Close up of kitchen faucet with a strong stream of water Close up of kitchen faucet with a strong stream of water

The Multi-Site PFAS Health Study

About

The Multi-site Study has launched in Hoosick Falls and Newburgh!
Call us today at 833-732-7697 to enroll.

 

What is the Multi-site PFAS Health Study?

Multi-Site Health Study with blue water droplet

The New York State Department of Health and the University at Albany’s School of Public Health are participating in a national Centers for Disease Control and Prevention (CDC)’s Agency for Toxic Substances and Disease Registry (ATSDR) five-year, Multi-site PFAS Health Study. This is the first study to look at relationships between exposure to PFAS in drinking water and certain health outcomes in multiple communities nationwide. Two New York communities were chosen as part of the national. Additional Multi-site PFAS Health Study communities are located in California, Colorado, Massachusetts, Michigan, New Jersey, and Pennsylvania.

New York communities chosen to participate in the Multi-site PFAS Health Study are the Hoosick Falls Area and the City of Newburgh. About 1,000 adults and 300 children from these communities are being recruited to join the study.

Did you receive our mailings or would you like to participate in the study? For more information, please visit PFAS Study Participation.

You can also follow us on Facebook, Twitter, or Instagram.

 

Study Timeline

  • Phase 1: University at Albany and the NYSDOH formed a community advisory panel (CAP) in both communities.
  • Phase 2: The study launched in January 2022 and is recruiting participants. This will be a 6-8 month process.
  • Phase 3: Participants will receive a report of their test results.

 

136
Adult clinic visits completed
13.6%
Percent of Our Goal
The PFAS Multi-site Health Study
George Education Center Room 254

1 University Place
Rensselaer, NY 12144
United States

Para traducir la pagina, por favor acuda a su navegador de internet. 

Tranpri itilize navigate pou ou ka tradui paj sa.

Please use your browser to translate this webpage.

Meet Our Team

 

Newburgh Clinic Team

Keir Graham, Roberta Chambers, Suntiah Frierson, Jasmine Monroy, Destini McMillan and Brittany Brown

Check out the Newburgh clinic!

Newburgh Clinic Team Members
(Left to Right: Keir, Roberta, Suntiah, Jasmine, Destini, and Brittany)

 

 

Hoosick Falls Clinic Team

Kayla Denue, Teresa Lassor, and Janaye Covington

Check out the Hoosick Falls clinic!

Hoosick Falls PFAS Team standing in front of building
Left to Right: Kayla, Teresa, and Janaye

 

UAlbany Team

Gloria Diaz, Elisa Grimm, Jordan McAdam, Nislei Alvarado, Stephania Lowman, Thomas Sweck and Khadija Rafiqi

Meet the UAlbany Team

PFAS Study UAlbany Team sitting in front of School of Public Health sign
(Left to Right: Gloria, Nislei, Stephania, Elisa, Jordan, Khadija, and Thomas)

 

New York State Department of Health Team

Dr. Sanghamitra Savadatti and June Moore

 

 

Study Investigators

 

Dr. Erin Bell

Dr. Bell is a Professor of Environmental Health Sciences at the University at Albany School of Public Health. Her research interests include examining the association of environmental exposures and adverse birth and child health outcomes, including neurodevelopment. She is particularly interested in the relationship between social factors and environmental exposures and their combined impact on child development. For more information, please visit Dr. Bell's faculty page.

 

Dr. Elizabeth L. Lewis-Michl

Dr. Lewis-Michl is the Director of the Division of Environmental Health Assessment within the Center for Environmental Health at the New York State Department of Health (NYSDOH). As Co-PI of the PFAS Multi-Site Health, Dr. Lewis-Michl will be responsible for the study's overall management within the NYSDOH. Dr. Lewis-Michl has extensive experience conducting a wide variety of health outcome and biomonitoring investigations including applied epidemiological research in communities with unusual environmental exposures. She holds a PhD in Socio-medical Sciences from Columbia University.

Published Literature

Our staff is dedicated to bringing scientific information to our communities and review recently published scientific research articles.

This page will be updated monthly. All of the articles listed have been published between 2015 and now and are peer reviewed. Older articles are available upon request. If you have any questions, please contact us by phone at 1-833-732-7697, by text at 518-898-0276, or by email at [email protected].

Esta página se actualizará mensualmente. Todos los artículos enumerados se han publicado entre 2015 y ahora. Los artículos más antiguos están disponibles bajo petición. Si tienes algunas preguntas, póngase en contacto con nosotros. Por favor contáctenos por teléfono a 1-833-732-7697, mensaje de texto a 518-898-0276, o por correo electrónico a [email protected].

Paj sa a pral mete ajou chak mwa. Tout atik ki nan lis yo te pibliye ant 2015 e kounye a. Pi gran atik yo disponib sou demann. Si ou gen nenpòt kesyon, tanpri kontakte nou. Tanpri Kontakte nou sou Telefòn a 1-833-732-7697, pa tèks a 518-898-0276, oubyen pa imèl a [email protected].


Dr. Katie Pelch and her team created a PFAS-TOX database that contains articles on PFAS and potential health outcomes that may be observed in humans, animals, or in-vitro. To maintain consistency between the PFAS-TOX database created by Dr. Pelch and our literature review webpage we have used their health outcome categories to organize our literature review webpage. If you have questions or want to discuss an article, please let us know and we will be happy to speak with you. We are able to set up a call in either Spanish or Haitian Creole. We can be reached by phone at 1-833-732-7697, by text at 518-898-0276, or by email at [email protected].

 

Infant and Childhood Health

 

Reproductive System

Reproduction includes effects on the reproductive system, reproductive function, pregnancy, and birth outcomes. Menstruation and puberty information can be found in the Hormones section. This section currently has 91 total papers: 85 from the last 6 years. Some studies include other endocrine-disrupting chemicals (EDCs) to measure outcomes following exposure to multiple toxicants. Although a study may find, or not find, an association between PFASs and other EDCs and reproductive outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Birthweight, birth size, and birth outcomes

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

Study Purpose: Emerging evidence suggests that PFAS affect birth outcomes, but the evidence is inconsistent. Therefore, this study aimed to systematically review the epidemiological evidence on PFAS exposure and birth outcomes.

Study 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.  More studies are needed to confirm these results.

Associations between prenatal exposure to perfluoroalkyl substances, hypomethylation of MEST imprinted gene and birth outcomes

Study Purpose: PFAS exposure has been linked to adverse birth outcomes, but the underlying mechanism is not understood. DNA methylation changes in the MEST gene may be a mechanism of the prenatal exposure effects of PFASs on fetal growth. The aim of the study was to investigate the prenatal PFAS exposure effects on DNA methylation changes in MEST genes involved in fetal growth.

Study Conclusion: In conclusion, our results suggest that prenatal PFAS exposure, especially PFOS, is associated with lower methylation levels at MEST promoter region, which not only leverages the role of imprinted gene in ensuring the integrity of fetal growth but also provides a potential mechanism for evaluating the prenatal exposure effect.

High in Utero Exposure to Perfluoroalkyl Substances from Drinking Water and Birth Weight: A Cohort Study among Infants in Ronneby, Sweden

Study Purpose: In utero PFAS exposure can influence birth weight, but little is known about the effects at very high levels. This study aimed to examine the association between in utero PFAS exposure and birth weight. 

Study Conclusion: This study shows that high exposure to PFAS may influence birth weight in a sex-specific way, though this is likely a minor influence.

Concentrations of per- and polyfluoroalkyl substances (PFAS) in human placental tissues and associations with birth outcomes

Study Purpose: Previous studies have observed associations between maternal serum PFAS concentrations and adverse pregnancy and birth outcomes such as lower birth weight or pre-eclampsia; however, few studies have explored these associations with birth outcomes and placental tissue PFAS concentrations. The goal of this study was to measure placental PFAS concentrations and examine associations with birth outcomes. 

Study Conclusion: The present study shows that several PFAS are frequently detected in the placenta, and our observed associations with birth outcomes indicate potential concern for adverse health effects on infants exposed to the highest levels of PFAS exposure. In this study, PFAS placental exposure was associated with sex-specific birth outcomes. They found that the highest exposure of placental PFOS was associated with lower birth weight for gestational age in infant males and higher birth weight in female infants.

Relationships between maternal perfluoroalkyl substance levels, polymorphisms of receptor genes, and adverse birth outcomes in the Hokkaido birth cohort study, Japan

Study Purpose: The goal of this study was to look at the association between PFOA and PFOS in third trimester women's blood samples, maternal genotypes, and birth outcomes in their children.

