Developmental Exposures to Perfluoroalkyl Substances (PFASs): An Update of Associated Health Outcomes
Purpose of Review
We reviewed and summarized the epidemiological evidence for the influence that pre- and postnatal exposures to perfluoroalkyl substances (PFASs) may have on health outcomes in offspring, with a particular focus on birth outcomes and postnatal growth, immunomodulatory effects and neurodevelopment.
PFASs are persistent organic pollutants that have been widely produced and used in a range of commercial products since the 1950s. Human exposures to PFASs are nearly ubiquitous globally, but studies that addressed potential health effects of PFASs have only begun to accumulate in recent years. Animal studies suggest adverse effects resulting from developmental encompasses prenatal exposures to PFASs. In humans, the developing fetus is exposed to PFASs via active or passive placenta transfer, while newborns might be exposed via breastfeeding or PFAS in the home environment.
Overall, epidemiological findings are consistent and suggest possible associations with fetal and postnatal growth and immune function, while the findings on neurodevelopmental endpoints to date are rather inconclusive. Methodological challenges and future directions for PFASs-focused research are discussed.
KeywordsPerfluoroalkyl substances Developmental exposures Fetal growth Immunotoxicity Neurodevelopment
ZL was supported by the NIH/NIEHS Pathway to Independence Award (K99ES026729).
Compliance with Ethical Standards
Conflict of Interest
Zeyan Liew, Houman Goudarzi, and Youssef Oulhote declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 10.CDC. Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey. 2009–2010 Data Documentation, Codebook, and Frequencies. Polyfluoroalkyl Chemicals (PFC_F). 2013. Available: http://wwwn.cdc.gov/nchs/nhanes/2009-2010/PFC_F.htm. Accessed 17 Oct 2017.
- 23.Sagiv SK, Rifas-Shiman SL, Fleisch AF, Webster TF, Calafat AM, Ye X, et al. Early pregnancy perfluoroalkyl substance plasma concentrations and birth outcomes in project viva: confounded by pregnancy hemodynamics? Am J Epidemiol. 2017; https://doi.org/10.1093/aje/kwx332.
- 33.Kishi R, et al. The Association of Prenatal Exposure to Perfluorinated chemicals with maternal essential and long-chain polyunsaturated fatty acids during pregnancy and the birth weight of their offspring: the Hokkaido study. Environ Health Perspect. 2015;123(10):1038–45.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Lee ES, Han S, Oh JE. Association between perfluorinated compound concentrations in cord serum and birth weight using multiple regression models. Reprod Toxicol. 2016;59:53–9.Google Scholar
- 74.• Oulhote Y, et al. Behavioral difficulties in 7-year old children in relation to developmental exposure to perfluorinated alkyl substances. Environ Int. 2016;97:237–45. This study with several PFASs exposure assessment showed inverse association of postnatal exposure to PFASs and childhood behavioral problems in childhood. CrossRefPubMedPubMedCentralGoogle Scholar
- 97.• Goudarzi H, et al. The Association of Prenatal Exposure to Perfluorinated chemicals with glucocorticoid and androgenic hormones in cord blood samples: the Hokkaido study. Environ Health Perspect. 2017;125(1):111–8. For the first time, the authors showed evidence regarding the effects of prenatal exposure to PFAS on glucocorticoids and androgenic hormones in the fetuses PubMedGoogle Scholar
- 105.Wang Y, Starling AP, Haug LS, Eggesbo M, Becher G, Thomsen C, et al. Association between Perfluoroalkyl substances and thyroid stimulating hormone among pregnant women: a crosssectional study. Environ Health. 2013;12:76. https://doi.org/10.1186/1476-069X-12-76.CrossRefPubMedPubMedCentralGoogle Scholar
- 126.Verner MA, et al. Associations of Perfluoroalkyl substances (PFAS) with lower birth weight: an evaluation of potential confounding by glomerular filtration rate using a physiologically based pharmacokinetic model (PBPK). Environ Health Perspect. 2015;123(12):1317–24.CrossRefPubMedPubMedCentralGoogle Scholar
- 128.Harris MH, et al. Predictors of per- and Polyfluoroalkyl substance (PFAS) plasma concentrations in 6-10 year old American children. Environ Sci Technol. 2017;51(9):5193–204.Google Scholar
- 135.• Liew Z, et al. Bias from conditioning on live birth in pregnancy cohorts: an illustration based on neurodevelopment in children after prenatal exposure to organic pollutants. Int J Epidemiol. 2015;44(1):345–54. This study provides extensive and detailed information regarding a common bias structure (leading to 'live-birth bias') that could arise when studying prenatal exposure effects to environmental factors on outcomes in the offspring in pregnancy cohorts CrossRefPubMedPubMedCentralGoogle Scholar
- 136.NTP. NTP Monograph. Immunotoxicity Associated with Exposure to Perfluorooctanoic Acid or Perfluorooctane Sulfonate. Research Triangle Park, NC: Office of Health Assessment and Translation, National Toxicology Program (NTP), National Institute of Environmental Health Sciences, National Institutes of Health, U.S. Department of Health and Human Services. 2016.Google Scholar