Modifying effects of vitamin D on associations between per- and polyfluoroalkyl substances exposure and risk of gestational diabetes mellitus: A prospective cohort study in Beijing, China

Feng Han; Ziwei Pei; Bing Lyu; Xin Zhang; Jian Zhang; Jiaying Liu

doi:10.1016/j.envint.2025.109641

Modifying effects of vitamin D on associations between per- and polyfluoroalkyl substances exposure and risk of gestational diabetes mellitus: A prospective cohort study in Beijing, China

Environ Int. 2025 Jun 25:202:109641. doi: 10.1016/j.envint.2025.109641. Online ahead of print.

Authors

Feng Han¹, Ziwei Pei², Bing Lyu², Xin Zhang³, Jian Zhang⁴, Jiaying Liu⁵

Affiliations

¹ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, NHC Key Laboratory of Public Nutrition and Health, Beijing 100050, China; NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Sciences Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, Beijing 100021, China.
² NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Sciences Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, Beijing 100021, China.
³ School of Pharmacy and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Avenida Wailong, Macau 999078, China.
⁴ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, NHC Key Laboratory of Public Nutrition and Health, Beijing 100050, China.
⁵ Beijing Laboratory of Food Quality and Safety, Department of Nutrition and Health, China Agricultural University, Beijing 100091, China. Electronic address: liujiaying@cau.edu.cn.

PMID: 40580707
DOI: 10.1016/j.envint.2025.109641

Abstract

Epidemiology studies suggested that exposure to Per- and Polyfluoroalkyl Substances (PFAS) might elevate the incidence of Gestational Diabetes Mellitus (GDM), but no study considered the modifying roles of vitamin D, an important nutrient related to GDM development. Thus, this study evaluated the modifying effects of maternal vitamin D on correlations of PFAS exposure with GDM by conducting a cohort study in Beijing, China. We recruited 111 pregnant women who had either one or more high risk factors for GDM in Beijing, China, in 2022. Blood samples collected from pregnant women in 11-13 gestational weeks were analyzed to detect 19 PFAS and 25-hydroxy vitamin D. GDM was confirmed via the Oral Glucose Tolerance Test (OGTT). All subjects were classed as possessing sufficient, insufficient, or deficient vitamin D concentrations. Vitamin D deficiency status was observed to be a significant modifier for associations between GDM risk and PFAS exposure, as well as continuous glucose concentrations in an OGTT (interaction p-value < 0.05). For women with vitamin D deficiency, exposure to five long-chain perfluoroalkyl carboxylates significantly elevated the GDM risk (p < 0.05), and the overall estimated risk ratio for GDM associated with 1 ng/mL increases in PFAS ranged from 3.750 to 8.097. The results suggested that adequate supplementation of vitamin D during early pregnancy could prevent the elevated risk of GDM caused by PFAS exposure.

Keywords: Gestational diabetes mellitus; Oral glucose tolerance test; Per- and polyfluoroalkyl substances; Pregnant women; Vitamin D.