Reducing exposure to high levels of perfluorinated compounds in drinking water improves reproductive outcomes: evidence from an intervention in Minnesota

Abstract

Background: Per-and polyfluoroalkyl substances (PFASs) have been detected in drinking water supplies around the world and are the subject of intense regulatory debate. While they have been associated with several illnesses, their effects on reproductive outcomes remains uncertain. Methods: We analyzed birth outcomes in the east Minneapolis-St. Paul metropolitan area from 2002 to 2011, where a portion of the population faced elevated exposure to PFASs due to long-term contamination of drinking water supplies from industrial waste disposal. Installation of a water filtration facility in the highly contaminated city of Oakdale, MN at the end of 2006 resulted in a sharp decrease in exposure to PFASs, creating a "natural experiment". Using a difference-indifferences approach, we compare the changes in birth outcomes before and after water filtration in Oakdale to the changes over the same period in neighboring communities where the treatment of municipal water remained constant. Results: Average birth weight and average gestational age were statistically significantly lower in the highly exposed population than in the control area prior to filtration of municipal water supply. The highly exposed population faced increased odds of low birth weight (adjusted odds ratio 1.36, 95% CI 1.25-1.48) and pre-term birth (adjusted odds ratio 1.14, 95% CI 1.09-1.19) relative to the control before filtration, and these differences moderated after filtration. The general fertility rate was also significantly lower in the exposed population (incidence rate ratio 0.73, 95% CI 0.69-0.77) prior to filtration and appeared to be rebounding post-2006. Conclusions: Our findings provide evidence of a causal relationship between filtration of drinking water containing high levels of exposure to PFASs and improved reproductive outcomes.

Maternal Levels of Perfluoroalkyl Substances (PFAS) during Early Pregnancy in Relation to Preeclampsia Subtypes and Biomarkers of Preeclampsia Risk

“…This may be relevant in the study of PFAS and preeclampsia given that PFAS have also been associated with a higher risk of preterm birth ( Meng et al. 2018 ; Waterfield et al. 2020 ).…”

“…In addition, having estimates of disease onset allowed for secondary analyses of these data using Cox proportional hazard models, which more adequately accounted for preterm birth as a competing risk (Weinberg et al 2017). This may be relevant in the study of PFAS and preeclampsia given that PFAS have also been associated with a higher risk of preterm birth (Meng et al 2018;Waterfield et al 2020). Last, this study measured PFAS exposure using maternal plasma collected in early pregnancy.…”

“…2020 ), preterm birth ( Meng et al. 2018 ; Waterfield et al. 2020 ), and preeclampsia ( Savitz et al.…”

“…Exposure to PFAS has been linked to a wide array of adverse health outcomes, including reproductive outcomes (Blake and Fenton 2020). For example, prenatal PFAS exposure has been linked to excessive gestational weight gain (Ashley-Martin et al 2016;Mitro et al 2020), preterm birth (Meng et al 2018;Waterfield et al 2020), and preeclampsia (Savitz et al 2012;Stein et al 2009).…”

Suspect and non-target screening of ovarian follicular fluid and serum – identification of anthropogenic chemicals and investigation of their association to fertility

“…PFAS are of particular concern due to their widespread occurrence in human blood. However, there are conicting results regarding the effects of PFAS on fertility in epidemiological studies, 25,27,[32][33][34][35][36][37] which stresses the need for further investigations, especially since PFAS seem to target the ovary in different ways. 38 For example, experimental in vitro studies suggest adverse effects of PFAS on oocyte maturation.…”