Study Conclusion: PFOS levels during pregnancy were associated with decreased birth weight, chest circumference, and birth Ponderal index (a measure of thinness at birth) and that those associations were different according to the maternal genotype LXRB. Further studies may help identify more vulnerable or preventive genetic groups.

Per- and polyfluoroalkyl substance (PFAS) exposure, maternal metabolomic perturbation, and fetal growth in African American women: A meet-in-the-middle approach

Study Purpose: Prenatal exposures to PFAS have been linked to reduced fetal growth. This study aims to investigate biological pathways and biomarkers underlying the association between serum PFAS and fetal growth using high-resolution metabolomics in a cohort of pregnant African American women in the Atlanta area, Georgia.

Study Conclusion: In this cohort of pregnant African American women, higher serum concentrations of PFOA and PFNA were associated with reduced fetal growth. Perturbations of biological pathways involved in amino acid, lipid and fatty acid, bile acid, and androgenic hormone metabolism were associated with PFAS exposures and reduced fetal growth, and uric acid was shown to be a potential intermediate biomarker. Our results provide opportunities for future studies to develop early detection and intervention for PFAS-induced fetal growth restriction.

Associations between exposure to perfluoroalkyl substances and birth outcomes: A meta-analysis

Study Purpose: This study reviews the published literature on the effects of prenatal PFAS exposure on birth outcomes, specifically premature birth, low birth weight, small for gestational age, and miscarriage.

Study Conclusion: In this study, we observed significant associations between PFOS and premature birth, PFOA and miscarriage, and PFOS and low birth weight. Study region, sampling time, and sample were potential sources of differences between the studies included in this paper. 

Association of maternal exposure to perfluoroalkyl and polyfluoroalkyl substances with infant growth from birth to 12 months: A prospective cohort study

Study Purpose: Although maternal PFASs have been associated with adverse birth outcomes, much less is known about their impact on infant growth during early infancy. This study investigates the association between maternal PFASs exposure and infant growth during the first 12 months of life.

Study Conclusion: In this study, there were negative associations found for maternal PFHpA exposure and infant length and PFBS exposure and weight and BMI. Maternal PFDoA exposure was positively associated with weight and BMI. The adverse association of maternal PFHpA exposure and infant length was more pronounced in males.

Early pregnancy loss: Do Per- and polyfluoroalkyl substances matter?

Study Purpose: PFAS can transfer across the blood-follicle barrier. However, it is unknown whether PFAS can affect human fertility. This study aims to analyze the associations of women's exposure to PFAs with pregnancy loss, the relevant processes of fertilization, zygote implantation, and embryo development.

Study Conclusion: Overall, this study concluded that most PFAS were not associated with early pregnancy loss at the current average exposure levels. As for the PFDA, there may exist susceptibility among different populations.

Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Study Purpose: This reviews and analyzes previous studies on the relationship of maternal PFAS exposure and adverse pregnancy outcomes.

Study Conclusion: It was found that maternal exposure to PFOS could be positively associated with preterm birth, while no statistically significant association have been found between PFASs exposure and miscarriage and stillbirth. Epidemiological evidence to date are insufficient to draw definitive conclusions on potential toxicities of PFASs with stronger statistical power.

Prenatal exposure to mixtures of persistent endocrine disrupting chemicals and postnatal body size in British girls

Study Purpose: This study investigates the association of prenatal exposure to endocrine disrupting chemicals such as PFAS, PCBs, and OCPS as mixtures with postnatal body size in female offspring.

Study Conclusion: This study found an inverse association between prenatal exposure to PFAS, PCBs, and OCPs and longitudinal postnatal body size through age 19 months.

Associations of paternal and maternal per- and polyfluoroalkyl substances exposure with cord serum reproductive hormones, placental steroidogenic enzyme and birth weight

Study Purpose: Maternal PFAS exposure has been associated with placental function and fetal growth. In this study, they evaluate the associations of maternal or paternal PFAS levels with placental function and fetal growth measures.

Study Conclusion: Several maternal PFAS were associated with fetal steroid hormones and placental enzymes. Despite a correlation of PFAS level within the couples, no association was found for paternal PFAS exposure on these outcomes. The findings suggest the intrauterine PFAS exposure effect on fetal endocrine hormones and growth is unlikely to be confounded by exposure sources or familial factors shared within the couples.

The relationship between maternal perfluoroalkylated substances exposure and low birth weight of offspring: a systematic review and meta-analysis

Study Purpose: This article reviews past studies to assess the association between maternal PFAS exposure and low birth weight in offspring.

Study Conclusion: The present meta-analysis showed a significant positive association between maternal prenatal PFOS exposure and LBW of offspring, but no association between maternal PFOA exposure and LBW of offspring. Meanwhile, we observed regional factors might influence the occurrence of LBW

Per- and polyfluoroalkyl substances exposure during pregnancy and adverse pregnancy and birth outcomes: A systematic review and meta-analysis

Study Purpose: Exposure to PFAS during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes; however, the findings have been inconsistent. This study provides an overview of these associations.

Study Conclusion: 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.

Effects of gestational exposures to chemical mixtures on birth weight using Bayesian factor analysis in the Health Outcome and Measures of Environment (HOME) Study

Study Purpose: This study looks at the effects of gestational exposures to chemical mixtures (including PFAS) on infant birth weight.

Study Conclusion: This study used three different statistical approaches to examine the association between birth weight and prenatal exposures to seven types of environmental chemical mixtures. They found that PCBs and PFASs displayed strong associations with reduced birth weight.

Exploring associations between prenatal exposure to multiple endocrine disruptors and birth weight with exposure continuum mapping

Study Purpose: This study examines how prenatal exposure to environmental mixtures influence birth weight or other adverse outcomes

Study Conclusion: Findings from our study revealed a wide range of prenatal exposure scenarios and found that combinations exhibiting higher levels of PBDEs were associated with lower birth weight and combinations with higher levels of PCBs and PFAS were associated with increased birth weight. Our ECM approach provides a promising framework for supporting studies of other exposure mixtures.

Prenatal exposure to mixtures of persistent endocrine-disrupting chemicals and birth size in a population-based cohort of British girls

Study Purpose: This study investigates the association of prenatal exposure to mixtures of PFASs, PCBs, and pesticides with birth size among female offspring in the United Kingdom.

Study Conclusion: These results are consistent with the hypothesis that prenatal exposure to mixtures of endocrine-disrupting chemicals may affect birth size.

PFAS concentration during pregnancy in relation to cardiometabolic health and birth outcomes

Study Purpose: To examine the relationship between PFAS concentration during pregnancy in relation to cardiometabolic health and birth outcomes.

Study Conclusion: This study observed a positive association between PFAS exposure and serum-lipid concentrations. No association was observed between PFAS exposure and birth weight. PFNA was associated with preterm birth.

Associations between prenatal maternal exposure to per- and polyfluoroalkyl substances (PFAS) and polybrominated diphenyl ethers (PBDEs) and birth outcomes among pregnant women in San Francisco

Study Purpose: To observe the associations between prenatal maternal exposure PFAS and PBDEs, and birth outcomes among pregnant women in San Francisco.

Study Conclusion: Most PFAS were not associated with adverse birth outcomes.

Persistent organic pollutants exposure in newborn dried blood spots and infant weight status: A case-control study of low-income Hispanic mother-infant pairs

Study Purpose: This study looks at the associations between PFAS and other pollutant exposure and birth weight and overweight status at 18 months old.

Study Conclusion: Some PFASs were associated with lower birth weight. No associations with infant overweight status at 18 months were observed.

Per- and polyfluoroalkyl substances in drinking water and birthweight in the US: A county-level study

Study Purpose: This study used public data to examine potential associations between PFAS in drinking water and birthweight at county levels.

Study Conclusion: Associations between PFAS and birthweight varied by the PFAS chemical in this study. Conclusions should be interpretation due to limitations of the 2 public datasets used.

Exposure to per- and polyfluorinated alkyl substances in pregnant Brazilian women and its association with fetal growth

Study Purpose: In this study, concentrations of PFAS were determined in the second trimester of pregnancy in Brazilian women.

Study Conclusion: To the best of our knowledge, this is the first study to assess whole blood concentrations of PFASs in pregnant Brazilian women. The results suggest ubiquitous exposure to PFOS and PFOA in pregnant women from Ribeirao Preto, an industrialized region in Brazil. PFOS and PFOA concentrations in pregnant women were positively associated with IUGR (p < 0.05). Further studies are needed to evaluate long-term effects of prenatal exposure of PFASs on developmental outcomes in children.

Associations of Exposure to Perfluoroalkyl Substances With Thyroid Hormone Concentrations and Birth Size

Study Purpose: To determine the associations between maternal serum-PFAS concentrations and birth weight, birth length, and head circumference.

