Exposure to perfluoroalkyl substances and women's fertility outcomes in a Singaporean population-based preconception cohort

Per- and polyfluoroalkyl substances in environment and potential health impacts: Sources, remediation treatment and management, policy guidelines, destructive technologies, and techno-economic analysis

Per- and polyfluoroalkyl Substances (PFAS), also known as forever chemicals and ubiquitous persistence, pose significant public health challenges due to their potential toxicity, particularly in drinking water and soil contamination. However, PFAS occurrence and their concentrations in different environmental matrices vary globally, but factors influencing trends, transport, fate, toxicity, and interactions with co-contaminants remain largely unexplored. Therefore, this review critically examines the state-of-the-art worldwide PFAS sources, distribution, and pathways, and evaluates how PFASs are processed in wastewater treatment, generally, which causes severe problems with the quality and safety of drinking water. Importantly, the review also underscores health issues due to PFAS consumption and recent research trends on developing effective treatment strategies to manage PFAS contamination. Potential effects of PFAS were linked to urban land use and the proportion of wastewater effluent in streamflow. Besides, major emphasis was provided on challenges for conventional treatment, destructive technologies, environmental accumulation, precursor transformation, and cost-investment related to PFAS removal technologies. To combat PFAS contamination, this review proposes a framework that promotes the comprehensive identification of prevalent compounds, with a focus on their eradication through knowledge-based and targeted analysis. Additionally, it explores the ongoing debate surrounding PFAS laws and legal frameworks, offering ideas for enhancing contamination management. Lastly, this review provides a strategic plan for improving response and preparedness, serving as a foundation for addressing future environmental challenges and informing health risk assessments.

The ENDOMIX perspective: how everyday chemical mixtures impact human health and reproduction by targeting the immune system†

Endocrine-disrupting chemicals are natural and synthetic compounds found ubiquitously in the environment that interfere with the hormonal-immune axis, potentially impacting human health and reproduction. Exposure to endocrine-disrupting chemicals has been associated with numerous health risks, such as neurodevelopmental disorders, metabolic syndrome, thyroid dysfunction, infertility, and cancers. Nevertheless, the current approach to establishing causality between these substances and disease outcomes has limitations. Epidemiological and experimental research on endocrine-disrupting chemicals faces challenges in accurately assessing chemical exposure and interpreting non-monotonic dose response curves. In addition, most studies have focused on single chemicals or simple mixtures, overlooking complex real-life exposures and mechanistic insights, in particular regarding endocrine-disrupting chemicals' impact on the immune system. The ENDOMIX project, funded by the EU's Horizon Health Program, addresses these challenges by integrating epidemiological, risk assessment, and immunotoxicology methodologies. This systemic approach comprises the triangulation of human cohort, in vitro, and in vivo data to determine the combined effects of chemical mixtures. The present review presents and discusses current literature regarding human reproduction in the context of immunotolerance and chemical disruption mode of action. It further underscores the ENDOMIX perspective to elucidate the impact of endocrine-disrupting chemicals on immune-reproductive health.

Per- and poly-fluoroalkyl substances (PFAS) accelerate biological aging mediated by increased C-reactive protein

Unhealthy biological aging is related to higher incidence of varied age-related diseases, even higher all-cause mortality. Previous small sample size study suggested that Per- and poly-fluoroalkyl substances (PFAS) was associated with biological aging, but the evidence of exposure-response relationships, potential effect modifiers, and potential mediators were not investigated. Therefore, we conducted a cross-sectional analysis of national study including 14, 865 adults in the US from 8 survey cycles of NHANES from 2003 to 2018, to investigate the associations of PFAS compounds in body serum, including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), with biological aging. Generalized linear models showed that higher human exposure to PFAS was associated with accelerated biological aging. Importantly, human exposure to PFOA, PFOS, PFNA, and PFHxS with detected level (above 0.10 ng/mL) was associated with an average of 3.3 year (95 %CI: 2.7, 3.9, P < 0.001), 14.9 year (95 %CI: 7.2, 22.7, P < 0.001), 10.9 years (95 %CI: 3.9, 17.7, P < 0.001), and 8.8 years (95 %CI: 4.8, 12.9, P < 0.001) of biological aging acceleration. Cubic spline models indicated exposure-response relationships where there was no safe threshold of PFAS level regarding harms to human healthy aging. The weighted sum regression model found the significant associations of PFAS compound mixture with biological aging acceleration, and PFOA was the dominant contributor among 4 PFAS compounds. Mediation analysis suggested that C-reactive protein, one of the inflammation biomarkers, might play as mediator in PFAS-induced accelerated biological aging, but not Triglyceride-glucose index. In summary, our study suggests that the effects of PFAS on biological aging acceleration should be of concern and more action plans to address their negative impact on human health should be launched.

