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Lorenzoni, Giulia (2018) Impact of perfluoroalkylated substances (PFAS) exposure on maternal and newborn health in Veneto region. [Ph.D. thesis]

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Abstract (italian or english)

Background. Perfluoroalkylated substances (PFAS) are persistent organic pollutants that accumulate in the fish, wildlife, and humans. In 2013, it has been discovered an area of the Veneto Region in which ground water, surface water, and drinking water were contaminated by PFAS. Appropriate interventions have been undertaken to contain the water pollution, reducing it effectively. However, it has been estimated that the contamination had started about fifty years before its discovery, leading to the long-term exposure of the population. The long-term exposure to PFAS is worrying because PFAS have been suggested to affect human health. Veneto Region has therefore organized a health surveillance programme of the population living in the polluted area. A specific aspect of such programme concerns the maternal and newborn health, which represents the focus of my PhD research project. The aims of the project were to review animal and human evidence related to this topic and to assess the effects of the exposure to PFAS on maternal and newborn health in the population living in the polluted area of Veneto Region.
Methods. The systematic review included relevant studies in the English language identified through the online database PubMed. Studies were eligible to the review if they assess the effect of PFAS exposure during the reproductive period on the health of the pregnant women and of the infant.
The identification of the outcomes of interest assessed in the study about maternal and newborn health in Veneto Region was based on the systematic review. The outcomes investigated were preeclampsia and gestational diabetes mellitus (GDM) (pregnancy complications), and intrauterine growth restriction, evaluated using a proxy of fetal growth, the Small for Gestational Age (SGA) (birth outcomes). The study was performed using an indirect measure of exposure to PFAS, defined as woman’s residence in the contaminated area (including 21 municipalities identified according to a Veneto Region Official Resolution). A control area that included 48 municipalities not exposed to PFAS contamination according to the performance limits of the National Institue of Health was chosen for comparision. The information sources included two administrative datasets, the Veneto Region Birth Registry and the Veneto Region hospital discharge records. For the pregnancy complications (preeclampsia and GDM), a medical chart review of pregnant women hospitalized is ongoing to validate the cases identified from the hospital discharge records.
Results. The systematic review led to the retrieval of 1096 records from PubMed. One hundred and thirty-nine records were judged to be eligible to the study. Overall, evidence retrieved suggests that PFAS exposure might affect the health of the pregnant woman and the development of the fetus.
The epidemiological study showed that newborns of mothers living in the contaminated area were significantly more likely to be SGA compared to newborns of mothers living in the control area (adjusted Odds Ratio 1.26, 95% C.I. 1.14-1.38). Looking at pregnancy complications (preeclampsia and GDM), preliminary results were available because the review of the medical chart is ongoing. Such preliminary results seem to suggest that the frequency of these pathological conditions is slightly higher in women living in the contaminated area compared to those living in the control ones. However, they must be taken with caution because the validation of preeclampsia and GDM cases is ongoing.
Conclusions. The results of the present research project suggest that PFAS exposure might affect maternal and newborn health. The present topic deserves further research, not only from the epidemiological point of view, but also for what concerns the pathophysiological mechanisms potentially involved in the association between PFAS exposure and adverse health outcomes in pregnant women and newborns.

Abstract (a different language)

