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Meta-Analysis
. 2022 Mar 24:10:855348.
doi: 10.3389/fpubh.2022.855348. eCollection 2022.

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

Si-Yu Gui  1   2 , Yue-Nan Chen  3 , Ke-Jia Wu  2 , Wen Liu  4 , Wen-Jing Wang  3 , Huan-Ru Liang  5 , Zheng-Xuan Jiang  1 , Ze-Lian Li  6 , Cheng-Yang Hu  7   8
Affiliations
Meta-Analysis

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

Si-Yu Gui et al. Front Public Health. .

Abstract

Background: A 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.

Methods: Three 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.

Results: The 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".

Conclusion: This 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.

Keywords: birth outcome; birth weight; meta-analysis; per- and polyfluoroalkyl substances; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Meta-analysis of the associations of PFOS and PFOA with birth weight (g) for per 1 ln(ng/ml) increment of exposure.
Figure 3
Figure 3
Meta-analysis of the associations of PFNS, PFUnDA and PFDA with birth weight (g) for per 1 ln(ng/ml) increment of exposure.
Figure 4
Figure 4
Meta-analysis of the association of PFOS, PFOA, PFHxS and PFHpS with birth weight (g) for top versus bottom categories of exposure.
Figure 5
Figure 5
Meta-analysis of the association of PFOS and PFOA with birth length (cm).
Figure 6
Figure 6
Meta-analysis of the association of PFDoDA and PFOS with head circumference (cm).
Figure 7
Figure 7
Meta-analysis of the association of PFOS and PFOA with ponderal index (g/cm3).
See this image and copyright information in PMC

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