Background Per- and polyfluoroalkyl substances (PFAS) are widespread and environmentally persistent chemicals with immunotoxic properties. Children are prenatally exposed through maternal transfer of PFAS to cord blood, but no studies have investigated the relationship with childhood leukemia. Methods We measured maternal serum levels of 19 PFAS in first-trimester samples collected in 1986-2010 and evaluated associations with acute lymphoblastic leukemia (ALL) in full-term offspring (<15 years) for 400 cases and 400 controls in the Finnish Maternity Cohort, matched on sample year, mother’s age, gestational age, birth order, and child’s sex. We analyzed continuous and categorical exposures, estimating odds ratios (OR) and 95% confidence intervals (CI) via conditional logistic regression adjusted for maternal smoking and correlated PFAS (ρ ≥ ±0.3). We also stratified by calendar period, mean diagnosis age, and the child’s sex. Results N‑methyl‑perfluorooctane sulfonamidoacetic acid (MeFOSAA) was associated with ALL in continuous models (per each doubling in levels: ORperlog2=1.22, CI = 1.07-1.39), with a positive exposure-response across categories (OR>90th percentile=2.52, CI = 1.33-4.78; p-trend = 0.01). While we found no relationship with perfluorooctane sulfonic acid (PFOS) overall, an association was observed in samples collected 1986-1995, when levels were highest (median = 17.9 µg/L; ORperlog2=4.01, CI = 1.62-9.93). A positive association with perfluorononanoic acid was suggested among first births (p-interaction = 0.06). The MeFOSAA association was mainly limited to children diagnosed before age 5 (p-interaction = 0.02). We found no consistent patterns of association with other PFAS, nor differences by sex. Conclusions These novel data offer evidence of a relationship between some PFAS and risk of the most common childhood cancer worldwide, including associations with the highest levels of PFOS and with a precursor, MeFOSAA.

中文翻译：

---

全氟烷基物质和多氟烷基物质的母体血清浓度与儿童急性淋巴细胞白血病

背景 全氟烷基物质和多氟烷基物质 (PFAS) 是广泛存在且具有环境持久性的化学物质，具有免疫毒性。儿童在产前会通过母体将 PFAS 转移到脐带血而接触到 PFAS，但尚无研究调查其与儿童白血病的关系。方法 我们测量了 1986 年至 2010 年收集的妊娠早期样本中 19 种 PFAS 的母体血清水平，并评估了 400 名病例和 400 名对照的足月后代（<15 岁）与急性淋巴细胞白血病 (ALL) 的相关性。芬兰产妇队列，根据样本年份、母亲年龄、胎龄、出生顺序和孩子性别进行匹配。我们分析了连续和分类暴露，通过针对母亲吸烟和相关 PFAS (ρ ≥ ±0.3) 进行调整的条件逻辑回归来估计比值比 (OR) 和 95% 置信区间 (CI)。我们还按日历周期、平均诊断年龄和孩子的性别进行分层。结果 N-甲基-全氟辛烷磺酰胺乙酸 (MeFOSAA) 在连续模型中与 ALL 相关（每次水平加倍：ORperlog2=1.22，CI = 1.07-1.39），跨类别具有积极的暴露反应（OR>90）百分位 = 2.52，CI = 1.33-4.78；p 趋势 = 0.01）。虽然我们发现总体上与全氟辛烷磺酸 (PFOS) 没有关系，但在 1986 年至 1995 年收集的样本中观察到了相关性，当时含量最高（中位数 = 17.9 µg/L；ORperlog2=4.01，CI = 1.62-9.93）。建议第一胎出生时与全氟壬酸呈正相关（p 交互作用 = 0.06）。 MeFOSAA 关联主要限于 5 岁之前诊断的儿童（p 交互作用 = 0.02）。我们没有发现与其他 PFAS 的一致关联模式，也没有发现性别差异。结论 这些新数据提供了某些 PFAS 与全球最常见儿童癌症风险之间关系的证据，包括与最高水平的 PFOS 及其前体 MeFOSAA 的关联。