Gestational PFAS concentrations in association with maternal depression and perceived stress during pregnancy and...

Depression and perceived stress are common perinatal morbidities. We assessed associations between prenatal per- and polyfluoroalkyl substances (PFAS) with prenatal and postpartum depression and perceived stress. We analyzed concentrations of 7 PFAS in maternal plasma or serum in the Environmental influences on Child Health Outcomes (ECHO) cohort (n = 4403). We ascertained prenatal depression diagnosis; prenatal and postpartum depressive symptom severity using a Patient-Reported Outcomes Measurement Information System Depression (PROMIS-D) t-score; and prenatal and postpartum perceived stress using a Perceived Stress Scale (PSS) t-score. Linear and modified Poisson models assessed associations of PFAS with outcomes. Quantile g-computation assessed PFAS mixtures. We evaluated effect modification by nativity and Social Vulnerability Index. N-MeFOSAA was positively associated, PFDA was inversely associated, and PFOS and PFOA were nonlinearly associated with multiple outcomes. For example, the highest category of N-MeFOSAA was associated with 0.93 (95 %CI: -0.17, 2.03) units higher postpartum PROMIS-D t-scores, and 1.88 (95 %CI: 1.05, 2.72) units higher postpartum PSS t-scores. In contrast, the highest category of PFDA was associated with 25 % (risk ratio [RR]: 0.75 [95 %CI: 0.56, 1.01]) lower risk of depression diagnosis and 0.83 (95 %CI: 0.14, 1.51) units lower prenatal PSS t-scores. The middle and highest categories of PFOS were associated with 26 % (RR: 1.26 [95 %CI: 1.05,1.52]) higher and 38 % (RR: 0.62 [95 %CI: 0.37, 1.05]) lower risk of depression diagnosis; and 0.97 (95 %CI: 0.09, 1.84) units higher and 0.04 (95 %CI: -1.53, 1.62) units lower prenatal PSS t-score. Some PFAS may be associated with altered depressive symptoms and perceived stress; investigation into mechanisms is needed.