'Forever chemicals' exposure in utero may raise blood pressure in kids years later

Exposure in utero to long-lasting environmental chemicals found in common household products may raise children's blood pressure years later, new research suggests.

Black children and boys appear to be especially at risk for higher blood pressure linked to pre-birth exposure to so-called forever chemicals according to the study, published June 12 in the Journal of the American Heart Association and presented at the Society for Epidemiologic Research conference in Boston.

"One of the key messages of our study is that children's health may be affected by environmental chemicals even before they are born," said lead author Zeyu Li, a graduate student researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore. "This is important because high blood pressure in youth is associated with a higher risk of adult high blood pressure and cardiovascular disease in adulthood."

Perfluoroalkyl and polyfluoroalkyl substances, or PFAS, are a large group of human-made chemicals that resist heat, water, grease and oil. They are found in a variety of products, including cleaning products, paint, stain- and water-resistant fabrics and carpeting, cosmetics, personal care products, cookware and food packaging.

PFAS are known as forever chemicals because they break down very slowly and have increasingly contaminated the air, water and soil. Prior research has shown that nearly everyone in the world is exposed to PFAS through what they eat and drink and the air they breathe. PFAS can also be absorbed through the skin.

Previous studies have found an association between PFAS and higher blood pressure in adults. Though studies have shown that PFAS can cross the placenta during pregnancy, little is known about whether forever chemicals play a role in raising blood pressure in children and adolescents years after these early exposures.

In the new study, researchers investigated whether prenatal PFAS exposures for 1,094 predominantly Black and Hispanic children born at a Boston medical center affected their blood pressure as they grew up. Maternal blood plasma measurements of PFAS were taken 24 to 72 hours after the women gave birth. Over a median 12 years of follow-up, researchers analyzed 13,404 blood pressure measurements taken from the children's medical records.

Overall, the higher the level of three types of PFAS – PFDeA, PFNA and PFUnA – in the mother's blood after delivery, the higher the child's systolic blood pressure, especially during the teenage years. Systolic blood pressure, the top number in a blood pressure reading, measures how hard blood pushes against artery walls during each heartbeat.

For boys and children born to Black mothers, each doubling of PFDeA, PFUnA and another type of PFAS called PFHpS was associated with a 6%-8% higher risk of elevated blood pressure.

In contrast, some PFAS were associated with lower diastolic blood pressure in early childhood. Diastolic is the bottom number in a blood pressure reading that represents the pressure in arteries between heartbeats, when the heart is at rest. But that association weakened and even turned positive as study participants entered adolescence, Li said.

"This study adds to a body of literature that seems to indicate these substances do have long-term effects," said Dr. Justin Zachariah, an associate professor of pediatric cardiology at Baylor College of Medicine and medical director of pediatric cardiology research at Texas Children's Hospital in Houston. Zachariah chaired the committee that wrote a 2024 American Heart Association scientific statement about environmental exposures and children's heart health.

"The major advance of this study is to demonstrate that there are a wide variety of people in our community that are affected," said Zachariah, who was not involved in the new study. "It is largely consistent with previous studies adding to a drumbeat of literature and with a cohort more representative of what America looks like at this point."

While the study did not look at what caused the stronger associations among boys or Black children, Zachariah noted that both groups experience higher rates of high blood pressure to begin with. Prior studies have found blood pressure to be higher in adolescent boys than girls and higher in non-Hispanic Black children than white children.

"These substances seem to be intensifying already-existing propensities," he said.

The stronger association during adolescence could be because the chemicals can accumulate and stay in children's bodies for years, allowing more time to exert and manifest their health effects, Li said.

Zachariah said the study points to the need for earlier interventions to prevent children from developing high blood pressure that could cause problems into adulthood.

Making people aware of the problem so they can choose whether and how to protect themselves and their children from environmental exposures is the first step, he said. That means labeling products that contain forever chemicals – such as nonstick cookware, plastic packaging, clothing and fabrics – and informing the public of their risks.

"The best we can do is make people aware and let them make choices for themselves" as to whether they want to control these exposures, Zachariah said. "Beyond that, if we as a community find these risks unacceptable, those are choices we need to make collectively."

Senior study co-author Dr. Mingyu Zhang, an assistant professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, said he was concerned about a recent Environmental Protection Agency announcement of its intent to roll back regulations on certain PFAS that would have reduced levels in drinking water, a major source of exposure.

"There's only so much one can do on an individual level," Zhang said. "This is not something we can solve on our own. These findings reinforce the need for better environmental protections, especially regulation of our water systems. We need these regulations to protect children and the generations to come."

While controlling chemical exposures is difficult, Zachariah said there are other steps parents can take to reduce their children's risks for developing high blood pressure, such as feeding them a heart-healthy diet, ensuring they get enough sleep, not smoking and remaining physically active.

"All of these things dominate your risk for cardiovascular disease," he said. "We have excellent data that changing diet reduces blood pressure. We need to make sure kids are eating diets that are healthful and rich in fruits and vegetables and low in sodium. We need to identify and address other risk factors that are present in a child's life."

Studies published in the American Heart Association's scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability.