Xuping Gao1, Wanze Ni2, Sui Zhu3, Yanxin Wu4, Yunfeng Cui2, Junrong Ma2, Yanhua Liu5, Jinlong Qiao2, Yanbin Ye6, Pan Yang7, Chaoqun Liu8, Fangfang Zeng9. 1. Department of Epidemiology, School of Basic Medicine and Public Health, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China; Department of Child & Adolescent Psychiatry, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health (Peking University Sixth Hospital), 51 HuayuanBei Road, Beijing, 100191, PR China. 2. Department of Epidemiology, School of Basic Medicine and Public Health, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China. 3. Department of Medical Statistics, School of Basic Medicine and Public Health, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China. 4. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Road 2, Guangzhou, 510080, Guangdong, China. 5. Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, PR China. 6. Department of Nutrition, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Road 2, Guangzhou, 510080, Guangdong, China. 7. Department of Occupational and Environmental Health, School of Basic Medicine and Public Health, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China. 8. Department of Nutrition, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China. Electronic address: chaoqunliu@jnu.edu.cn. 9. Department of Epidemiology, School of Basic Medicine and Public Health, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, PR China. Electronic address: zengffjnu@126.com.
Abstract
BACKGROUND: Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes; however, the findings have been inconsistent. We aimed to conduct a systematic review and meta-analysis to provide an overview of these associations. METHODS: The online databases PubMed, EMBASE and Web of Science were searched comprehensively for eligible studies from inception to February 2021. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random- or fixed-effects models, and dose-response meta-analyses were also conducted when possible. FINDINGS: A total of 29 studies (32,905 participants) were included. The pooled results demonstrated that perfluorooctane sulfonate (PFOS) exposure during pregnancy was linearly associated with increased preterm birth risk (pooled OR per 1-ng/ml increase: 1.01, 95% CIs: 1.00-1.02, P = 0.009) and perfluorononanoate (PFNA) and perfluorooctanoate (PFOA) exposure showed inverted U-shaped associations with preterm birth risk (P values for the nonlinear trend: 0.025 and 0.030). Positive associations were also observed for exposure to perfluorodecanoate (PFDA) and miscarriage (pooled OR per 1-ng/ml increase: 1.87, 95% CIs: 1.15-3.03) and PFOS and preeclampsia (pooled OR per 1-log increase: 1.27, 95% CIs: 1.06-1.51), whereas exposure to perfluoroundecanoate (PFUnDA) was inversely associated with preeclampsia risk (pooled OR per 1-log increase: 0.81, 95% CIs: 0.71-0.93). Based on individual evidence, detrimental effects were observed between PFDA exposure and small for gestational age and between PFOA and PFOS and intrauterine growth restriction. No significant associations were found between pregnancy PFAS exposure and other adverse pregnancy outcomes (i.e., gestational diabetes mellitus, pregnancy-induced hypertension, low birth weight, and large and small for gestational age). INTERPRETATION: Our findings indicated that PFOS, PFOA and PFNA exposure during pregnancy might be associated with increased preterm birth risk and that PFAS exposure might be associated with the risk of miscarriage and preeclampsia. Due to the limited evidence obtained for most associations, additional studies are required to confirm these findings.
BACKGROUND: Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes; however, the findings have been inconsistent. We aimed to conduct a systematic review and meta-analysis to provide an overview of these associations. METHODS: The online databases PubMed, EMBASE and Web of Science were searched comprehensively for eligible studies from inception to February 2021. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random- or fixed-effects models, and dose-response meta-analyses were also conducted when possible. FINDINGS: A total of 29 studies (32,905 participants) were included. The pooled results demonstrated that perfluorooctane sulfonate (PFOS) exposure during pregnancy was linearly associated with increased preterm birth risk (pooled OR per 1-ng/ml increase: 1.01, 95% CIs: 1.00-1.02, P = 0.009) and perfluorononanoate (PFNA) and perfluorooctanoate (PFOA) exposure showed inverted U-shaped associations with preterm birth risk (P values for the nonlinear trend: 0.025 and 0.030). Positive associations were also observed for exposure to perfluorodecanoate (PFDA) and miscarriage (pooled OR per 1-ng/ml increase: 1.87, 95% CIs: 1.15-3.03) and PFOS and preeclampsia (pooled OR per 1-log increase: 1.27, 95% CIs: 1.06-1.51), whereas exposure to perfluoroundecanoate (PFUnDA) was inversely associated with preeclampsia risk (pooled OR per 1-log increase: 0.81, 95% CIs: 0.71-0.93). Based on individual evidence, detrimental effects were observed between PFDA exposure and small for gestational age and between PFOA and PFOS and intrauterine growth restriction. No significant associations were found between pregnancy PFAS exposure and other adverse pregnancy outcomes (i.e., gestational diabetes mellitus, pregnancy-induced hypertension, low birth weight, and large and small for gestational age). INTERPRETATION: Our findings indicated that PFOS, PFOA and PFNA exposure during pregnancy might be associated with increased preterm birth risk and that PFAS exposure might be associated with the risk of miscarriage and preeclampsia. Due to the limited evidence obtained for most associations, additional studies are required to confirm these findings.
Authors: Stephanie M Eick; Elizabeth A Enright; Amy M Padula; Max Aung; Sarah D Geiger; Lara Cushing; Jessica Trowbridge; Alexander P Keil; Hyoung Gee Baek; Sabrina Smith; June-Soo Park; Erin DeMicco; Susan L Schantz; Tracey J Woodruff; Rachel Morello-Frosch Journal: Environ Int Date: 2022-04-09 Impact factor: 13.352
Authors: Emma V Preston; Marie-France Hivert; Abby F Fleisch; Antonia M Calafat; Sharon K Sagiv; Wei Perng; Sheryl L Rifas-Shiman; Jorge E Chavarro; Emily Oken; Ami R Zota; Tamarra James-Todd Journal: Environ Int Date: 2022-06-06 Impact factor: 13.352