of reported bed and wake times for perceived overnight sleep duration and perceived sleep quality; sleep midpoint was excluded because models incorporating it did not converge.
Among 303 individuals, 43% were non-Hispanic Black (NHB), 39% non-Hispanic White (NHW), 16% Hispanic/Latina, and 72% had government-assisted health insurance. Across pregnancy, the proportion of individuals reporting short sleep increased modestly, perceived sleep quality worsened, and sleep midpoint remained relatively stable, with no differences in overall patterns by race and ethnicity. On average, NHB individuals were 8% more likely to report short sleep (< 7 h), and Hispanic/Latina individuals reported better sleep quality than NHW individuals. Higher BMI, lower educational attainment, parity, and government insurance were associated with worse sleep across domains. Three joint trajectory groups were identified: “Worst Sleepers” (short duration/poor quality; 60.7%), “Restless Sleepers” (7–9 h/lower quality; 25.4%), and “Best Sleepers” (adequate duration/high quality; 13.9%); 64% of NHB and 53% of nulliparous individuals were classified as “Worst Sleepers.”
Adverse sleep patterns were common across pregnancy. The findings support evaluating both sleep quantity and perceived quality during prenatal care and investigating modifiable clinical, social, and environmental contributors to persistent sleep difficulties, particularly among groups disproportionately represented in unfavorable sleep profiles.
Amir J. Lueth, Danielle R. Stevens, S. Gaston et al.· BMC Pregnancy and Childbirth· 0 citations
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