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BACKGROUND: Perfluoroalkyl substances (PFAS) may affect body mass index (BMI) and other components of cardiometabolic (CM) risk during childhood, hut evidence is scarce and inconsistent.

OBJECTIVES: We estimated associations between prenatal PFAS exposures and outcomes relevant to cardiometabolic risk, including a composite CM risk score.

METHODS: We measured perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in maternal plasma (first trimester). We assessed weight gain from birth until 6 mo. At 4 and 7 y, we calculated the age- and sex-specific z-scores for BMI, waist circumference (WC), and blood pressure (BP) (n approximate to 1,000). At age 4, we calculated the age-, sex-, and region specific z-scores for cholesterol, triglycerides (TGs), high-density (HDL-C), and low-density lipoprotein cholesterol (LDL-C) (n = 627). At age 4, we calculated a CM-risk score (n = 386) as the sum of the individual age-, sex-, and region-specific z-scores for WC, BP, HDL-C, and TGs. We used the average between the negative of HDE-C z-score and TGs z-score to give similar weight to lipids and the other components in the score. A higher score indicates a higher cardiometaholic risk at age 4.

RESULTS: PFOS and PFOA were the most abundant PFAS (geometric mean: 5.80 and 2.32 ng/mL respectively). In general, prenatal PFAS concentrations were not associated with individual outcomes or the combined CM-risk score. Exceptions were positive associations between prenatal PFHxS and TGs z-score [for a doubling of exposure, beta = 0.11; 95% confidence interval (CI): 0.01, 0.21], and between PFNA and the CM-risk score (beta=0.60; 95% CI: 0.04, 1.16). There was not clear or consistent evidence of modification by sex.

CONCLUSIONS: We observed little or no evidence of associations between low prenatal PFAS exposures and outcomes related to cardiometabolic risk in a cohort of Spanish children followed from birth until 7 y.