Per- and polyfluoroalkyl substances (PFAS): Trends in mass spectrometric analysis for human biomonitoring and exposure patterns from recent global cohort studies

Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants that have been shown to contribute to human exposure, thereby raising a range of health concerns. In this context, human biomonitoring is essential for linking exposure levels of PFAS with their potential health risks. Mass spectrometry-based analytical techniques have been extensively adopted for the evaluation of PFAS levels across various cohorts. However, challenges arising from the use of biological samples (e.g., plasma, serum, urine, etc.) necessitate ongoing research and refinement of analytical methodologies. This review provides an overview of current trends in mass spectrometry-based approaches for human biomonitoring of PFAS, including sample collection and preparation, and instrumental techniques. We also explore analytical strategies to overcome challenges in obtaining PFAS-free blank matrices and address the risk of background contamination. Moreover, this review examines differing PFAS exposure patterns across regions by analyzing recent international cohort studies, specifically those conducted in the US and China over the past five years. Accordingly, several key research gaps in biomonitoring studies that need to be addressed moving forward are highlighted.

Associations between per- and poly-fluoroalkyl substance (PFAS) exposure and immune responses among women in the California Teachers study: A cross-sectional evaluation

INTRODUCTION

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants that have been linked to a number of health outcomes, including those related to immune dysfunction. However, there are limited numbers of epidemiological-based studies that directly examine the association between PFAS exposure and immune responses.

METHODS

In this cross-sectional study nested in the California Teachers Study cohort, we measured nine PFAS analytes in serum. Of the 9 analytes, we further evaluated four (PFHxS [perfluorohexane sulfonate], PFNA [perfluorononanoic acid], PFOA [perfluorooctanoic acid], PFOS [perfluorooctanesulfonic acid]) that had detection levels of > 80 %, in relation to 16 systemic inflammatory/immune markers and corresponding immune pathways (Th1 [pro-inflammatory/macrophage activation], B-cell activation, and T-cell activation). Study participants (n = 722) were female, completed a questionnaire regarding various health measures and behaviors, and donated a blood sample between 2013-2016. The association between PFAS analytes and individual immune markers and pathways were evaluated by calculating odds ratios (OR) and 95 % confidence intervals (CI) in a logistic regression model. PFAS analytes were evaluated both as a dichotomous exposure (above or below the respective median) and as a continuous variable (per 1 unit increase [ng/mL]).

RESULTS

The prevalence of detecting any PFAS analyte rose with increasing age, with the highest PFAS prevalence observed among those aged 75 + years and the lowest PFAS prevalence observed among those aged 40-49 years (study participant age range: 40-95 years). Significant associations with BAFF (B-cell activating factor) levels above the median were observed among participants with elevated (defined as above the median) levels of PFHxS (OR=1.53), PFOA (OR=1.43), and PFOS (OR=1.40). Similarly, there were statistically significant associations between elevated levels of PFHxS and TNFRII (tumor necrosis factor receptor 2) levels (OR=1.78) and IL2Rα (interleukin 2 receptor subunit alpha) levels (OR=1.48). We also observed significant inverse associations between elevated PFNA and sCD14 (soluble cluster of differentiation 14) (OR=0.73). No significant associations were observed between elevated PFNA and any immune marker. Evaluation of PFAS exposures as continuous exposures in association with dichotomized cytokines were generally consistent with the dichotomized associations.

CONCLUSIONS

PFAS exposure was associated with altered levels of circulating inflammatory/immune markers; the associations were specific to PFAS analyte and immune marker. If validated, our results may suggest potential immune mechanisms underlying associations between the different PFAS analytes and adverse health outcomes.