Study Conclusion: In this study, several PFASs were negatively associated with birth size and increased thyroid hormone levels; however, this did not explain lower birth weight among children exposed to PFAS.

Exposure to PFAS and small for gestational age newborns: A birth records study in Veneto Region (Italy)

Study Purpose: To examine the association between PFAS exposure and the risk of small for gestational age in a PFAS contaminated area.

Study Conclusion: The findings suggest that living in a contaminated area by PFAS may have an effect on fetal growth. Individual data on exposure is needed to confirm the direct association.   

Prenatal exposure to 11 perfluoroalkyl substances and fetal growth: A large-scale, prospective birth cohort study

Study Purpose: To investigate whether prenatal maternal exposure to 11 PFAS is associated with fetal growth.

Study Conclusion: The study results suggest that prenatal, maternal exposure to PFAS with longer carbon chains may have effect on fetal growth.

Maternal serum levels of perfluoroalkyl substances in early pregnancy and offspring birth weight

Study Purpose: To examine associations between first-trimester exposure to PFAS and birth weight and examine differences between boys and girls.

Study Conclusion: This study observed associations between prenatal exposure for five different PFASs and birth weight, with more pronounced associations in girls than in boys.

Prenatal exposure to per- and polyfluoroalkyl substances and infant growth and adiposity: the Healthy Start Study

Study Purpose: To test the hypothesis that faster growth in early infancy may be associated with maternal PFAS concentrations.

Study Conclusion: Although maternal PFAS concentrations are inversely associated with infant weight and adiposity at birth, rapid gain may occur in infancy, particularly in fat mass.      

First-trimester maternal concentrations of polyfluoroalkyl substances and fetal growth throughout pregnancy

Study Purpose: To determine the association between first-trimester maternal concentrations of PFAS and fetal growth.

Study Conclusion: Study results did not suggest an overall association between prenatal PFASs and fetal growth.

Maternal serum concentrations of perfluoroalkyl substances and birth size in British boys

Study Purpose: To determine the association of prenatal maternal serum concentrations and birth size in boys.

Study Conclusion: Prenatal exposure to high levels of PFOS may be associated with reduced birth size in male infants.

Cumulative exposure to environmental pollutants during early pregnancy and reduced fetal growth: the Project Viva cohort

Study Purpose: To examine interactions between early pregnancy exposure to cigarette smoke, traffic pollution, and PFAS on birth weight for gestational age.

Study Conclusion: Prenatal exposure to PFOS was associated with lower fetal growth.

Prenatal Exposure to Perfluoroalkyl Substances: Infant Birth Weight and Early Life Growth

Study Purpose: To determine if prenatal PFAS exposure was associated with birth weight, body composition and growth until 2 years of age.

Study Conclusion: The study observed inverse associations between prenatal serum PFAS concentrations and anthropometry until age 2 years. Prenatal serum PFAS concentrations were not associated with growth rate in the first 2 years of life.

Gestational exposure to endocrine disrupting chemicals in relation to infant birth weight: a Bayesian analysis of the HOME Study

Study Purpose: To examine the association of gestational exposure to endocrine disrupting chemicals, including PFAS.

Study Conclusion: Gestational exposure to PFAS had small associations with birth weight.          

Prenatal exposure to perfluoroalkyl substances and birth outcomes in a Spanish birth cohort

Study Purpose: To estimate associations between prenatal PFAS exposure and birth outcomes, and the influence of kidney factors, in a birth cohort.

Study Conclusion: PFAS showed little association with birth outcomes. Higher PFHxS, PFOA, and PFNA were associated with reduced birth weight. The association between PFOS and low birth weight seems to be sex-specific.

Maternal Concentrations of Perfluoroalkyl Substances and Fetal Markers of Metabolic Function and Birth Weight

Study Purpose: To examine associations between first-trimester maternal plasma PFAS concentrations and birth weight.

Study Conclusion: All associations between maternal PFAS concentrations and cord blood adipocytokine concentrations were small.

Other

Mixtures of persistent organic pollutants are found in vital organs of late gestation human fetuses

Study Purpose: This study measured persistent organic pollutants, such as PFAS, in maternal serum, placenta, and fetal tissues in 20 pregnancies that ended in stillbirth.

Study Conclusion: This study quantified many POPs in fetal tissues. All studied chemicals were detected in fetal adipose tissue even in places when the chemical was not detected in the maternal serum and placenta.

A case-cohort study of perinatal exposure to potential endocrine disrupters and the risk of cryptorchidism in the Norwegian HUMIS study

Study Purpose: Exposure to PFAS and other endocrine-disrupting chemicals (EDCs) during the critical period of testicular descent may increase the risk of cryptorchidism and male fertility. The objective of this study was to investigate 27 potential EDCs in breast milk and the risk of cryptorchidism.

Study Conclusion: Perinatal exposure to PCB-74, PCB-114, PCB-194, and B-HCH were associated with increased odds of congenital cryptorchidism.

Exposure to endocrine disrupting chemicals (EDCs) and cardiometabolic indices during pregnancy: The HOME Study

Study Purpose: Toxicology studies have identified pregnancy as a time sensitive to endocrine disrupting chemicals (EDCs), such as PFAS, and cardiometabolic indices in women. No study has examined this in humans.

Study Conclusion: Overall, there were positive associations between PBDEs with glucose and cholesterol levels during pregnancy, while negative associations were found between some phthalates and cholesterol. No relationship was noted for BPA or PFAS with cardiometabolic indices during pregnancy across both models.

Associations of single and multiple per- and polyfluoroalkyl substance (PFAS) exposure with vitamin D biomarkers in African American women during pregnancy

Study Purpose: Vitamin D has been linked to various physiological function in pregnant women and their fetuses. This study aims to evaluate the associations of PFAs levels with vitamin D levels during pregnancy in a cohort of African American women in Atlanta.

Study Conclusion: This study suggests that exposure to PFAs might disturb vitamin D metabolism among pregnant African American women and that some of these effects might be changed by the sex of the fetus. More studies are needed to confirm these findings.

Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Study Purpose: This reviews and analyzes previous studies on the relationship of maternal PFAS exposure and adverse pregnancy outcomes.

Study Conclusion: It was found that maternal exposure to PFOS could be positively associated with preterm birth, while no statistically significant association have been found between PFASs exposure and miscarriage and stillbirth. Epidemiological evidence to date are insufficient to draw definitive conclusions on potential toxicities of PFASs with stronger statistical power.

Associations of single and multiple per- and polyfluoroalkyl substance (PFAS) exposure with vitamin D biomarkers in African American women during pregnancy

Study Purpose: Vitamin D has been linked to various physiological function in pregnant women and their fetuses. This study aims to evaluate the associations of PFAs levels with vitamin D levels during pregnancy in a cohort of African American women in Atlanta.

Study Conclusion: This study suggests that exposure to PFAs might disturb vitamin D metabolism among pregnant African American women and that some of these effects might be changed by the sex of the fetus. More studies are needed to confirm these findings.

Maternal exposure to perfluoroalkyl chemicals and anogenital distance in the offspring: a Faroese cohort study

Study Purpose: Exposure to PFASs has in some studies been associated with reduced anogenital distance in newborns, an indicator of prenatal anti-androgenic exposure. The aim of this study was to investigate the association between maternal PFAS exposure and offspring anogenital distance in a population with wide ranges of PFAS exposures.

Study Conclusion: In conclusion, we found that maternal PFAS exposure was significantly associated with a longer AGDs in boys. No significant associations were found among girls, suggesting sex-dimorphic effects of PFASs. Whether the observed association with longer ASD and PFAS influences the reproductive health of males is unknown and needs to be investigated further.

Prenatal exposures to mixtures of endocrine disrupting chemicals and children's weight trajectory up to age 5.5 in the SELMA study

Study Purpose: This study evaluates the effect of prenatal exposure to mixtures of endocrine disrupting chemical (such as PFASs) mixtures on birthweight and childhood weight trajectories.

Study Conclusion: Prenatal exposure to EDC mixtures was associated with lower birthweight and altered infant weight gain trajectories.

Exposure to perfluoroalkyl substances in early pregnancy and risk of sporadic first trimester miscarriage

Study Purpose: The aim of this study was to investigate whether PFASs in early pregnancy are associated with unexplained, sporadic first trimester miscarriage.

Study Conclusion: There was an association between PFOA and miscarriage in this study. The study can only represent early placentation and clinical pregnancy loss during the second half of the first trimester.

