| ObjectivesTo investigate the correlation between bisphenol A(BPA)exposure during pregnancy,gestational weight gain and maternal pre-eclampsia,and to explore their interaction on maternal preeclampsia.MethodsThis study mainly relied on the China-Wuhu birth cohort.Women in the first trimester of pregnancy were recruited from the obstetrics and gynecology clinic of Wuhu Maternal and Child Health Hospital,and followed up during pregnancy,and observed the pregnancy outcome of pregnant women.A total of 2671 pregnant women were entered the birth cohort study from October 21,2020 to January 27,2022.The nested case-control study was adopted in this study design.Pregnant women who conform to the criteria according to inclusion criteria were included in the cohort,and then prospective follow-up was conducted to fill in questionnaires during the first,second and third trimesters.The pregnant women’s blood was collected and stored in a-80℃refrigerator,and blood samples collected when the pregnant women first entered the cohort were detected.Ultra Performance Liquid Chromatography-triple Quadrupole Mass Spectrometry(UPLC-MS/MS)was used to determine the concentration of BPA in serum during pregnancy.A total of 53 pregnant women were clinically diagnosed with preeclampsia.Patients that do not meet the inclusion criteria and patients with missing blood samples are excluded,and a total of35 preeclampsia pregnant women were included.A 1:2 match was conducted based on the same pre pregnancy BMI and age of pregnant women(±2 years),and 70 non preeclampsia pregnant women were chosen as controls.Statistical analysis was performed using IBM SPSS 26.0 software.Compare the differences between groups usingχ~2 test and t-test;Compare the correlation between BPA concentration,gestational weight gain,and blood pressure during each pregnancy using Spearman correlation analysis.The normal test found that the serum BPA concentration during pregnancy showed a skewed distribution,and it still did not obey the normal distribution after natural logarithm(ln)conversion.Since the detection rate of BPA in serum(58.10%)did not exceed 2/3,it was constructed as an ordered three categorical variable:those whose detection concentration was lower than the detection limit(LOD)were classified as low concentration groups,and those whose detection concentration was higher than LOD were equally divided into medium concentration groups and high concentration groups.Conditional logistic regression model was used to analyze the relationship between BPA level,gestational weight gain and the risk of preeclampsia.If other confounding variables enter the model resulting in a>10%change in the association between BPA exposure levels and gestational weight gain with preeclampsia,then this variable will be retained in the model.Analyze the interaction between BPA exposure and gestational weight gain on the prevalence of preeclampsia using multiplication and addition models.Use the PROCESS program plugin to test the mediating effect of gestational weight gain between BPA exposure and preeclampsia.Test levelα=0.05(bilateral test).ResultsA total of 105 serum samples were examined in this study,and BPA concentrations ranged from<0.01 to 1.83 ng/ml,with a median of 0.22 ng/ml.The mean age of the subjects was(28.17±4.17)years,the age range was 20 to 37 years,and the pre-pregnancy BMI was(22.36±3.63)kg/m~2.By comparing the general data of the two groups,Chi-square test analysis showed that there were statistical differences in the distribution of education level,second-hand smoke exposure and excessive gestational weight gain between the two groups(P<0.05).The results of the t-test showed that blood pressure in the case group was higher than that in the control group in both middle and late pregnancy(P<0.05).Spearman’s correlation analysis showed that there was no correlation between BPA concentration and blood pressure in the middle and late pregnancy,while gestational weight gain was positively correlated with diastolic blood pressure in the second trimester and systolic and diastolic blood pressure in the third trimester(P<0.05).Adjusting for covariates such as education level and second-hand smoke exposure,conditional logistic regression analysis showed that the risk of developing preeclampsia in the BPA high concentration exposure group was 2.93 times higher than that in the low concentration exposure group(95%CI:1.13-7.62).Taking the group with insufficient or appropriate weight gain as a reference,the group with excessive gestational weight gain has a 3.25-fold increased risk of developing preeclampsia(95%CI:1.07-9.83).The results of interaction effect analysis showed that using the BPA undetected and no excessive weight gain group as the reference group,the BPA detected and excessive weight gain group significantly increased the risk of preeclampsia in pregnant women(OR=5.67,95%CI:1.37-23.58).The effect magnitude of the additive model interaction is relative excess risk due to interaction(RERI),attributable proportion due to interaction(AP)greater than 0,and the confidence interval of the synergy index(S)greater than 1,indicating that BPA exposure and gestational weight gain have a synergistic effect on the occurrence of preeclampsia in pregnant women,with AP=0.3532,35.32%of all cases of preeclampsia in pregnant women were attributed to the additive interaction between BPA detection and excessive gestational weight gain.Exploring the mediating role of exposure gestational weight gain in the association between BPA exposure and preeclampsia,the analysis revealed no statistically significant results for BPA exposure on the gestational weight gain pathway.ConclusionBPA exposure and gestational weight gain are both risk factors for preeclampsia in pregnant women,and there is a significant interaction between the two in the risk of preeclampsia in pregnant women,with the interaction effect accounting for 35.32%of the total effect.It is recommended that further research on the etiological mechanisms be conducted to explore in depth the etiological links between them. |
PDF Full Text Request