Association between exposure to per- and polyfluoroalkyl substances and missed miscarriage: A hospital-based case-control study in Shanghai, China

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants linked to reproductive disruptions. This study investigated the relationship between PFAS exposure and missed miscarriage in a hospital-based, case-control study in Shanghai, China. There were 393 women in our research, including 198 cases and 195 controls. Concentrations of 30 PFAS in plasma were quantified using HPLC-MS/MS, and 15 PFAS were detected at a rate greater than 90 percent. PFOA, L-PFOS, and PFOS isomers were significantly higher in the cases than those in the controls. 13 PFAS showed significant positive associations with miscarriage risk after adjustment for confounders, particularly PFOA (OR: 2.99, 95 % CI: 1.96-4.68) and various PFOS isomers. BKMR analysis confirmed higher overall PFAS levels were associated with increased miscarriage risk. These findings highlight the potential reproductive toxicity of PFAS and underscore the need for further investigations and regulatory actions to mitigate PFAS exposure in pregnant women.

Exposure to Environmental Chemicals and Infertility Among US Reproductive-Aged Women

Environmental chemical exposure has been rising over the past few decades but its impact on fertility remains uncertain. We assessed exposures to 23 common chemicals across a range of sociodemographic characteristics and their relationship with self-reported infertility. The analytic sample was non-pregnant women aged 18-49 years without a history of hysterectomy or oophorectomy (n = 2579) from the National Health and Nutrition Examination Survey (2013-2016). Environmental chemical exposure was assessed with biospecimens and dichotomized as high and low levels of exposure based on the median. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) for the association between high levels of exposure and infertility, adjusted for age, race, education level, family income, and smoking status. We observed associations between infertility and cadmium [aOR: 1.88; 95% CI: 1.02-3.47] and arsenic [aOR: 1.88 (1.05-3.36)]. Two pesticides hexachlorobenzene [OR: 2.04 (1.05-3.98)] and oxychlordane [OR: 2.04 (1.12-3.69)] were also associated with infertility in unadjusted analyses. There were negative associations with two Per- and polyfluoroalkyl substances with n-perfluorooctanoic acid [aOR: 0.51: (0.30-0.86)] and n-perfluorooctane sulfonic acid [aOR: 0.51: (0.26-0.97). Specific chemicals may contribute to infertility risk, highlighting the need for targeted public health strategies to mitigate exposure.

Advancing toxicity studies of per- and poly-fluoroalkyl substances (pfass) through machine learning: Models, mechanisms, and future directions

Perfluorinated and perfluoroalkyl substances (PFASs), encompassing a vast array of isomeric chemicals, are recognized as typical emerging contaminants with direct or potential impacts on human health and the ecological environment. With the complex and elusive toxicological profiles of PFASs, machine learning (ML) has been increasingly employed in their toxicity studies due to its proficiency in prediction and data analytics. This integration is poised to become a predominant trend in environmental toxicology, propelled by the swift advancements in computational technology. This review diligently examines the literature to encapsulate the varied objectives of employing ML in the toxicity studies of PFASs: (1) Utilizing ML to establish Quantitative Structure-Activity Relationship (QSAR) models for PFASs with diverse toxicity endpoints, facilitating the targeted toxicity prediction of unidentified PFASs; (2) Investigating and substantiating the Adverse Outcome Pathway (AOP) through the synergy of ML and traditional toxicological methods, with this refining the toxicity assessment framework for PFASs; (3) Dissecting and elucidating the features of established ML models to advance Open Research into the toxicity of PFASs, with a primary focus on determinants and mechanisms. The discourse extends to an in-depth examination of ML studies, segregating findings based on their distinct application trajectories. Given that ML represents a nascent paradigm within PFASs research, this review delineates the collective challenges encountered in the ML-mediated study of PFAS toxicity and proffers strategic guidance for ensuing investigations.

