PFAS exposure linked to gestational diabetes and insulin problems

Exposure to per- and polyfluoroalkyl substances (PFAS), a class of highly persistent environmental chemicals commonly referred to as "forever chemicals," is associated with a higher risk of gestational diabetes mellitus and altered markers of insulin resistance and insulin secretion, according to a new systematic review and meta-analysis led by researchers at the Icahn School of Medicine at Mount Sinai.

The review, published in The Lancet eClinicalMedicine, represents the most comprehensive evaluation to date of PFAS exposure in relation to diabetes risk and clinical markers of glycemic control across the lifespan.

Key findings

• Higher PFAS exposure was consistently associated with increased likelihood of gestational diabetes mellitus
• PFAS exposure was linked to higher levels of insulin resistance and insulin secretion
• Evidence linking PFAS exposure to type 1 or type 2 diabetes remains inconclusive, highlighting gaps in the current literature

Why this study is important

PFAS are widely used in consumer and industrial products, including food packaging, nonstick cookware, stain- and water-resistant textiles, and firefighting foams. These chemicals persist in the environment and accumulate in the human body over time.

Although research on PFAS and diabetes risk has grown in recent years, findings have been inconsistent, and prior reviews have rarely examined continuous clinical markers of diabetes, such as insulin resistance and secretion.

This is the most comprehensive synthesis of evidence to date examining how PFAS exposure relates not only to diabetes risk, but also to the underlying clinical markers that precede disease. Our findings suggest that pregnancy may be a particularly sensitive window during which PFAS exposure may increase risk for gestational diabetes."

 Sandra India-aldana, PhD, MPH, MPhil, postdoctoral fellow, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, and co-first author of the study

Clinical and public health implications

Gestational diabetes increases the risk of pregnancy complications and is associated with long-term health risks for both mother and child, including a higher likelihood of developing type 2 diabetes later in life.

"These results are alarming as almost everyone is exposed to PFAS, and gestational diabetes can have severe long-term complications for mothers and their children. We need larger longitudinal studies with well-characterized type 1 and type 2 diabetes cases to fully characterize PFAS impacts on diabetes risk and its long-term complications for affected individuals and their families," said Damaskini Valvi, MD, PhD, MPH, Professor and Director of Graduate Education in Public Health at Icahn School of Medicine at Mount Sinai, and senior author of this paper. "These results underscore the importance of considering PFAS and other hazardous environmental chemical exposures as part of comprehensive clinical risk assessment and preventive care, particularly during pregnancy."

For clinicians, the findings suggest that:

• Environmental exposure history, including potential PFAS sources, may be relevant during preconception and prenatal care
• Environmental health counseling and guidance on PFAS exposure reduction strategies may be appropriate for individuals planning pregnancy

"Gestational diabetes has lasting implications for both mother and child," said Xin Yu, PhD, MS, postdoctoral fellow, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, and co-first author of the study. "This research supports the growing recognition that environmental exposures like PFAS should be part of conversations around preventive care and risk reduction during pregnancy."

What this means for patients and the public

For people who are pregnant or considering pregnancy, the findings suggest that PFAS exposure may increase the risk of developing gestational diabetes. PFAS can be found in some consumer products and contaminated food or beverages, and reducing exposure where possible may be a precautionary step.

The researchers emphasize that more high-quality, long-term studies are needed to clarify PFAS' role in other forms of diabetes, but the current evidence supports increased awareness of PFAS exposure during pregnancy.

What's next

The research team plans to extend this work by conducting larger population studies examining the impact of the exposome and genome-exposome interactions in diabetes and other related health outcomes, such as obesity and chronic liver disease.

Funding

This research was supported by the National Institutes of Health under Grant R01ES033688.