Association of Perfluoroalkyl and Polyfluoroalkyl Substances With Premature Ovarian Insufficiency in Chinese Women

Context: Perfluoroalkyl and polyfluoroalkyl substances (PFASs), a group of ubiquitous environmental chemicals with properties of endocrine disruption, are often detectable in humans. Objective: The current study investigated the association between exposure to PFAS and primary ovarian insufficiency (POI). Design, Patients, Interventions, and Main Outcome Measures: Levels of plasma PFAS were measured in 120 Chinese women with overt POI and 120 healthy control subjects from 2013 to 2016. Associations between PFAS levels and odds of POI, as well as hormonal profiles, were evaluated using multiple logistic regression and multiple linear regression models. Results: Levels of perfluorooctanate (PFOA), perfluorooctane sulfonate (PFOS), and perfluorohexanesulfonate (PFHxS) were positively associated with the risks of POI (highest vs. lowest tertile, PFOA: OR, 3.80; 95% CI, 1.92-7.49; PFOS: OR, 2.81; 95% CI, 1.46-5.41; PFHxS: OR, 6.63; 95% CI, 3.22-13.65). In patients with POI, levels of PFOS and PFHxS exposure were positively associated with FSH (PFOS: adjusted beta, 0.26; 95% CI, 0.15 to 0.38; PFHxS: adjusted beta, 0.16; 95% CI, 0.04 to 0.28) and negatively associated with estradiol (PFOS: adjusted beta, -0.30; 95% CI, -0.47 to -0.12; PFHxS: adjusted beta, -0.19; 95% CI, -0.37 to -0.02). Exposure to PFOS and PFOA was associated with elevation of prolactin (PFOS: adjusted beta, 0.17; 95% CI, 0.06 to 0.29; PFOA: adjusted beta, 0.16; 95% CI, 0.01 to 0.30) or with a decrease of free triiodothyronine (PFOS: adjusted beta, -0.88; 95% CI, -1.64 to 20.09; PFOA: adjusted beta, -0.90; 95% CI, -1.88 to 0.09) and thyroxine (PFOS: adjusted beta, 22.99; 95% CI, -4.52 to -1.46; PFOA: adjusted beta, -3.42; 95% CI, -5.39 to -1.46). Conclusion: High exposure to PFOA, PFOS, and PFHxS is associated with increased risk of POI in humans.