Per- and Polyfluoroalkyl Substances and Breastfeeding as a Vulnerable Function: A Systematic Review of Epidemiological Studies

Timmermann, Clara Amalie Gade; Avenbuan, Oyemwenosa N.; Romano, Megan E.; Braun, Joseph M.; Tolstrup, Janne Schurmann; Vandenberg, Laura N.; Fenton, Suzanne E.

doi:10.3390/toxics11040325

Cited by 19 publications

(12 citation statements)

References 82 publications

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“…In utero exposure to persistent organic pollutants such as PFAS is associated with negative outcomes in pregnancy, after birth, and later in life [ 32 ]. PFAS have been associated with increased incidence of gestational diabetes, childhood obesity, preeclampsia, reduced lactation duration, and fetal growth restriction [ 189 – 196 ]. Unfortunately, the toxicological effects of PFAS as a mixture are generally unknown [ 197 ].…”

Section: General Discussion and Future Directionsmentioning

confidence: 99%

Determinants of maternal and neonatal PFAS concentrations: a review

McAdam

Bell

2023

Environ Health

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Per- and polyfluoroalkyl substances (PFAS) are used for their properties such as stain and water resistance. The substances have been associated with adverse health outcomes in both pregnant mothers and infants, including pre-eclampsia and low birthweight. A growing body of research suggests that PFAS are transferred from mother to fetus through the placenta, leading to in utero exposure. A systematic review was performed using the PubMed database to search for studies evaluating determinants of PFAS concentrations in blood matrices of pregnant mothers and neonates shortly after birth. Studies were included in this review if an observational study design was utilized, exposure to at least one PFAS analyte was measured, PFAS were measured in maternal or neonatal matrices, at least one determinant of PFAS concentrations was assessed, and results such as beta estimates were provided. We identified 35 studies for inclusion in the review and evaluated the PFAS and determinant relationships among the factors collected in these studies. Parity, breastfeeding history, maternal race and country of origin, and household income had the strongest and most consistent evidence to support their roles as determinants of certain PFAS concentrations in pregnant mothers. Reported study findings on smoking status, alcohol consumption, and pre-pregnancy body mass index (BMI) suggest that these factors are not important determinants of PFAS concentrations in pregnant mothers or neonates. Further study into informative factors such as consumer product use, detailed dietary information, and consumed water sources as potential determinants of maternal or neonatal PFAS concentrations is needed. Research on determinants of maternal or neonatal PFAS concentrations is critical to estimate past PFAS exposure, build improved exposure models, and further our understanding on dose–response relationships, which can influence epidemiological studies and risk assessment evaluations. Given the potential for adverse outcomes in pregnant mothers and neonates exposed to PFAS, it is important to identify and understand determinants of maternal and neonatal PFAS concentrations to better implement public health interventions in these populations.

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Section: General Discussion and Future Directionsmentioning

confidence: 99%

Determinants of maternal and neonatal PFAS concentrations: a review

McAdam

Bell

2023

Environ Health

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“…29 Associations differed by specific PFAS but were most consistent for perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA). 29 All but one of the previous studies were conducted in Scandinavian countries. The sole US study was conducted in a population having higher serum PFOA concentrations relative to the general US population.…”

Section: Introductionmentioning

confidence: 99%

“…6,22 Several studies have examined associations between pregnancy PFAS concentrations and breastfeeding duration. 7,[23][24][25][26][27][28][29] In a recent systematic review of the six previous epidemiologic studies on this topic, five of the six found higher PFAS concentrations were associated with shorter breastfeeding duration. 29 Associations differed by specific PFAS but were most consistent for perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA).…”

Section: Introductionmentioning

confidence: 99%

“…7,[23][24][25][26][27][28][29] In a recent systematic review of the six previous epidemiologic studies on this topic, five of the six found higher PFAS concentrations were associated with shorter breastfeeding duration. 29 Associations differed by specific PFAS but were most consistent for perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA). 29 All but one of the previous studies were conducted in Scandinavian countries.…”

Section: Introductionmentioning

confidence: 99%

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Maternal serum per- and polyfluoroalkyl substances during pregnancy and breastfeeding duration

