Blood Exposure Profile of Per- and Polyfluoroalkyl Substances and Their Alternatives in Pregnant Women: Pathophysiological Concentrations, Interactions with Endogenous Biomolecules, and Associated Potential Health Risks

Per- and polyfluoroalkyl substances (PFAS) are widely used in industrial and consumer products, leading to global environmental pollution and human exposure. Given the restricted use of legacy PFAS and the continued high market demand, numerous fluorinated alternatives have emerged. Some of these alternatives as emerging pollutants share similar environmental fates and health impacts with legacy PFAS. Biomonitoring data indicate that pregnant women around the world are frequently exposed to PFAS. Mounting evidence suggests that pollutants entering the human body can cause biological perturbations through interactions with endogenous biomolecules. However, there has been no comprehensive review regarding exposure levels and associated potential health risks so far, due to interactions between exogenous PFAS and endogenous biomolecules in pregnant women and fetuses. This is especially true in relation to PFAS alternatives, which represent a new class of pollutants. Herein, we summarize the exposure levels and influencing factors of PFAS and their alternatives in pregnant women. Furthermore, we scrutinize the mechanisms of adverse outcomes mediated by PFAS-biomolecule interactions and explore the potential maternal and fetal health risks. Given the continued use of PFAS and their alternatives, systematic biomonitoring and mechanistic studies are essential to clarify maternal-fetal health impacts and to support accurate risk assessment.