Perfluorooctanoic acid (PFOA) or perfluorooctane sulfonate (PFOS) and DNA methylation in newborn dried blood spots in the Upstate KIDS cohort

Study Purpose: PFOA and PFOS may alter prenatal development, through modifying DNA. Prior studies on this subject have had few subjects and inconsistent results. This study examines relationships between PFOA and PFOS with DNA changes among nearly 600 infants.

Study Conclusion: There was limited evidence of an association between high concentrations of PFOA/PFOS and DNA changes in newborns in this study. Future studies are needed in populations with higher concentrations of PFOA/PFOS.

Prenatal Exposure to Per- and Polyfluoroalkyl Substances, Umbilical Cord Blood DNA Methylation, and Cardio-Metabolic Indicators in Newborns: The Healthy Start Study

Study Purpose: This study looks at the associations between prenatal PFAS exposure and changes in DNA in umbilical cord blood.

Study Conclusion: DNA changes in umbilical cord blood were associated with maternal PFAS concentrations during pregnancy, which could affect offspring growth, metabolism, and immune function.

Per- and polyfluoroalkyl substance mixtures and gestational weight gain among mothers in the Health Outcomes and Measures of the Environment study

Study Purpose: This study looks at associations between PFAS exposure and gestational weight gain.

Study Conclusion: Although there were consistent small increases in gestational weight gain with increasing PFOA, PFOS, and PFNA serum concentrations in this cohort, the associations were imprecise. Additional investigation of the association of PFAS with GWG in other cohorts would be informative and could consider pre-pregnancy BMI as a potential modifier.

Perfluoroalkyl substances exposure in early pregnancy and preterm birth in singleton pregnancies: a prospective cohort study

Study Purpose: To investigate the associations between prenatal PFAS exposure and preterm birth among singleton live births.

Preeclampsia and hypertensive disorders of pregnancy

Endocrine-Disrupting Chemical Exposures in Pregnancy: a Sensitive Window for Later-Life Cardiometabolic Health in Women

Study Purpose: Pregnancy can be seen as a "stress test" with complications predicting later-life cardiovascular disease risk. Here, we review the growing epidemiological literature evaluating environmental endocrine-disrupting chemical (EDC) exposure in pregnancy in relation to two important cardiovascular disease risk factors, hypertensive disorders of pregnancy and maternal obesity.

Study Conclusion: Although numerous studies evaluated pregnancy outcomes, few evaluated the postpartum period or assessed chemical mixtures. Overall, there is a need to better understand whether pregnancy exposure to these chemicals could contribute to adverse cardiometabolic health outcomes in women, particularly given that cardiovascular disease is the leading cause of death in women.

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

Study Purpose: This study examines the associations between PFAS, any preeclampsia diagnosis, and early- and late-onset preeclampsia. In addition, they estimate associations between PFAS and biomarkers that provide an estimate of pro- and anti- angiogenic activity within the placenta.

Study Conclusion: Maternal PFAS concentrations were associated with higher odds of late-onset preeclampsia. Differences in preeclampsia should be considered in future studies because populations may have different distributions of disease subtypes.

Exposure to perfluoroalkyl substances in early pregnancy and the risk of hypertensive disorders of pregnancy: A nested case-control study in Guangxi, China

Study Purpose: Previous studies have examined the associations between exposure to PFAS and the risk of hypertensive disorders of pregnancy. However, these studies have had some limitations. This study again addresses this association.

Study Conclusion: This study found that combined exposure to nine PFAS had a positive effect on the development of hypertensive disorders of pregnancy (HDP). PFOS and PFBS were positively associated with HDP risk, while PFHxS and PFHpA were negatively associated with the HDP risk in women in Guangxi, China.

Considering Environmental Exposures to Per- and Polyfluoroalkyl Substances (PFAS) as Risk Factors for Hypertensive Disorders of Pregnancy

Study Purpose: This reviews the literature on associations between PFAS and hypertensive disorders of pregnancy and recommends next steps for research and prevention.

Study Conclusion: Positive associations between 6 PFASs--PFOA, PFOS, PFHxS, PFHpA, PFBS, and PFNA-- and risk for HDP have been reported in some studies, though these associations have not been seen in other studies.

Exposure to perfluoroalkyl substances and blood pressure in pregnancy among 1436 women from the Odense Child Cohort

Study Purpose: This study investigates the association between PFAS exposure in early pregnancy and maternal blood pressure throughout pregnancy, gestational hypertension, and preeclampsia.

Study Conclusion: The strength of the relationship between PFAS exposure blood pressure may appear small. However, at a population level this may slightly shift the distribution of blood pressure towards an increased incidence of gestational hypertension. If blood pressure increases in pregnancy, it may have a long-term impact on health not only of the pregnant woman but also of her offspring.

Exposure to toxic metals and per- and polyfluoroalkyl substances (PFAS) and the risk of preeclampsia and preterm birth in the United States: A review

Study Purpose: This article reviews past studies to provide an overview on environmental contaminants (such as PFAS) and the development of preeclampsia and preterm birth among U.S. women.

Study Conclusion: There are inconsistent findings on the relationship between PFASs and preeclampsia and preterm birth.

Per- and Polyfluoroalkyl Substances in Early Pregnancy and Risk for Preeclampsia: A Case-Control Study in Southern Sweden

Study Purpose: To investigate the association between serum concentrations of PFAS in early pregnancy and the risk of developing preeclampsia.

Study Conclusion: This study provides limited support for the association between PFAS and preeclampsia in a population with relatively low exposure levels.

Study Conclusion: There were no associations between maternal PFAS levels in early pregnancy and infant length, preterm birth, or spontaneous or indicated preterm birth.

Association of perfluoroalkyl substances with gestational hypertension and preeclampsia in the MIREC study

Study Purpose: To examine the relationship between background levels of PFOA, PFOS, and PFHxS and the development of gestational hypertension or preeclampsia in a Canadian pregnancy cohort.

Study Conclusion: Higher levels of PFHxS were associated with the development of preeclampsia, but not gestational hypertension. Both PFOA and PFOS were not associated with either outcome.

Perfluoroalkyl substances in early pregnancy and risk of hypertensive disorders of pregnancy: A prospective cohort study

Study Purpose: This study looks at associations between PFAS exposure and hypertensive disorders of pregnancy.

Study Conclusion: Maternal levels of PFASs in early pregnancy were not associated with gestational hypertension, preeclampsia, or hypertensive disorders of pregnancy.

Early pregnancy serum levels of perfluoroalkyl substances and risk of preeclampsia in Swedish women

Study Purpose: To investigate the association between early pregnancy serum levels of PFAS and preeclampsia.

Study Conclusion: Increasing serum levels of PFOS and PFNA during early pregnancy were associated with a clinically relevant risk of preeclampsia, adjusting for established confounders.

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the risk of hypertensive disorders of pregnancy

Study Purpose: PFAS have been reported to disrupt the endocrine system and reproductive system, but information on the association between PFAS and preeclampsia is not consistent. This study looks at the association between prenatal PFAS exposure and hypertensive disorders of pregnancy.

Study Conclusion: Prenatal exposure to PFBS was associated with elevated risk of preeclampsia and hypertensive disorders of pregnancy.

Fertility and treatment

Follicular fluid and blood levels of persistent organic pollutants and reproductive outcomes among women undergoing assisted reproductive technologies

Study Purpose: Persistent organic pollutants (POPs), such as PFAS, are chemicals resistant to degradation. This study measured POP levels in women who were seeking fertility treatment.

Study Conclusion: These results suggest that age plays a role in the chemical transfer from blood to follicular fluid and that exposure to POPs is associated with fertility treatment outcomes.

Associations between human internal chemical exposure to Persistent Organic Pollutants (POPs) and In Vitro Fertilization (IVF) outcomes: Systematic review and evidence map of human epidemiological evidence

Study Purpose: The aim of this study was to review the evidence on associations between internal levels of persistent organic pollutants, such as PFAs, and IVF outcomes among women.

Study Conclusion: The review showed that many types of persistent pollutants (POPs) are in follicular fluid and serum of women attending IVF treatments. Globally, there were inconsistent findings across studies for specific exposure-outcome dyads, suggesting that adverse effects of POPs on IVF outcomes cannot be ruled out. These results suggest that POPs may impair embryo quality and pregnancy rates.

Perfluoroalkyl Chemicals and Male Reproductive Health: Do PFOA and PFOS Increase Risk for Male Infertility?

Study Purpose: This review looks at previous studies on PFOS/PFOA effects on male reproductive health.

Study Conclusion: Human and rodent studies suggest that increased PFAS exposure could be associated with changes in some enzymes, including gonadal or serum testosterone, testicular receptors for gonadotropin, growth hormone, and IGF-1 and semen parameters.