Razionale. Le sostanze perfluoroalchiliche (PFAS) sono inquinanti organici persistenti. Nel 2013, la scoperta di un’area inquinata da PFAS nella Regione Veneto ha portato all’immediata adozione di interventi atti al contenimento della contaminazione. Tuttavia, si stima che la contaminazione sia iniziata circa cinquant’anni prima della sua scoperta, determinando un’esposizione di lungo corso della popolazione. Questa scoperta ha destato grande preoccupazione poichè è stato suggerito che gli PFAS abbiano effetti avversi sulla salute umana. La Regione Veneto ha quindi attivato un piano di sorveglianza sanitaria della popolazione esposta. Un aspetto specifico di questo programma riguarda la salute materno-infantile che ha costituito il focus del mio progetto di Dottorato. Il progetto aveva come obiettivi quello di effettuare una revisione delle evidenze sull’animale e l’uomo riguardo questo tema e di condurre uno studio epidemiologico sulla salute materno-infantile della popolazione esposta nella Regione Veneto.
Metodi. Nella revisione sistematica sono stati inclusi tutti gli studi pertinenti, in lingua inglese, identificati dal motore di ricerca PubMed. Gli studi venivano considerati pertinenti se valutavano l’effetto dell’esposizione a PFAS, durante il periodo riproduttivo, sulla crescita intrauterina e le anomalie congenite strutturali e funzionali (esiti sul nato) e sul rischio di sviluppare preeclampsia, diabete gestazionale e disturbi della tiroide (esiti sulla donna in gravidanza).
Sulla base della revisione, sono stati identificati gli esiti di salute materno-infantile analizzati nello studio epidemiologico. Nello specifico, sono stati valutati il rischio di preeclampsia e diabete gestazionale (esiti sulla donna in gravidanza) e quello di nascere piccolo per l’età gestazionale (SGA: Small for Gestational Age) come proxy di crescita intrauterina. Lo studio ha utilizzato una misura indiretta di esposizione a PFAS rappresentata dalla residenza della donna nell’area contaminata (che include 21 Comuni identificati da una Deliberazione della Giunta Regionale della Regione Veneto). È stata inoltre identificata un’area di controllo impiegata come termine di confronto. Le fonti informative utilizzate sono state il Registro Nascita e le Schede di Dimissione Ospedaliere (SDO) della Regione del Veneto. Per quanto riguarda gli esiti sulla donna in gravidanza (preeclampsia e diabete gestazionale), è in corso un processo di validazione dei casi identificati dalle SDO, mediante la revisione delle cartelle delle donne ricoverate.
Risultati. La revisione sistematica ha identificato 1096 risultati, lo screening dei quali ha portato all’inclusione di 139 risultati. Gli studi inclusi sembrano suggerire che l’esposizione a PFAS possa influenzare negativamente la salute della donna in gravidanza e lo sviluppo del nato, sia nel breve che nel lungo termine.
Lo studio epidemiologico mostra che i nati da madri residenti nell’area contaminata hanno una probabilità significativamente maggiore di nascere SGA rispetto ai nati da madri residenti nell’area di controllo (Odds Ratio aggiustato 1.26, 95% I.C. 1.14-1.38). Per quanto riguarda gli esiti sulla donna in gravidanza, vengono presentati i risultati preliminari in quanto la revisione delle cartelle è in corso. Questi risultati sembrano suggerire che la frequenza degli esiti di interesse (preeclampsia e diabete gestazionale) sia maggiore nelle donne nell’area contaminata rispetto a quella nelle donne nell’area di controllo.
Conclusioni. I risultati del presente progetto di ricerca sembrano suggerire che l'esposizione a PFAS possa influire sulla salute della madre e del neonato. Questo argomento merita ulteriori ricerche, non solo dal punto di vista epidemiologico, ma anche riguardo i meccanismi patofisiologici potenzialmente coinvolti nell'associazione tra esposizione a PFAS ed esiti di salute avversi sulla donna in gravidanza e sul nato.

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EPrint type:Ph.D. thesis
Tutor:Facchin, Paola
Supervisor:Manea , Silvia
Ph.D. course:Ciclo 31 > Corsi 31 > MEDICINA DELLO SVILUPPO E SCIENZE DELLA PROGRAMMAZIONE SANITARIA
Data di deposito della tesi:28 November 2018
Anno di Pubblicazione:25 November 2018
Key Words:PERFLUOROALKYLATED SUBSTANCES; PFAS; MATERNAL HEALTH; NEWBORN HEALTH; SOSTANZE PERFLUOROALCHILICHE; SALUTE MATERNA; SALUTE NEONATALE
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/01 Statistica medica
Struttura di riferimento:Dipartimenti > Dipartimento di Salute della Donna e del Bambino
Codice ID:11423
Depositato il:06 Nov 2019 13:44
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