Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Deji, Zhuoma; Liu, Peng; Wang, Xin; Zhang, Xin; Luo, Yuehua; Huang, Zhenzhen

doi:10.1016/j.scitotenv.2021.146984

Cited by 40 publications

(12 citation statements)

References 64 publications

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“…Some studies ( 48 , 49 , 51 ) transformed data in log-transformed form, while Negri et al ( 47 ) performed separate meta-analyses of log-transformed and untransformed data as two groups. The highlight is that Deji et al ( 50 ) recently published a meta-analysis that attempted to analyze the association between PFOA, PFOS, PFNA, PFHxS and PTB, miscarriage, and stillbirth, but they incorrectly included two inappropriate studies. The first is Louis et al ( 103 ), who examined the association between PFAS and “pregnancy loss,” which is fundamentally different from “miscarriages” or “stillbirth,” as we have described above.…”

Section: Discussionmentioning

confidence: 99%

“…The other is Bjerregaard-Olesen et al ( 120 ), who provided back-exponentiation of the linear parameter estimates [relative levels (RL)] of the association between PFAS and the number of miscarriages in 1,438 Danish pregnant women from 2008 to 2013. However, Deji et al ( 50 ) directly combined RL values with other effect estimates (e.g., OR), without any interpretation, which is inappropriate. Additionally, they incorrectly combined log-transformed and untransformed data directly, and these effect estimates extracted from the continuous exposure analysis and the estimates used to generate the meta-analysis were inconsistently scaled and standardized so that the conclusions drawn had to be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one SRMA has assessed the effects of PFAS exposure on pregnancy outcomes including miscarriage, PTB, and stillbirth, and four meta-analyses focused on PFOA/PFOS with BW. Specifically, the SRMA ( 50 ) on pregnancy outcomes encountered a crucial methodological issue in which estimates from single studies are not comparable and thus make the final estimates difficult to interpret. In the three studies on BW ( 47 , 48 , 51 ), they all concluded that PFOA was significantly associated with BW.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Exposure to Per- and Polyfluoroalkyl Substances and Birth Outcomes: A Systematic Review and Meta-Analysis

Gui

Chen

et al. 2022

Front. Public Health

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BackgroundA large body of emerging evidence suggests that per- and polyfluoroalkyl substances (PFAS) affect birth outcomes in various pathways, but the evidence is inconsistent. Therefore, this study aimed to systematically review the epidemiological evidence on PFAS exposure and birth outcomes.MethodsThree electronic databases were searched for epidemiological studies through February 13, 2021. We used random-effects meta-analysis for eight birth outcome indicators to calculate summary effect estimates for various exposure types. The risk of bias and the overall quality and level of evidence for each exposure-outcome pair were assessed.ResultsThe initial search identified 58 potentially eligible studies, of which 46 were ultimately included. Many PFAS were found to have previously unrecognized statistically significant associations with birth outcomes. Specifically, birth weight (BW) was associated with PFAS, with effect sizes ranging from −181.209 g (95% confidence interval (CI) = −360.620 to −1.798) per 1 ng/ml increase in perfluoroheptanesulfonate (PFHpS) to −24.252 g (95% CI = −38.574 to −9.930) per 1 ln (ng/ml) increase in perfluorodecaoic acid (PFDA). Similar patterns were observed between other PFAS and birth outcomes: perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with birth length (BL) and ponderal index (PI), PFOS and perfluorododecanoic acid (PFDoDA) with head circumference (HC), PFHpS with gestational age (GA), and perfluorononanoic acid (PFNA) and PFHpS with preterm birth (PTB). Additionally, PFDA showed a statistically significant association with small for gestational age (SGA). The level of the combined evidence for each exposure-outcome pair was considered to be “moderate”.ConclusionThis study showed that PFAS exposure was significantly associated with increased risks of various adverse birth outcomes and that different birth outcome indicators had different degrees of sensitivity to PFAS. Further studies are needed to confirm our results by expanding the sample size, clarifying the effects of different types or doses of PFAS and the time of blood collection on birth outcomes, and fully considering the possible confounders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association Between Exposure to Per- and Polyfluoroalkyl Substances and Birth Outcomes: A Systematic Review and Meta-Analysis

