Abstract:
Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with
adverse pregnancy outcomes. The aim of the present study was to examine the determinants of
different serum PFAS concentrations in late pregnancy and their relationship with birth outcomes in
southern Malawi. The sample included 605 pregnant women with a mean age of 24.8 years and their
offspring from three districts in the southern region of Malawi. Six PFAS were measured in serum
from third-trimester women. The serum PFAS concentrations were assessed with head circumference,
birth length, birth weight, gestational age and ponderal index. Participants living in urban areas had
significantly higher serum levels of PFOA, PFNA and SumPFOS, while SumPFHxS concentrations
were higher in women from rural settings. High PFOA, PFNA and SumPFHxS concentrations were
generally inversely associated with head circumference. Birth length was negatively associated with
PFOA and PFNA while SumPFHxS was negatively associated with birth weight. SumPFOS was
inversely associated with gestational age. Urban area of residence was the strongest predictor for
high PFAS concentrations in the maternal serum and was generally associated with adverse birth
outcomes. The results highlight the need to investigate SumPFHxS further as it follows a pattern that
is different to similar compounds and cohorts.
