Perfluorooctanoic acid and low birth weight: Estimates of US attributable burden and economic costs from 2003 through 2014

Abstract

Background and objective: In utero exposure to perfluorooctanoic acid (PFOA) has been associated with decreases in birth weight. We aimed to estimate the proportion of PFOA-attributable low birth weight (LBW) births and associated costs in the US from 2003 to 2014, a period during which there were industry-initiated and regulatory activities aimed at reducing exposure.

Methods: Serum PFOA levels among women 18-49 years were obtained from the National Health and Nutrition Examination Survey (NHANES) for 2003-2014; birth weight distributions were obtained from the Vital Statistics Natality Birth Data. The exposure-response relationship identified in a previous meta-analysis (18.9g decrease in birth weight per 1ng/mL of PFOA) was applied to quantify PFOA-attributable LBW (reference level of 3.1ng/mL for our base case, 1 and 3.9ng/mL for sensitivity analyses). Hospitalization costs and lost economic productivity were also estimated.

Results: Serum PFOA levels remained approximately constant from 2003-2004 (median: 3.3ng/mL) to 2007-2008 (3.5ng/mL), and declined from 2009-2010 (2.8ng/mL) to 2013-2014 (1.6ng/mL). In 2003-2004, an estimated 12,764 LBW cases (4% of total for those years) were potentially preventable if PFOA exposure were reduced to the base case reference level (10,203 cases in 2009-2010 and 1,491 in 2013-2014). The total cost of PFOA-attributable LBW for 2003 through 2014 was estimated at $13.7 billion, with $2.97 billion in 2003-2004, $2.4 billion in 2009-2010 and $347 million in 2013-2014.

Conclusions: Serum PFOA levels began to decline in women of childbearing age in 2009-2010. Declines were of a magnitude expected to meaningfully reduce the estimated incidence of PFOA-attributable LBW and associated costs.

Keywords: Economic costs; Low birth weight; NHANES; PFOA exposure.