Endocrine disrupting chemicals: Impacts on human fertility and fecundity during the peri-conception period

Study Purpose: The goals of this study include:

  1. Identify and review evidence regarding the effects of endocrine-disrupting chemicals on adult male and female fertility, reproductive hormone concentrations, gamete and embryo characteristics, as well as the time to pregnancy
  2. To investigate whether individuals or couples diagnosed as sub-fertile have higher endocrine-disrupting chemical levels
  3. To highlight where little or no data exists that prevents associations from being identified.

Study Conclusion: Currently, the findings from human studies do not support a consistent effect of PFAS on male fertility. No association is evident from animal studies. For women, nearly all measured fertility results had conflicting findings. Few animal studies have been conducted regarding female fertility and PFAS exposure.

Persistent organic pollutants and couple fecundability: a systematic review

Study Purpose: To summarize the strength of evidence for associations of four common groups of persistent organic pollutants and a couple's probability to conceive. To identify gaps and limitations in the literature in order to inform policy decisions and future research.

Study Conclusion: This review found no support for associations between female exposure to pesticides or male exposure to any persistent organic pollutant's groups and time to pregnancy.

Parental plasma concentrations of perfluoroalkyl substances and In Vitro fertilization outcomes

Study Purpose: This study looks at whether maternal or paternal PFAS levels have effects on in vitro fertilization (IVF) outcomes.

Study Conclusion: These results suggest that PFAS may have reproductive effects on both men and women, and that exposure to PFAS may negatively affect IVF outcomes.

Per- and poly-fluoroalkyl substances (PFASs) in follicular fluid from women experiencing infertility in Australia

Study Purpose: This study investigates if associations exist between PFAS concentrations, age, and fertilization rate. This study also investigates the associations between PFAS concentrations and infertility.

Study Conclusion: PFASs were detected in follicular fluid of Australian women who had been treated at an IVF clinic. This study found that PFAS in follicular fluids was linked to an increased risk of some infertility factors. Increased age was associated with decreased fertilization rate. There was no relationship between PFAS and fertilization rate.   

Perfluoroalkyl substances and endometriosis-related infertility in Chinese women

Study Purpose: To examine the association between PFASs and endometriosis-related infertility.

Study Conclusion: Exposure to PFBS may increase the risk of female infertility due to endometriosis.

Perfluoroalkyl and polyfluoroalkyl substances and measures of human fertility: a systematic review

Study Purpose: To review current evidence on the association between exposure to PFASs and measures of human fertility.

Study Conclusion: For PFOS and PFOA, the literature indicates an association with female fertility in women who have had children.

Women’s Health

Perfluoroalkyl Substances and Incident Natural Menopause in Midlife Women: The Mediating Role of Sex Hormones

Study Purpose: PFAS exposure has been associated with earlier natural menopause; however, the underlying mechanisms are not well understood, or how the relationship is affected by sex hormones. This study investigates the relationship between PFAS and menopause and how the relationship may be affected by sex hormones.

Study Conclusion: In conclusion, this study is the first to investigate and quantify the degree to which FSH is an explanatory factor for the shortened time to natural menopause in midlife women with higher exposure to PFAS. Although mediation analysis still does not concretely establish a causal pathway, our findings provide evidence that PFAS exposure may accelerate ovarian aging through endocrinologic mechanisms associated with changing serum concentrations of FSH. Any potential mechanism underlying the relationships between PFAS exposure and natural menopause is likely to involve an interplay of hormones, beyond the action of single hormone levels. Future replication of our findings should consider other hormones such as luteinizing hormone in the analysis.

Per- and Poly-fluoroalkyl Substances (PFAS) and Female Reproductive Outcomes: PFAS Elimination, Endocrine-Mediated Effects, and Disease

Study Purpose: This paper summarizes the role of PFAS in female reproductive tract dysfunction and disease. Since these chemicals can affect reproductive tissue, this is also discussed.

Study Conclusion: Given the global decline in female fertility and the ability of PFAS to negatively impact female reproductive health, further studies are needed to examine effects on women.

Perfluoroalkyl substances (PFAS) in drinking water and risk for polycystic ovarian syndrome, uterine leiomyoma, and endometriosis: A Swedish cohort study

Study Purpose: PFAS may interfere with the female reproductive system. The aim of this study is to investigate possible associations between PFAS exposure and PCOS, uterine leiomyoma, and endometriosis.

Study Conclusion: Exposure to high levels of PFAS in drinking water was associated with increased risk of PCOS and possibly uterine leiomyoma, but not endometriosis. The findings for PCOS are consistent with prior studies reporting positive associations between PCOS and PFAS exposure at background levels.

Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Study Purpose: This reviews and analyzes previous studies on the relationship of maternal PFAS exposure and adverse pregnancy outcomes.

Study Conclusion: It was found that maternal exposure to PFOS could be positively associated with preterm birth, while no statistically significant association have been found between PFASs exposure and miscarriage and stillbirth. Epidemiological evidence to date are insufficient to draw definitive conclusions on potential toxicities of PFASs with stronger statistical power.

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) and their effects on the ovary

Study Purpose: To review the available literature for correlations between PFAS exposure and ovarian function.

Study Conclusion: The published literature supports associations between PFAS exposure and adverse reproductive outcomes; however, the evidence remains insufficient to infer a causal relationship between PFAS exposure and ovarian disorders.

Quantitative bias analysis of a reported association between perfluoroalkyl substances (PFAS) and endometriosis: The influence of oral contraceptive use

Study Purpose: To evaluate the influence of oral birth control use on the association between PFAS and endometriosis.

Study Conclusion: Study results suggest that the influence of oral contraceptive use on the association between PFAS levels and endometriosis is relatively small.

Endocrine-disrupting chemicals and uterine fibroids

Study Purpose: A useful summary of the known literature showing associations between environmental exposure to endocrine disrupting chemicals and uterine fibroids.

Study Conclusion: Delineating the effects of EDC exposure and the underlying mechanisms by which they, or other environmental exposures, promote MSC progression to UFs, including the role of epigenetic alterations and acquisition of mutations in genes such as MED12, will be key to the development of new interventions to prevent and treat this important disease of women.

Perfluoroalkyl substances and endometriosis in US women in NHANES 2003-2006

Study Purpose: To examine the relationship between PFAS and endometriosis.       

Study Conclusion: These findings suggest that PFOA, PFNA, and PFOS may be of interest in future studies with improved endometriosis diagnostic criteria and prospectively measured exposure.

Placenta

The transplacental transfer efficiency of per- and polyfluoroalkyl substances (PFAS): a first meta-analysis

Study Purpose: The aim of this study was to provide a review of literature on PFAS transfer rates across the human placental barrier by means of a meta-analysis based on systematic review.

Study Conclusion: The results of this study showed that PFAS with sulfonyl groups are transferred less efficiently than those containing carboxyl groups. Less well studied PFAS such as PFHxA, 6:2 FTS, and PFBA are highly efficiently transported across the placental barrier, suggesting that PFAS with a more complex structure may also enter the fetal circulation. The potential consequences for fetal health need to be further investigated, as these compounds are increasingly used, but their mode of action is poorly understood.

Placental Transfer and Composition of Perfluoroalkyl Substances (PFASs): A Korean Birth Panel of Parent-Infant Triads

Study Purpose: In this study, they measured PFAS concentrations in maternal, paternal, and umbilical cord serum collected from 62 pregnant women and their matched biological fathers. Placental transfer rates of PFAS were calculated.

Study Conclusion: The results of this study showed different concentrations and types of PFAS among maternal, paternal, and cord serum. Placental transfer rates of PFAS differed by compound, and several factors such as gestational age were associated with placental transfer.

The occurrence of PFAS in human placenta and their binding abilities to human serum albumin and organic anion transporter 4

Study Purpose: To better understand the occurrence of PFAS in the placenta and how PFAS might transfer from the placenta.

Study Conclusion: The placental transfer of PFAS is related to the length of the PFAS. More research is needed to understand the occurrence of PFAS in the placenta and the transfer mechanisms of PFAS.

Organophosphate Flame Retardants, Highly Fluorinated Chemicals, and Biomarkers of Placental Development and Disease during Mid-Gestation

Study Purpose: This study measured 12 PFASs and flame retardants in healthy pregnant women in the middle of the pregnancy and examined signs of placental development and disease.

Study Conclusion: This study found potential associations of PFAS and flame retardant exposure with signs related to placenta-related pregnancy complications. Associations with blood pressure and lipid concentrations need further research.

Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: A review including the placenta as a target tissue and possible driver of peri- and postnatal effects

Study Purpose: To review early life exposure to PFAS and potential latent health outcomes.