Gui

Chen

et al. 2022

Front. Public Health

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“…This is particularly problematic for pregnant people, as PFOA and PFOS are detectable in the placenta and in the umbilical cord blood of newborns, oftentimes at equal or greater concentrations in the fetus compared to the mother ( Morello-Frosch et al, 2016 ; Kang et al, 2021 ; Panagopoulos Abrahamsson et al, 2021 ). A recent systematic review concluded that PFOA and PFOS were associated with an increased risk of delivering preterm ( Deji et al, 2021 ). However, systematic reviews examining the relationship between PFAS, birthweight, and small and large for gestational age are inconsistent ( Steenland et al, 2018 ; Dzierlenga et al, 2020 ; Gao et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Prenatal PFAS and psychosocial stress exposures in relation to fetal growth in two pregnancy cohorts: Applying environmental mixture methods to chemical and non-chemical stressors

Eick

Enright

Padula

et al. 2022

Environment International

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“…Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic compounds that have been used in many industrial and consumer applications for over 70 years because of their high thermal and chemical stability 1 . Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two of the most studied long-chain PFAS, and are reported to induce adverse effects on human, including immunotoxicity 2 , carcinogenicity 3 , and reproductive and developmental toxicity 4 . Due to their persistence in the environment and potential health implications in humans, PFOS and PFOA production and applications have been restricted in Europe and North America 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Emerging and legacy PFAS and cytokine homeostasis in women of childbearing age

Nian

Zhou

Feng

et al. 2022

Sci Rep

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Per- and polyfluoroalkyl substances (PFAS) are widespread chemicals. Legacy PFAS have been phased out of production in most developed countries and emerging PFAS (short-chain PFAS and polyfluorinated compounds) are used as legacy PFAS alternatives. The effect of legacy and emerging PFAS on cytokine homeostasis in human remains poorly understood. This study aimed to evaluate the associations between legacy and emerging PFAS and cytokine profiles, and identify the main contributors to the disturbance of cytokine homeostasis. We quantified 21 PFAS in 198 Chinese women of childbearing age from 2015 to 2016. 13 cytokines were measured using the Meso Scale Discovery U-PLEX and V-PLEX platforms. The associations between PFAS exposure and cytokine levels were assessed using multiple linear regression (single-exposure), and Bayesian kernel machine regression (BKMR) models (PFAS mixture exposure). In single PFAS models, legacy and alternative PFAS were positively associated with Th1 and Treg cytokines, and negatively associated with Th2 and Th17 cytokines. For instance, each ln-unit increase in 6:2 chlorinated perfluoroalkyl ether sulfonic acid (6:2 Cl-PFESA), perfluorooctanoic acid (PFOA), and perfluorooctane sulfonate (PFOS) was associated with a decrease in IL-10 by − 0.228 (95% CI: − 0.336, − 0.120), − 0.153 (95% CI: − 0.277, − 0.030), and − 0.174 (95% CI: − 0.339, − 0.010), respectively. The BKMR model showed a significantly positive association of PFAS mixture with TGF-β and a negative association with IL-10. Overall, these results indicate that both legacy and emerging PFAS may affect the homeostasis of cytokines.

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Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Cited by 40 publications

References 64 publications

Association Between Exposure to Per- and Polyfluoroalkyl Substances and Birth Outcomes: A Systematic Review and Meta-Analysis

Association Between Exposure to Per- and Polyfluoroalkyl Substances and Birth Outcomes: A Systematic Review and Meta-Analysis

Prenatal PFAS and psychosocial stress exposures in relation to fetal growth in two pregnancy cohorts: Applying environmental mixture methods to chemical and non-chemical stressors

Emerging and legacy PFAS and cytokine homeostasis in women of childbearing age

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