title: Relationship of perfluorooctanoic acid exposure to pregnancy outcome based on birth records in the mid-Ohio Valley.
abstract: BACKGROUND
  Perfluorooctanoic acid (PFOA) is a potential cause of adverse pregnancy outcomes, but previous studies have been limited by low exposures and small study size.
  
  
  OBJECTIVE
  Using birth certificate information, we examined the relation between estimated PFOA exposure and birth outcomes in an area of West Virginia and Ohio whose drinking water was contaminated by a chemical plant.
  
  
  METHODS
  Births in the study area from 1990 through 2004 were examined to generate case groups of stillbirth (n = 106), pregnancy-induced hypertension (n = 224), preterm birth (n = 3,613), term low birth weight (n = 918), term small-for-gestational-age (SGA) (n = 353), and a continuous measure of birth weight among a sample of term births (n = 4,534). A 10% sample of term births ≥ 2,500 g were selected as a source of controls (n = 3,616). Historical estimates of serum PFOA were derived from a previously developed fate and transport model. In a second study, we examined 4,547 area births linked to a survey with residential history data.
  
  
  RESULTS
  In the analysis based only on birth records, we found no consistent evidence of an association between estimated PFOA exposure and stillbirth, pregnancy-induced hypertension, preterm birth, or indices of fetal growth. In the analysis of birth records linked to the survey, PFOA was unrelated to pregnancy-induced hypertension or preterm birth but showed some suggestion of an association with early preterm birth. Measures of growth restriction showed weak and inconsistent associations with PFOA.
  
  
  CONCLUSIONS
  Based on the analysis using the health survey, these results provide little support for an effect of PFOA exposure on most pregnancy outcomes, except for early preterm birth and possibly fetal growth restriction.
authors.affiliation: Department of Epidemiology, Brown University, Providence, Rhode Island 02912, USA. david_savitz@ brown.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Savitz
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Stein
authors.forename: Beth
authors.initials: B
authors.lastname: Elston
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wellenius
authors.forename: Scott M
authors.initials: SM
authors.lastname: Bartell
authors.forename: Hyeong-Moo
authors.initials: HM
authors.lastname: Shin
authors.forename: Veronica M
authors.initials: VM
authors.lastname: Vieira
authors.forename: Tony
authors.initials: T
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D001719:Birth Certificates; D002210:Caprylates / Q000633:toxicity*; D005260:Female; D005466:Fluorocarbons / Q000633:toxicity*; D006801:Humans; D009820:Ohio; D011247:Pregnancy; D011256:Pregnancy Outcome; D014903:West Virginia
chemical_list: D002210:Caprylates; D005466:Fluorocarbons; C023036:perfluorooctanoic acid