Study Conclusion: The effects of PFAS on humans differs based on the compound. Early life PFAS exposure may disrupt placental growth and function, increasing susceptibility for later life chronic conditions, which could worsen from lifelong PFAS exposure.

Perfluoroalkyl Substances (PFAS) and Their Effects on the Placenta, Pregnancy, and Child Development: a Potential Mechanistic Role for Placental Peroxisome Proliferator-Activated Receptors (PPARs)

Study Purpose: To review the current literature on PFAS and their effects on the placenta, pregnancy outcomes, and child health.

Study Conclusion: This review summarizes how PFAS, critical environmental contaminants, may contribute to diseases of pregnancy as well as early and later child health. 

Other

Per- and polyfluoroalkyl substances (PFAS) and male reproductive function in young adulthood; a cross-sectional study

Study Purpose: This study aims to examine biomarkers of reproductive functin in young adult males according to current environmental exposure to single and combined PFAS.

Study Conclusion: We examined exposure to a range of common PFAS in relation to biomarkers of male reproductive function and found an association with higher levels of FSH (follicle-stimulating hormone) among young men from the general population in Denmark. Further studies on especially combined exposure to PFAS are needed to expand our understanding of potential endocrine disruption from both legacy and emerging compounds in relation to male reproductive function.

Quantitation of linear and branched perfluoroalkane sulfonic acids (PFSAs) in women and infants during pregnancy and lactation

Study Purpose: This paper reviews the literature on the effects of PFAS exposure, with a  specific focus on male reproduction.

Study Conclusion: Increasing awareness of the potential health implications of PFAS and realization of the extent of environmental contamination has led to a rising demand for research into definitive health risks and effective remediation strategies. Animal models have been widely employed to investigate in vitro and in vivo consequences of PFAS exposure, as well as the toxicology of these chemicals. Such studies complement a growing body of evidence from human epidemiological studies. However, the literature abounds with conflicting evidence, and as such, it remains challenging to draw accurate conclusions regarding the causality of PFAS related health issues. This situation is exacerbated by the repeated demonstration that outcomes differ depending on factors such as the specific PFAS chemical(s) (of which there are over 4,700), stage of development (i.e., during fetal development or in later life) and duration of exposure, level and mix of contamination, route of exposure, and interaction with other environmental contaminants and toxicants, all of which are influenced by geographical location. These factors present significant difficulties for researchers in planning, executing, and interpreting studies, and thus hinder our ability to directly compare PFAS exposure studies. While standardization therefore remains an essential priority for future research, the identification of appropriate cellular model(s) with which to directly investigate and unlock the interaction of PFAS with the male reproductive system would also be advantageous. In addition, agreement is needed regarding endpoint measures, in which subtle changes, such as decreases in fertility or metabolic sequelae, may be used as early markers of PFAS-mediated health effects, rather than more extreme factors such as tumors. In this regard, the male reproductive system offers notable advantages as a sensitive marker of human disease and may ultimately provide a unique opportunity for assessing the emerging threat to human health posed by PFAS exposure. Indeed, this model draws on a growing body of evidence of a strong association between a male’s general health and reproductive potential, with infertility being strongly correlated with future health concerns such as testicular cancer, ischemic heart disease and diabetes.

 

A Review of Per- and Polyfluorinated Alkyl Substance Impairment of Reproduction

Study Purpose: In this article, they review studies describing PFAS exposure and reproductive effects in animals and humans. The aim was to compare environmental occurrence and effects of the most prominent long-chain PFAS compounds and their short-chain replacements.

Study Conclusion: The chemical properties of PFAS are valuable for manufacturing and consumer convenience; however, these same properties make them resistant to degradation and persistent in the environment, wildlife, and humans. Generally, longer carbon chains in PFAS correlate with higher toxicity, however, differential reproductive effects are observed in vitro and in vivo. Short-chain PFAS tend to bioaccumulate less, but are more persistent in surface water. While surface water data show individual short-chain PFAS presence to be in the low ng/L range, sum total concentrations of PFAS are orders of magnitude higher. Some studies indicate that reproductive effects of PFAS seen in laboratory models and human cell lines are at concentrations greater than what will be realized in the environment. Most studies do not consider mixture toxicity; epidemiological studies inherently address mixture toxicity. Epidemiological studies indicate that environmentally-relevant PFAS concentrations are associated with reproductive effects. Indeed, even though most ecological and epidemiological studies quantify a few PFAS, these studies are effectively assessing the impact of many more PFAS. The majority of evidence for reproductive effects is linked to long-chain PFAS exposure. Long-chain PFAS is on the decline worldwide but will remain an exposure issue. Short-chain PFAS exposure is on the rise. Even though some specific short-chain PFAS have been studied, data on reproductive effects of short-chain PFAS are considerably less than for long-chain. In addition, there are many short-chain PFAS byproducts from manufacturing that have yet to be identified.

Quantitation of linear and branched perfluoroalkane sulfonic acids (PFSAs) in women and infants during pregnancy and lactation

Study Purpose: PFAS are associated with negative health effects and exposure during fetal life and infancy are of concern. The objective of this study was to investigate types of PFAS in never-pregnant, pregnant, and postpartum women and infants. 

Study Conclusion: The linear relations between PFSA concentrations in infants aged six months and mothers in pregnancy week 18 confirm that pregnancy and lactation are major excretion routes for PFSA, but accumulate in the infant. The observed great variability in PFSA burden among mothers and infants, as well as the reduced maternal transfer of branched PFHxS isoforms and increased transfer of branched PFOS isoforms compared to the respective linear isoforms to the infant, might impact adverse health effects associated with PFSA exposure, but this should be confirmed in future studies.

Overview of the Mechanisms of Action of Selected Bisphenols and Perfluoroalkyl Chemicals on the Male Reproductive Axes

Study Purpose: This study provides an overview of mechanisms of action common to PFAS and bisphenols on male fertility.

Study Conclusion: The negative impact of endocrine disrupting chemicals (EDCs) (such as PFAS) on fertility has been demonstrated. However, there are differences between laboratory experiments and human studies. We are exposed to many different EDCs and not all mixtures can be evaluated. The results of this review provided indication that persistent and non-persistent EDCs are associated with formation of ROS, disruption of BTB, disturbance of testosterone production, and interference with estrogenic and antiandrogenic signaling at environmentally relevant concentrations.

Mixtures of persistent organic pollutants are found in vital organs of late gestation human fetuses

Study Purpose: This study measured persistent organic pollutants, such as PFAS, in maternal serum, placenta, and fetal tissues in 20 pregnancies that ended in stillbirth.

Study Conclusion: This study quantified many POPs in fetal tissues. All studied chemical projects were detected in fetal adipose tissue even in places when the chemical was not detected in the maternal serum and placenta.

A case-cohort study of perinatal exposure to potential endocrine disrupters and the risk of cryptorchidism in the Norwegian HUMIS study

Study Purpose: Exposure to PFAS and other endocrine-disrupting chemicals (EDCs) during the critical period of testicular descent may increase the risk of cryptorchidism and male fertility. The objective of this study was to investigate 27 potential EDCs in breast milk and the risk of cryptorchidism.

Study Conclusion: Perinatal exposure to PCB-74, PCB-114, PCB-194, and B-HCH were associated with increased odds of congenital cryptorchidism.

Exposure to endocrine disrupting chemicals (EDCs) and cardiometabolic indices during pregnancy: The HOME Study

Study Purpose: Toxicology studies have identified pregnancy as a time sensitive to endocrine disrupting chemicals (EDCs), such as PFAS, and cardiometabolic indices in women. No study has examined this in humans.

Study Conclusion: Overall, there were positive associations between PBDEs with glucose and cholesterol levels during pregnancy, while negative associations were found between some phthalates and cholesterol. No relationship was noted for BPA or PFAS with cardiometabolic indices during pregnancy across both models.

Associations of single and multiple per- and polyfluoroalkyl substance (PFAS) exposure with vitamin D biomarkers in African American women during pregnancy

Study Purpose: Vitamin D has been linked to various physiological function in pregnant women and their fetuses. This study aims to evaluate the associations of PFAs levels with vitamin D levels during pregnancy in a cohort of African American women in Atlanta.

Study Conclusion: This study suggests that exposure to PFAs might disturb vitamin D metabolism among pregnant African American women and that some of these effects might be changed by the sex of the fetus. More studies are needed to confirm these findings.

Association between maternal exposure to perfluoroalkyl and polyfluoroalkyl substances and risks of adverse pregnancy outcomes: A systematic review and meta-analysis

Study Purpose: This reviews and analyzes previous studies on the relationship of maternal PFAS exposure and adverse pregnancy outcomes.

