399 Exposure to phthalates, perfluorinated compounds and organochlorines and pregnancy outcomes in women from Greenland, Poland and Ukraine
研究分析了1322名孕妇的多种环境污染物暴露与妊娠结局的关联，发现邻苯二甲酸酯、全氟化合物和有机氯与出生体重降低及小于胎龄儿风险增加有关，但与早产无明确关联。
<h3>Objectives</h3> Evidence for effects of environmental contaminants on pregnancy outcomes remains inconclusive. We investigated the associations between multiple, correlated exposures and related pregnancy outcomes using Bayesian, multivariate dimension reduction, and shrinkage regression approaches to account for multiple testing and interrelatedness of exposures and outcomes. <h3>Methods</h3> We evaluated a cohort of 1322 singletons, born to 547 mothers from Greenland, 197 from Warsaw, Poland, and 588 from Kharkiv, Ukraine, who were recruited in 2002–2004 during routine antenatal care visits. Three secondary metabolites of both diethylhexyl and diisononyl phthalates (DEHP, DINP), eight perfluorinated compounds (PFCs; including PFOS and PFOA), and organochlorines (<i>p,p-</i>DDE and PCB-153) were measured and detected in 72–100% of maternal serum samples. Outcomes were preterm birth (<37 weeks), birth weight, and small for gestational age (SGA; <10<sup>th</sup> percentile age- and gender-specific birth weight). We analysed exposures (clustered, high dimension predictors) and continuous and dichotomous outcomes with partial least squares (PLS) regression, and sparse PLS-discriminant analysis (sPLS-DA), respectively. We compared results with elastic net penalised regression, and Bayesian stochastic search variable selection with spike-and-slab priors of (nonlinear) generalised additive models. <h3>Results</h3> While applied methods had various degrees of sparseness, we observed generally consistent associations between DEHP metabolites, several PFCs and both organochlorines, and decreased birth weight and increased risk of SGA. There was no clear evidence of associations between contaminants and preterm birth. <h3>Conclusions</h3> Findings suggest that several environmental contaminants are independently associated with impaired fetal growth. Methods which account for correlations between variables and multiple testing may better discriminate robust exposure-response associations than conventional univariate linear and logistic regression models.