Friedman

Dabelea

Keil

et al. 2023

Environmental Epidemiology

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Background/objectives: Per-and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals that may affect breastfeeding duration. We examined associations between maternal PFAS concentrations during pregnancy and breastfeeding cessation. We investigated potential effect modification by parity status. Methods: Among 555 women enrolled in the Healthy Start study (2009)(2010)(2011)(2012)(2013)(2014), we quantified maternal serum concentrations of 5 PFAS during mid-to late-pregnancy (mean 27 weeks of gestation). Participants self-reported their breastfeeding practices through 18-24 months postnatally. Among all participants and stratified by parity, we estimated associations between maternal PFAS concentrations and breastfeeding discontinuation by 3 and 6 months, using Poisson regression, and breastfeeding duration, using Cox regression. Results: Median PFAS concentrations were similar to those in the general US population. Associations between PFAS and breastfeeding duration differed by parity status. After adjusting for covariates, among primiparous women, associations between PFAS and breastfeeding cessation by 3 and 6 months were generally null, with some inverse associations. Among multiparous women, there were positive associations between perfluorohexane sulfonate, perfluorooctane sulfonate, perfluorooctanoate (PFOA), and perfluorononanoate and breastfeeding cessation by 3 and 6 months. For example, per ln-ng/mL increase in PFOA, the risk ratio for breastfeeding discontinuation by 6 months was 1.45 (95% confidence interval, 1.18, 1.78). Hazard ratios reflected similar patterns between PFAS and breastfeeding duration. Conclusions: Among primiparous women, we did not find evidence for associations between PFAS concentrations and breastfeeding duration. In contrast, among multiparous women, PFAS serum concentrations were generally inversely associated with breastfeeding duration, though estimates may be biased due to confounding by unmeasured previous breastfeeding.

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“…We have recently demonstrated in a pilot study that circulating polyfluoroalkyl substances (PFASs) were associated with the HBM lipid composition, with high exposure being associated with reduced nutritional quality of HBM, with reduction in total lipid content, reduced concentration of polyunsaturated FAs (PUFAs), such as lipids containing docosahexaenoic acid- and arachidonic acid, while lipid containing saturated FAs were increased with higher PFAS exposure . PFASs are industrial chemicals that are used in a wide range of industrial and consumer applications, and their persistence in the environment has led to their widespread distribution in water, soil, wildlife, and humans. − Epidemiological studies indicate a potential inverse relationship between maternal PFAS levels and duration of breastfeeding. − Studies in animal models have shown that exposure to PFAS during gestation can lead to impaired mammary differentiation and stunted mammary epithelial development in offspring . Together, the current data suggest that accumulated PFAS exposure may disrupt lactation and alter the composition of breast milk.…”

Section: Introductionmentioning

confidence: 99%

Impact of Environmental Exposures on Human Breast Milk Lipidome in Future Immune-Mediated Diseases

Hyötyläinen,

Ghaffarzadegan,

Karthikeyan

et al. 2024

Environ. Sci. Technol.

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The composition of human breast milk (HBM) exhibits significant variability both between individuals and within the same individual. While environmental factors are believed to play a role in this variation, their influence on breast milk composition remains inadequately understood. Herein, we investigate the impact of environmental factors on HBM lipid composition in a general population cohort. The study included mothers (All Babies In Southeast Sweden study) whose children later progressed to one or more immune-mediated diseases later in life: type 1 diabetes (n = 9), celiac disease (n = 24), juvenile idiopathic arthritis (n = 9), inflammatory bowel disease (n = 7), hypothyroidism (n = 6), and matched controls (n = 173). Lipidome of HBM was characterized by liquid chromatography combined with high-resolution mass spectrometry. We observed that maternal age, body mass index, diet, and exposure to perfluorinated alkyl substances (PFASs) had a marked impact on breast milk lipidome, with larger changes observed in the milk of those mothers whose children later developed autoimmune diseases. We also observed differences in breast milk lipid composition in those mothers whose offspring later developed autoimmune diseases. Our study suggests that breast milk lipid composition is modified by a complex interaction between genetic and environmental factors, and, importantly, this impact was significantly more pronounced in those mothers whose offspring later developed autoimmune/ inflammatory diseases. Our findings also suggest that merely assessing PFAS concentration may not capture the full extent of the impact of chemical exposures; thus, the more comprehensive exposome approach is essential for accurately assessing the impact of PFAS exposure on HBM and, consequently, on the health outcomes of the offspring.

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Per- and Polyfluoroalkyl Substances and Breastfeeding as a Vulnerable Function: A Systematic Review of Epidemiological Studies

Cited by 19 publications

References 82 publications

Determinants of maternal and neonatal PFAS concentrations: a review

Determinants of maternal and neonatal PFAS concentrations: a review

Maternal serum per- and polyfluoroalkyl substances during pregnancy and breastfeeding duration

Impact of Environmental Exposures on Human Breast Milk Lipidome in Future Immune-Mediated Diseases

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