Perfluoroalkyl and Polyfluoroalkyl Substances in Relation to the Participant-Reported Total Pregnancy and Live Birth Numbers among Reproductive-Aged Women in the United States

Perfluoroalkyl and polyfluoroalkyl substances (PFASs), widely utilized in various industries, may pose potential reproductive well-being risks. However, the research on the impact of PFAS exposures on pregnancy and live birth rates remains scarce. To address this gap, we conducted a cross-sectional study using the data from the United States National Health and Nutrition Examination Survey (NHANES) collected between 2013 and 2018. We focused on six PFAS compounds measured in the serum of women aged 20 to 50 years, employing the Poisson regression, Quantile G-composition (Qgcomp), and Weighted Quantile Sum (WQS) regression models. Adjusting for age, racial/ethnic origin, educational level, marital status, family income, body mass index (BMI), menarche age, birth control pill use, and other female hormone consumption, the Poisson regression identified significant negative associations between the individual PFAS exposures and pregnancy and live birth numbers (p < 0.05 for all 24 null hypotheses for which the slope of the trend line is zero). The Qgcomp analysis indicated that a one-quartile increase in the mixed PFAS exposures was associated with reductions of 0.09 (95% CI: -0.15, -0.03) in the pregnancy numbers and 0.12 (95% CI: -0.19, -0.05) in the live birth numbers. Similarly, the WQS analysis revealed that a unit increase in the WQS index corresponded to decreases of 0.14 (95% CI: -0.20, -0.07) in the pregnancy numbers and 0.14 (95% CI: -0.21, -0.06) in the live birth numbers. Among the six specific PFAS compounds we studied, perfluorononanoic acid (PFNA) had the most negative association with the pregnancy and live birth numbers. In conclusion, our findings suggest that PFAS exposures are associated with lower pregnancy and live birth numbers among women of reproductive age.

Reproductive toxicity of PFOA, PFOS and their substitutes: A review based on epidemiological and toxicological evidence

Per- and polyfluoroalkyl substances (PFAS) have already drawn a lot of attention for their accumulation and reproductive toxicity in organisms. Perfluorooctanoic acid (PFOA) and perfluorooctanoic sulfonate (PFOS), two representative PFAS, are toxic to humans and animals. Due to their widespread use in environmental media with multiple toxicities, PFOA and PFOS have been banned in numerous countries, and many substitutes have been produced to meet market requirements. Unfortunately, most alternatives to PFOA and PFOS have proven to be cumulative and highly toxic. Of the reported multiple organ toxicities, reproductive toxicity deserves special attention. It has been confirmed through epidemiological studies that PFOS and PFOA are not only associated with reduced testosterone levels in humans, but also with an association with damage to the integrity of the blood testicular barrier. In addition, for women, PFOA and PFOS are correlated with abnormal sex hormone levels, and increase the risk of infertility and abnormal menstrual cycle. Nevertheless, there is controversial evidence on the epidemiological relationship that exists between PFOA and PFOS as well as sperm quality and reproductive hormones, while the evidence from animal studies is relatively consistent. Based on the published papers, the potential toxicity mechanisms for PFOA, PFOS and their substitutes were reviewed. For males, PFOA and PFOS may produce reproductive toxicity in the following five ways: (1) Apoptosis and autophagy in spermatogenic cells; (2) Apoptosis and differentiation disorders of Leydig cells; (3) Oxidative stress in sperm and disturbance of Ca2+ channels in sperm membrane; (4) Degradation of delicate intercellular junctions between Sertoli cells; (5) Activation of brain nuclei and shift of hypothalamic metabolome. For females, PFOA and PFOS may produce reproductive toxicity in the following five ways: (1) Damage to oocytes through oxidative stress; (2) Inhibition of corpus luteum function; (3) Inhibition of steroid hormone synthesis; (4) Damage to follicles by affecting gap junction intercellular communication (GJIC); (5) Inhibition of placental function. Besides, PFAS substitutes show similar reproductive toxicity with PFOA and PFOS, and are even more toxic to the placenta. Finally, based on the existing knowledge, future developments and direction of efforts in this field are suggested.

How Per- and Poly-Fluoroalkyl Substances Affect Gamete Viability and Fertilization Capability: Insights from the Literature

There has been emerging research linking per- and poly-fluoroalkyl substances (PFAS) to gamete viability and fertility. PFAS, prevalent in the environment and water supplies, undergo slow degradation due to their C-F bond and a long half-life (2.3-8.5 years). In females, PFAS inhibit the hypothalamic-pituitary-gonadal (HPG) axis, reducing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, leading to the inhibition of androgen and estradiol production. PFAS have been found to cause detrimental effects on egg quality through impairing folliculogenesis. In males, PFAS can impair sperm motility and morphology: two fundamental qualities of successful fertilization. PFAS exposure has been proven to inhibit testosterone production, sperm capacitation, and acrosomal reaction. After fertilization, the results of PFAS exposure to embryos have also been investigated, showing reduced development to the blastocyst stage. The aim of this review is to report the main findings in the literature on the impact of PFAS exposure to gamete competency and fertilization capability by highlighting key studies on both male and female fertility. We report that there is significant evidence demonstrating the negative impacts on fertility after PFAS exposure. At high doses, these environmentally abundant and widespread compounds can significantly affect human fertility.