Study Conclusion: It was found that maternal exposure to PFOS could be positively associated with preterm birth, while no statistically significant association have been found between PFASs exposure and miscarriage and stillbirth. Epidemiological evidence to date are insufficient to draw definitive conclusions on potential toxicities of PFASs with stronger statistical power.

Associations of single and multiple per- and polyfluoroalkyl substance (PFAS) exposure with vitamin D biomarkers in African American women during pregnancy

Study Purpose: Vitamin D has been linked to various physiological function in pregnant women and their fetuses. This study aims to evaluate the associations of PFAs levels with vitamin D levels during pregnancy in a cohort of African American women in Atlanta.

Study Conclusion: This study suggests that exposure to PFAs might disturb vitamin D metabolism among pregnant African American women and that some of these effects might be changed by the sex of the fetus. More studies are needed to confirm these findings.

Maternal exposure to perfluoroalkyl chemicals and anogenital distance in the offspring: a Faroese cohort study

Study Purpose: Exposure to PFASs has in some studies been associated with reduced anogenital distance in newborns, an indicator of prenatal anti-androgenic exposure. The aim of this study was to investigate the association between maternal PFAS exposure and offspring anogenital distance in a population with wide ranges of PFAS exposures.

Study Conclusion: In conclusion, we found that maternal PFAS exposure was significantly associated with a longer AGDs in boys. No significant associations were found among girls, suggesting sex-dimorphic effects of PFASs. Whether the observed association with longer ASD and PFAS influences the reproductive health of males is unknown and needs to be investigated further.

Prenatal exposures to mixtures of endocrine disrupting chemicals and children's weight trajectory up to age 5.5 in the SELMA study

Study Purpose: This study evaluates the effect of prenatal exposure to mixtures of endocrine disrupting chemical (such as PFASs) mixtures on birthweight and childhood weight trajectories.

Study Conclusion: Prenatal exposure to EDC mixtures was associated with lower birthweight and altered infant weight gain trajectories.

Exposure to perfluoroalkyl substances in early pregnancy and risk of sporadic first trimester miscarriage

Study Purpose: The aim of this study was to investigate whether PFASs in early pregnancy are associated with unexplained, sporadic first trimester miscarriage.

Study Conclusion: There was an association between PFOA and miscarriage in this study. The study can only represent early placentation and clinical pregnancy loss during the second half of the first trimester.

Perfluorooctanoic acid (PFOA) or perfluorooctane sulfonate (PFOS) and DNA methylation in newborn dried blood spots in the Upstate KIDS cohort

Study Purpose: PFOA and PFOS may alter prenatal development, through modifying DNA. Prior studies on this subject have had few subjects and inconsistent results. This study examines relationships between PFOA and PFOS with DNA changes among nearly 600 infants.

Study Conclusion: There was limited evidence of an association between high concentrations of PFOA/PFOS and DNA changes in newborns in this study. Future studies are needed in populations with higher concentrations of PFOA/PFOS.

Prenatal Exposure to Per- and Polyfluoroalkyl Substances, Umbilical Cord Blood DNA Methylation, and Cardio-Metabolic Indicators in Newborns: The Healthy Start Study

Study Purpose: This study looks at the associations between prenatal PFAS exposure and changes in DNA in umbilical cord blood.

Study Conclusion: DNA changes in umbilical cord blood were associated with maternal PFAS concentrations during pregnancy, which could affect offspring growth, metabolism, and immune function.

Per- and polyfluoroalkyl substance mixtures and gestational weight gain among mothers in the Health Outcomes and Measures of the Environment study

Study Purpose: This study looks at associations between PFAS exposure and gestational weight gain.

Study Conclusion: Although there were consistent small increases in gestational weight gain with increasing PFOA, PFOS, and PFNA serum concentrations in this cohort, the associations were imprecise. Additional investigation of the association of PFAS with GWG in other cohorts would be informative and could consider pre-pregnancy BMI as a potential modifier.

Perfluoroalkyl substances exposure in early pregnancy and preterm birth in singleton pregnancies: a prospective cohort study

Study Purpose: To investigate the associations between prenatal PFAS exposure and preterm birth among singleton live births.

 

Breastfeeding

Breastfeeding covers PFAS and levels in human milk, breastfeeding duration, levels in dairy milk and formula, and trends over time. This section currently 38 total papers; 26 from the last 6 years. Although a study may find, or not find, an association between PFASs and breastfeeding outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Breastfeeding

Current Breast Milk PFAS Levels in the United States and Canada: After All This Time, Why Don't We Know More?

Study Purpose: The objectives of this study are to 1. document published breast milk concentrations in North America 2. estimate breast milk PFAS levels from maternal serum concentration in national surveys and communities impacted by PFAS 3. compare measured/estimated milk PFAS concentrations to screening values.

Study Conclusion: This paper used three studies reporting breast milk concentrations in the United States and Canada. Measured and estimated breast milk concentrtaions were compared to children's drinking water screening values. Breast milk concentrations varies widely between different communities. All estimated breast milk PFOA and PFOS concentrations exceeded drinking water screening values for children. Exceeding a children’s drinking water screening value does not indicate that adverse health effects will occur and should not be interpreted as a reason to not breastfeed; it indicates that the situation should be further evaluated. It is past time to have a better understanding of environmental chemical transfer to—and concentrations in—an exceptional source of infant nutrition.

Polychlorinated dioxins and dibenzofurans (PCDD/F), polybrominated dioxins and dibenzofurans (PBDD/F), polychlorinated biphenyls (PCB), polybrominated diphenyl ethers (PBDE), and per- and polyfluoroalkyl substances (PFAS) in German breast milk samples (LUPE 8)

Study Purpose: This study quantified PBDEs, PFAS, and ADONA in breast milk samples collected in two German states and breast milk and blod samples from subjects additionally exposed to PFOA.

Study Conclusion: For PCDD/F, PBDD/F, dl-PCB, PBDE, and ndl-PCB, our results are in line with other recently published studies in Europe. In contrast to previous studies from Germany lower concentrations of these compounds were found in breast milk samples. The concentrations of PFAS are low and only PFOA and PFOS could be quantified in some samples. For all target analytes a declining time trend could be observed. Nevertheless, this study shows that the population is still exposed to various persistent organic pollutants and that a further reduction in exposure to these compounds is necessary to prevent health risks.

Prenatal and postnatal exposure to emerging and legacy per-/polyfluoroalkyl substances: Levels and transfer in maternal serum, cord serum, and breast milk

Study Purpose: Gestation and lactation are vulnerable stages for fetuses and newborns. During these periods, PFASs accumulated in mothers can be transferred to newborns through placenta and/or breastfeeding, causing potential health risks. To investigate the pre- and postnatal PFAS exposure of newborns, this study analyzed 21 emerging and legacy PFASs in 60 sets of maternal serum samples and breast milk samples.

Study Conclusion: The one month postnatal exposure to PFASs via breastfeeding was much higher than prenatal exposure in utero. This study enhances the understanding of transplacental and breastfeeding transfer of PFASs and provides assessments of prenatal and postnatal exposure of newborns to emerging and legacy PFASs.

Breastfeeding initiation and duration after high exposure to perfluoroalkyl substances through contaminated drinking water: A cohort study from Ronneby, Sweden

Study Purpose: This study investigates associations between high PFAS exposure and 1. initiation and 2. duration of breastfeeding.

Study Conclusion: Exposure to high levels of PFAS seemed to be associated with increased risks of not initiating breastfeeding duration in primiparous mothers. The findings imply that the ability of first-time mothers to establish breastfeeding is a sensitive outcome after high exposure to PFAS.

Occurrence and infant exposure assessment of per and polyfluoroalkyl substances in breast milk from South Africa

Study Purpose: This study investigates the occurrence of PFAS in breast milk of nursing mothers from South Africa.

Study Conclusion: This study provides background data on the occurrence and infant exposure assessment of PFAS in exclusively breastfed infants. The results that PFAS with short and long carbon chains were more prevalent and occurred at higher concentrations in breast milk. The study found that the concentrations of PFAS did not influence infant birth weight and gestational period, however, infant sex and frequency of milk consumption showed strong relationships with PFAS levels in breast milk. Further analysis showed that on average, breastfed infants are at risk to PFOA but not PFOS.

Exposure to per- and polyfluoroalkyl substances associates with an altered lipid composition of breast milk

Study Purpose: This study sought to define the impact of maternal exposure to PFAS on lipid composition of human breast milk and to study the combined impact of maternal PFAS exposure and breast milk lipid composition on the growth of infants.

Study Conclusion: This data suggests that maternal exposure to PFAS impacts the nutritional quality of the breast milk, which, in turn, could impact children.

