Durham, NC – Liping Feng, MD, associate professor of obstetrics and gynecology affiliated with the Duke Institute for Global Health, wants to know if toxic environmental exposures increase the number of preeclampsia, a serious and potentially life-threatening complication of pregnancy. .
Her question took her from tracking late-night e-waste shipments to Taizhou, China, to measuring the reproductive health of rabbits drinking contaminated water to represent the Hau River in Pittsboro, North Carolina.
Besides dedicating her medical career to maternal and child health, Feng has a personal interest in these questions. “Both of my daughters have some type of clinical anxiety,” she said. “I don’t think it’s a genetic problem because none of our family members have similar disorders, and at the same time, problems have occurred for both. I suspect exposure to chemicals in the uterine environment may contribute to these problems.”
Before the COVID-19 pandemic, Feng worked from 2017 to 2019 in Taizhou on projects that measured the impact of recycling old devices from electronic products, known as e-waste, on maternal and child health.
“Seventy percent of the world’s e-waste is recycled at two sites within China, where families will turn their homes into e-waste recycling centers,” Feng said. Part of this project asked her to track e-waste shipments to gauge exposure among the population she was studying.
But just three months after returning to Durham in late 2019, the global pandemic has dramatically changed the trajectory of Feng’s research. With the world in lockdown, it soon became clear that she would not be able to continue working with her Chinese colleagues and that she would need to shift her focus to a local research project.
Feng has been working on exposure during pregnancy to per- and polyfluoroalkyl compounds, called PFAS, with colleagues in Shanghai. Heather Stapleton, a Duke University professor and exposure scientist, was conducting research that measured PFAS concentrations in drinking water from Pittsboro.
These chemicals, known as “forever compounds” because of their durability, are used to repel moisture and grease across a variety of different everyday objects such as carpets, upholstery, and even food packaging.
Stapleton, who is conducting research on environmental exposures, discovered PFAS in her family’s drinking water in Cary, North Carolina, and wanted to learn more. Learning about Feng’s experience and desire to start work on a new project, Stapleton reached out and invited her to collaborate on the ongoing project in Pittsboro.
Together, they went to perform “both spatial and temporal sampling on the Howe River to understand how it has changed, which may provide some insights into the sources of PFAS in this community,” Stapleton said.
Feng was eager to start work with Stapleton and knew that PFAS contamination was “a local problem that is also a global problem”. These chemicals have a long history and according to Feng, they are constantly adapting to new environmental rules and regulations. But Feng is concerned about the increasing number of people at risk and a lack of knowledge about the potential dangers of PFAS.
By the time Feng joined the project, Stapleton’s team had collected water samples from much of central North Carolina. Samples showed that PFAS compounds were present in samples from drinking water sources in Cary, Jordan Lake, and Howe River.
Stapleton’s team worked with collaborators at the Environmental Protection Agency (EPA) and North Carolina State University to show that PFAS compounds in Jordan Lake can be traced as far as the Howe River. Stapleton’s team was then able to narrow their focus to testing in Pittsboro, a town that gets drinking water from Haw.
The researchers observed higher concentrations of PFAS in their samples that were higher than in surrounding cities using other water sources.
Stapleton set out to explore the exact amount of PFAS concentrations that Pittsboro residents were exposed to and how their exposure might affect their health. Feng’s expertise in maternal and child health would become a major part of the questions the researchers wanted to ask once they understood the exposures.
Feng designed a study raising rabbits who drank water that was tailored to match the concentrations and groups of PFAS found in Pittsboro. Specifically, she wanted to know if exposure to this water could be associated with increased cases of preeclampsia. Previous studies made this association for individual PFAS compounds, but Feng wanted to measure the exact mixture of PFAS that Pittsboro residents were consuming.
Preeclampsia is a high blood pressure disorder that occurs during pregnancy. It affects the functions of organs such as the kidneys, liver and lungs. Pre-eclampsia is a serious and sometimes life-threatening disorder in pregnant or newly pregnant women. Feng suggests that identifying this connection – if any – is one step in the process of understanding the true impact of PFAS contamination and exposure worldwide.
Feng and Stapleton said this trial is innovative because it uses an actual blend of PFAS compounds, unlike many lab studies that only look at the effects of individual PFAS compounds in isolation. “Studying the mixture allows us to conceptually imitate our real life,” Feng said. “This is the advantage of the mixture.”
In the real world, exposure to chemicals can be like soup, she explains: The flavor of the individual ingredient before adding it to the pot isn’t the flavor you get at the end.
“There are very few studies looking at mixtures of PFAS compounds, and I agree that this is really important because people are not exposed to one compound of PFAS at a time, we are exposed to mixtures,” Stapleton said.
Feng’s analysis confirmed an association between Pittsboro drinking water consumption with PFAS, gestational hypertension, and preeclampsia among rabbits. Feng immediately started to think about how to proceed.
In addition to their lab work, Feng and Stapleton facilitate town halls to help Pittsboro residents become more aware of PFAS exposure. News of this exposure was naturally worrisome for the residents because they weren’t sure how their physical health would be affected by their exposure.
“Community members don’t know about this problem and after they knew, their first reaction was, ‘Wait, what’s going on?'” Feng said. The researchers knew they would have to carefully educate the community about their exposure.
Stapleton said the team’s strategy has centered on transparency. “We show them the data, where their average exposure levels are and how they compare to average levels in the United States based on the Centers for Disease Control and Prevention’s Biosurveillance Program.”
Feng and Stapleton continue work to measure the effect of exposure to PFAS compounds on physical health. Specifically, Feng’s group found that in utero exposure to PFAS in mice led to changes in local motor development in the offspring. While their research is relatively new, Feng is using her findings to identify other communities across the United States and around the world interested in researching exposure to PFAS. Their findings have been published in Environmental Health Journals and are shared among environmental conferences that are now focusing on research like hers with the goal of raising awareness of PFAS exposure.
Feng recently established a group of people interested in PFAS exposure research. It is also developing guidelines and educational programs that will be designed to increase community awareness of PFAS compounds.
Feng said her primary hope and mission in her research is to “increase physician awareness and obtain standard guidance for physicians to learn how to educate and care for their patients exposed to PFAS.”
Alessandro Figueroa is a second-year graduate student at the University of North Carolina’s Gillings School of Public Health.
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