Modeling 1-D aqueous film forming foam transport through the vadose zone under realistic site and release conditions

Aqueous film forming foams (AFFFs) have been used to extinguish fires since the 1960s, leading to widespread subsurface contamination by per- and polyfluoroalkyl substances (PFAS), an essential component of AFFF. This study presents 1-D simulations of PFAS migration in the vadose zone resulting from AFFF releases. Simulation scenarios used soil profiles from three US Air Force (USAF) installations, encompassing a range of climatic conditions and hydrogeologic environments. A three-component mixture, representative of major constituents of AFFF, facilitated the exploration of competitive and synergistic effects of co-constituents on PFAS migration. To accurately capture unsaturated transport of PFAS in porous media, the model considers (1) surfactant-induced flow, (2) non-linear sorption to the solid phase, (3) competitive accumulation at the air-water interface, and (4) the moisture-dependence of the air-water interfacial area. Defined PFAS releases were consistent with fire training exercises, emergency responses, and accidental spills of record. Simulation results illustrate the importance of hydrogeologic, climatic, geochemical, and AFFF release conditions on PFAS transport and retention. Comparison of field observations and model simulations for Ellsworth AFB indicate that much of the PFOA and PFOS mass is associated with the air-water interface and the solid phase, which limits their migration potential in the vadose zone. Results also show that rates of migration in the aqueous phase are largely controlled by hydrogeologic properties, including recharge rates and hydraulic conductivity. AFFF spill scenarios varying in volume, concentration, and frequency reveal the importance of release characteristics in determining rates of PFAS migration and concentration peaks. Variability is attributed to non-linear sorption processes, where, contrary to simple linear partitioning formulations, transport is strongly affected by the concentration of PFAS species. Simulations also demonstrate the importance of modeling the AFFF as a mixture since competitive interfacial accumulation effects are shown to enhance the mobility of less surface-active PFAS compounds.

The adverse role of endocrine disrupting chemicals in the reproductive system

Reproductive system diseases pose prominent threats to human physical and mental well-being. Besides being influenced by genetic material regulation and changes in lifestyle, the occurrence of these diseases is closely connected to exposure to harmful substances in the environment. Endocrine disrupting chemicals (EDCs), characterized by hormone-like effects, have a wide range of influences on the reproductive system. EDCs are ubiquitous in the natural environment and are present in a wide range of industrial and everyday products. Currently, thousands of chemicals have been reported to exhibit endocrine effects, and this number is likely to increase as the testing for potential EDCs has not been consistently required, and obtaining data has been limited, partly due to the long latency of many diseases. The ability to avoid exposure to EDCs, especially those of artificially synthesized origin, is increasingly challenging. While EDCs can be divided into persistent and non-persistent depending on their degree of degradation, due to the recent uptick in research studies in this area, we have chosen to focus on the research pertaining to the detrimental effects on reproductive health of exposure to several EDCs that are widely encountered in daily life over the past six years, specifically bisphenol A (BPA), phthalates (PAEs), polychlorinated biphenyls (PCBs), parabens, pesticides, heavy metals, and so on. By focusing on the impact of EDCs on the hypothalamic-pituitary-gonadal (HPG) axis, which leads to the occurrence and development of reproductive system diseases, this review aims to provide new insights into the molecular mechanisms of EDCs' damage to human health and to encourage further in-depth research to clarify the potentially harmful effects of EDC exposure through various other mechanisms. Ultimately, it offers a scientific basis to enhance EDCs risk management, an endeavor of significant scientific and societal importance for safeguarding reproductive health.

