Perfluoroalkyl and polyfluoroalkyl substances and human fetal growth: a systematic review.
BACKGROUND
Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) is ubiquitous in most regions of the world. The most commonly studied PFASs are perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA). Animal studies indicate that maternal PFAS exposure is associated with reduced fetal growth. However, the results of human studies are inconsistent.


OBJECTIVE
To summarize the evidence of an association between exposure to PFASs, particularly PFOS and PFOA, and human fetal growth.


METHODS
Systematic literature searches were performed in MEDLINE and EMBASE. We included original studies on pregnant women with measurements of PFOA or PFOS in maternal blood during pregnancy or the umbilical cord and associations with birth weight or related outcomes according to the PFAS level. Citations and references from the included articles were investigated to locate more relevant articles. Study characteristics and results were extracted to structured tables. The completeness of reporting as well as the risk of bias and confounding were assessed.


RESULTS
Fourteen studies were eligible. In utero PFOA exposure was associated with decreased measures of continuous birth weight in all studies, even though the magnitude of the association differed and many results were statistically insignificant. PFOS exposure and birth weight were associated in some studies, while others found no association.


CONCLUSIONS
Higher PFOS and PFOA concentrations were associated with decreased average birth weight in most studies, but only some results were statistically significant. The impact on public health is unclear, but the global exposure to PFASs warrants further investigation.
Department of Pediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital , Aarhus N , Denmark.
Cathrine Carlsen
CC
Bach
Bodil Hammer
BH
Bech
Nis
N
Brix
Ellen Aagaard
EA
Nohr
Jens Peter Ellekilde
JP
Bonde
Tine Brink
TB
Henriksen
D017738:Alkanesulfonic Acids / Q000633:toxicity*; D000818:Animals; D001724:Birth Weight / Q000187:drug effects; D002210:Caprylates / Q000633:toxicity*; D004781:Environmental Exposure / Q000009:adverse effects; D004785:Environmental Pollutants / Q000633:toxicity; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D005466:Fluorocarbons / Q000633:toxicity*; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome
D017738:Alkanesulfonic Acids; D002210:Caprylates; D004785:Environmental Pollutants; D005466:Fluorocarbons; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid
birth weight; epidemiology; humans; perfluorinated chemicals; perfluoroalkyl acids; perfluorooctane sulfonate; perfluorooctanoate; small for gestational age