title: The Navigation Guide - evidence-based medicine meets environmental health: systematic review of human evidence for PFOA effects on fetal growth.
abstract: BACKGROUND
  The Navigation Guide methodology was developed to meet the need for a robust method of systematic and transparent research synthesis in environmental health science. We conducted a case study systematic review to support proof of concept of the method.
  
  
  OBJECTIVE
  We applied the Navigation Guide systematic review methodology to determine whether developmental exposure to perfluorooctanoic acid (PFOA) affects fetal growth in humans.
  
  
  METHODS
  We applied the first 3 steps of the Navigation Guide methodology to human epidemiological data: 1) specify the study question, 2) select the evidence, and 3) rate the quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using prespecified criteria. We evaluated each study for risk of bias and conducted meta-analyses on a subset of studies. We rated quality and strength of the entire body of human evidence.
  
  
  RESULTS
  We identified 18 human studies that met our inclusion criteria, and 9 of these were combined through meta-analysis. Through meta-analysis, we estimated that a 1-ng/mL increase in serum or plasma PFOA was associated with a -18.9 g (95% CI: -29.8, -7.9) difference in birth weight. We concluded that the risk of bias across studies was low, and we assigned a "moderate" quality rating to the overall body of human evidence.
  
  
  CONCLUSIONS
  On the basis of this first application of the Navigation Guide systematic review methodology, we concluded that there is "sufficient" human evidence that developmental exposure to PFOA reduces fetal growth.
authors: Program on Reproductive Health and the Environment, University of California, San Francisco, Oakland, California, USA.
authors: Paula I
authors: PI
authors: Johnson
authors: Patrice
authors: P
authors: Sutton
authors: Dylan S
authors: DS
authors: Atchley
authors: Erica
authors: E
authors: Koustas
authors: Juleen
authors: J
authors: Lam
authors: Saunak
authors: S
authors: Sen
authors: Karen A
authors: KA
authors: Robinson
authors: Daniel A
authors: DA
authors: Axelrad
authors: Tracey J
authors: TJ
authors: Woodruff
mesh_terms: D001724:Birth Weight / Q000187:drug effects; D002210:Caprylates / Q000097:blood / Q000633:toxicity*; D004782:Environmental Health; D019317:Evidence-Based Medicine; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D005466:Fluorocarbons / Q000097:blood / Q000633:toxicity*; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy
chemical_list: D002210:Caprylates; D005466:Fluorocarbons; C023036:perfluorooctanoic acid