Toxicity of environmentally relevant concentration of PFAS chemicals in Lumbriculus variegatus (Oligochaeta, Lumbriculidae) - A multi-bioindicator study

PFAS, or per- and polyfluoroalkyl substances, are a family of man-made chemicals found in a variety of products from non-stick cookware and food wrappers to firefighting foams. PFAS are persistent and widely distributed in the environment, including aquatic environments. In this study we examined the impact of PFAS chemicals on the physiological and behavioral endpoints of Lumbriculus variegatus (i.e., blackworms). Lumbriculus variegatus is a species of freshwater annelid worm that plays key roles in shallow freshwater ecosystems. At an environmentally relevant concentration of 1 μg/L, 12-day aqueous exposure to long chain PFAS, including PFOA, PFOS and PFDA, each markedly slowed the pulse rate of the dorsal blood vessel in L. variegatus, indicating a suppressive effect on blood circulation. The mean pulse rate was reduced from 9.6 beats/minute to 6.2 and 7.0 beats/min in PFOA and PFOS, respectively (P < 0.0001). Further, PFOA, PFOS and PFDA reduced the escape responsiveness of L. variegatus to physical stimulation. The percentage of worms showing normal escape behavior was reduced from 99.0% in control to 90.6% in the PFOS exposed group (P < 0.01). In a chronic (4 week) growth study, exposure to overlying water and sediment spiked with PFOA, PFOS or PFDA reduced the total biomass and the number of worms, indicating a suppressive effect on worm population growth. For instance, PFOA and PFDA reduced the total dry biomass by 26.3% and 28.5%, respectively, compared to the control (P < 0.05). The impact of PFAS on blackworm physiology is accompanied by an increase in lipid peroxidation. The level of malondialdehyde (MDA), an indicator of lipid peroxidation, and catalase, a major antioxidant enzyme, were markedly increased in PFOA, PFOS and PFDA exposed groups. Interestingly, exposure to PFHxA, a short chain PFAS, had no detectable effect on any of the measured endpoints. Our results demonstrate that L. variegatus is highly sensitive to the toxic impact of long chain PFAS chemicals as measured by multiple endpoints including blood circulation, behavior, and population growth. Such toxicity may have a detrimental impact on L. variegatus and the freshwater ecosystems where it resides.

Non-target screening and human risk assessment for adult and child populations of semi-volatile organic compounds in residential indoor dust in Spain

In this work, an analytical strategy based on non-target screening of semi-volatile organic compounds and subsequent risk assessment for adult and child populations has been conducted for the first time in household indoor dust samples in Spain. The methodology was based on a microwave-assisted extraction followed by gas chromatography coupled to high resolution mass spectrometry determination, using a hybrid quadrupole-orbitrap analyzer. The procedure was applied to 19 residential indoor dust samples, collected in different Spanish regions (namely Galicia, La Rioja, Catalunya, the Balearic Islands, and the Valencian Region). From the generated data, 4067 features were obtained, of which 474 compounds were tentatively identified with a high level of identification confidence (probable structure by library spectrum match or confirmed by reference standard), using a restrictive set of identification criteria. Most of the identified chemicals were natural products, metabolites, additives, and substances with industrial applications in the field of foods, cosmetics, pharmaceuticals, pesticides, and plastics. Finally, risk assessment was carried out by applying the threshold of toxicological concern approach, showing that risk to adult and child populations associated with the presence of the identified substances in the indoor dust was not expected, although the existence of indoor environments with conditions of potential risk cannot be discarded under a worst-case scenario approach.

Higher serum AMH level is associated with better pregnancy outcomes of IVF/ICSI assisted pregnancy in infertile patients under 35 years old

This study aimed to investigate the effect of anti-Mullerian hormone (AMH) on the pregnancy outcome of infertility assisted by IVF/Micro-Insemination/Embryo Transfer Infertility Assistance (IVF/ICSI-ET). A total of 324 patients under the age of 35 who received IVF/ICSI-ET assistance in our center were included in this analysis. AMH levels of these patients were measured by chemiluminescence method and divided into clinical pregnancy group (175 cases) and non-pregnancy group (149 cases) according to the final pregnancy outcome. The relationship between the two groups' pregnancy outcomes and AMH levels was analyzed. The above association was re-evaluated after excluding patients with polycystic ovary syndrome. There was no significant difference in age, body mass index (BMI), follicle-stimulating hormone (FSH), and 2 pronucleus (PN) between clinical and non-clinical pregnancy groups. Compared with the clinical pregnancy group, the level of AMH in the non-pregnancy group was significantly lower (p < 0.05). A higher AMH level was closely related to better IVF/ICSI-ET assisted pregnancy outcome in vitro. After excluding AMH abnormalities, the AMH level was still significantly associated with pregnancy outcomes of in vitro IVF/ICSI-ET-assisted pregnancy. Our results show a correlation between AMH level and pregnancy outcome of in vitro IVF/ICSI-ET assisted pregnancy. For women under age 35, lower AMH levels may be one of the predictors of adverse pregnancy outcomes. For patients with low AMH level, it is suggested to strengthen monitoring to ensure the safety and smoothness of the pregnancy process.

Prenatal exposure to per- and polyfluoroalkyl substances and infant sleep disturbance: A prospective cohort study

BACKGROUND

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect fetal brain development, yet no study has investigated the potential association between prenatal PFAS exposure and infant sleep.

OBJECTIVES

To explore the associations of prenatal PFAS exposure with infant sleep disturbances during the first year of life in a prospective cohort study.

METHODS

We recruited 4127 pregnant women from the Shanghai Birth Cohort (SBC) and followed their children from birth to 12 months old. A total of 2366 infants were included in the 6-month analyses, and 2466 infants in the 12-month analyses. Ten PFAS were quantified in blood serum collected in the first trimester. Sleep quality was measured using the Brief Infant Sleep Questionnaire. We used multiple linear regression and multinomial logistic regression to estimate the individual effects of PFAS on sleep outcomes. We utilized a quantile-based g-computation model to determine the joint effects of the PFAS mixture on infant sleep outcomes. Additionally, generalized estimating equation (GEE) models were performed to examine the longitudinal effects of PFAS exposure during pregnancy.

RESULTS

In infants aged 6 months, perfluorooctane sulfonate and perfluoroheptanoic acid were associated with a more than 2-fold risk of parent-reported sleep problems as severe. Perfluorodecanoic acid was associated with an increased risk of often or almost always snoring in one-year-old infants (relative risk ratios, 1.79; 95% CI, 1.12-2.86). PFAS mixtures were positively associated with nighttime awakenings both among infants aged 6 months (β, 0.11; 95% CI, 0.04-0.19) and 12 months (β, 0.11; 95% CI, 0.05-0.18). Prenatal exposure to PFAS were associated with longer sleep latency, increased nighttime awakenings, longer nocturnal wakefulness hours, snoring, and earlier sleep-onset time in infants aged 6-12 months, according to GEE models.

CONCLUSIONS

Our study suggests that prenatal exposure to PFAS may increase the risk of sleep disturbance in infants.

Adherence to the Mediterranean Diet in Women and Reproductive Health across the Lifespan: A Narrative Review

The Mediterranean diet (MD) has been previously proven to have various health-related benefits; however, its effect on women's reproductive health over a lifespan is yet to be summarized. This study aimed to summarize the evidence-based knowledge regarding the association between the MD and selected reproductive health outcomes. By searching PubMed, ScienceDirect, and Google Scholar databases, as well as reference lists, 21 studies were included in this narrative review. The available evidence was very limited; however, there is some suggestion that higher adherence to the MD may be positively associated with a lower risk of early age menarche (1 study) and shorter menstrual cycles (1 study), but is unrelated to dysmenorrhea (1 study). Moreover, no study to date has examined the relationship between the MD and the onset age of natural menopause. Considering reproductive health diseases, there was limited evidence that a higher adherence to the MD was associated with a lower risk of premenstrual syndrome (1 study), an improvement in sexual health and a lower prevalence of sexual dysfunction (3 studies), and an improvement in the general condition of with endometriosis and the pain they can experience (1 study). The largest number of studies were found for polycystic ovarian syndrome (PCOS; 7 studies) and infertility (6 studies). Results showed that a higher adherence to the MD was associated with a lower risk of infertility, while results for PCOS were unclear, but mostly indicated a beneficial trend. Further investigations are necessary to establish the role of adherence to the MD in reproductive health maintenance and its possible role in the prevention and treatment of reproductive health diseases in women.