Concentrations of perfluoroalkyl substances in donor breast milk in Southern Spain and their potential determinants

Study Purpose: This study assesses the concentrations of PFAS in breast milk from donors to a human milk bank and explore factors potentially related to this exposure.

Study Conclusion: Several PFAS, including short-chain compounds, are detected in pooled donor milk samples. Breast milk may be an important pathway for the PFAS exposure of breastfed infants, including preterm infants in NICUs. Despite the reduced sample size, these data suggest that various lifestyle factors influence PFAS concentrations, highlighting the use of PCPs.

Per- and Polyfluoroalkyl Substances (PFAS) in Breast Milk: Concerning Trends for Current-Use PFAS

Study Purpose: This study reviewed current levels of various PFAS in U.S. mothers' breastmilk.

Study Conclusion: Our results indicate that while the legacy PFOS and PFOA are still the most abundant PFAS in breast milk, similar to the studies from the early 2000s, the detection frequencies and concentrations of several current-use short chain PFAS have significantly increased since then.

Exposure to perfluoroalkyl substances through human milk in preterm infants

Study Purpose: This study aimed to quantify the potential exposure of preterm infants to PFASs through breast milk.

Study Conclusion: The exposure of preterm infants to PFASs through breast feeding might exceed values reported for older, healthier infants.

Regional occurrence of perfluoroalkane substances in human milk for the global monitoring plan under the Stockholm Convention on Persistent Organic Pollutants during 2016-2019

Study Purpose: The human milk monitoring component of the global monitoring plan under the Stockholm Convention on Persistent Organic Pollutants was implemented from 2016-2019 and had 44 human milk samples from 42 countries collected and analyzed for PFASs.

Study Conclusion: Statistical analysis showed that PFOS and PFOA levels in breast milk were significantly different between European countries and African and Latin American countries, as well as between high-income and low-income countries. PFOA tended to have higher concentrations in wealthier countries. No correlation was found for population density.

Endocrine-disrupting chemicals and breastfeeding duration: a review

Study Purpose: This study describes current literature investigating how chemicals such as PFAS affect mammary gland development and function, thereby impacting lactation duration.

Study Conclusion: Certain chemicals may play a role in mammary gland development, function, and lactation, which can affect breastfeeding duration. PFSAs may reduce breastfeeding duration through impaired mammary gland development.

Determination and assessment of human dietary intake of per and polyfluoroalkyl substances in retail dairy milk and infant formula from South Africa

Study Purpose: This study measured PFAS levels in dairy milk and infant formula to start quantifying how much exposure people receive through these products.

Study Conclusion: This study presents the first data on the occurrence and human dietary intake of PFAS in dairy milk and infant formulas on the African continent. The data showed that long chain perfluorocarboxylic acids are
ubiquitous in South African dairy milk and infant formula. Compared to long chain (C9 – C14) PFAS, the concentrations of PFOA and PFOS were generally low.

Biomonitoring of PFOA, PFOS and PFNA in human milk from Czech Republic, time trends and estimation of infant's daily intake
Study Purpose: This is a longitudinal observation of three PFAS in human breast milk. It provides helpful information about these levels over time.
Study Conclusion: Significant time-related decreasing trends in the PFOS and PFOA levels in human milk were observed. Nevertheless, the body burden of infants from breastfeeding might pose an enhanced health risk to infants when the current PTWI values are applied. These findings strongly support the present EU efforts to phase out PFOA, it's salts and PFOA related compounds. Since PFOS exposure there has still been widely detected despite PFOS usage reduction measures, the major exposure routes should be further monitored and, if possible, eliminated.

Emerging per- and polyfluoroalkyl substances (PFAS) in human milk from Sweden and China

Study Purpose: To determine the level of PFAS in breast milk.

Study Conclusion: China saw higher levels of PFASs in breast milk samples than Swedish samples.

Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies

Study Purpose: To see if infants exposed to PFOS or PFOA have a higher rate (prevalence) of ADHD diagnosis.

Study Conclusion: The study did not observe a significant increase in the prevalence of ADHD diagnosis in association with early life exposure to PFOS and PFOA, in a sample of almost 5,000 children from nine European population based studies.

Concentrations of perfluoroalkyl substances in human milk from Ireland: Implications for adult and nursing infant exposure

Study Purpose: This study attempted to better quantify PFAS levels in breast milk.

Study Conclusion: Concentrations in human milk in Ireland fall within the range of those reported previously for other countries, and exposure to PFASs of Irish nursing infants via consumption of human milk does not appear to constitute a health concern.

A transgenerational toxicokinetic model and its use in derivation of Minnesota PFOA water guidance

Study Purpose: This study attempts to create a model to guide water recommendations.

Study Conclusion: This study observed breastfed infant serum levels at 4.4-fold higher than in formula-fed infants, with both of these scenarios producing serum levels in excess of the adult steady-state level.

Poly- and perfluoroalkyl substance concentrations in human breast milk and their associations with postnatal infant growth

Study Purpose: This study examined the concentrations of PFASs in breast milk from 174 women and investigated the association between lactation exposure to these PFASs through breast milk consumption and the postnatal growth of infants.

Study Conclusion: This study demonstrated that lactation exposure to C8-C10 PFCAs, 8:2 FTOH, and 6:2 Cl-PFESA through breast milk consumption may affect postnatal infant growth.

Per- and polyfluoroalkyl substances in human breast milk and current analytical methods

Study Purpose: To review current information on PFAS in human breast milk, including the challenges of analysis and the possible modes of transfer from maternal blood.

Study Conclusion: Data suggests a global decline in PFAS levels in breast milk.

The serum concentrations of perfluoroalkyl compounds were inversely associated with growth parameters in 2-year old children

Study Purpose: This study investigates the relationship between the serum levels of PFASs and growth in 2-year-old children.

Study Conclusion: In conclusion, the serum concentrations of PFCs were inversely associated with growth parameters in 2-year-old children.

Perfluoroalkyl Acids (PFAAs) in Serum from 2-4-Month-Old Infants: Influence of Maternal Serum Concentration, Gestational Age, Breast-Feeding, and Contaminated Drinking Water

Study Purpose: This study investigates associations between PFAS levels in 2-4 month-old infants and factors that may contribute to these levels.

Study Conclusion: PFOA, PFNA, and PFHxS infant levels increased with exclusive breastfeeding in this study. Infants living in areas with PFAS-contaminated drinking water had higher PFBS and PFHxS levels. Prenatal and postnatal PFAS exposure appear to contribute to infant PFAS levels.

Perfluoroalkyl substances (PFASs) in breast milk from Korea: Time-course trends, influencing factors, and infant exposure

Study Purpose: In this study, PFASs were analyzed in breast milk samples collected during various lactation periods to determine maternal exposure levels, variations over time, and infant health risks.

Study Conclusion: PFOS, PFOA, PFUnDA, and PFNA were the predominant compounds found in these breast milk samples. The concentrations of PFASs in breast milk were correlated with maternal age, BMI, and the mother's number of children. Dietary behaviors, such as snack and milk consumption and the frequency of eating out, were associated with increased levels of PFASs. The daily intakes of PFOS and PFOA for infants through breast milk consumption were lower than the recommended threshold.

Perfluoroalkyl substances in Breast milk, infant formula and baby food from Valencian Community (Spain)

Study Purpose: This study reports levels of PFASs in breast milk, infant formulas, and baby food from a Spanish community in order to evaluate the infant exposure to these substances through the diet.

Study Conclusion: This study found PFBA in 100% of the samples of breast milk and other baby foods. The dietary intake of PFOS and PFOA varies significantly depending on the infant diet.

Exposure of Norwegian toddlers to perfluoroalkyl substances (PFAS): The association with breastfeeding and maternal PFAS concentrations

Study Purpose: To examine the PFAS blood levels in toddlers and to determine their relationship with maternal PFAS concentrations in pregnancy and breastfeeding duration.

Study Conclusion: These results suggests that transplacental transfer and breastfeeding are among the main determinants of PFOS, PFOA, PFHxS, and PFHpS levels in toddlers, while that was not the case for PFNA and PFUnDA.

Shorter duration of breastfeeding at elevated exposures to perfluoroalkyl substances

Study Purpose: To determine whether maternal exposure to PFASs affects the ability to breastfeed.

Study Conclusion: Increased maternal levels of PFAS are associated with a decreased duration of breastfeeding in this study.

Maternal serum perfluoroalkyl substances during pregnancy and duration of breastfeeding

Study Purpose: This study looks at the association between maternal PFAS exposure and breastfeeding duration.

Study Conclusion: Higher PFOA concentrations in mothers were related to shorter breastfeeding duration in this study.

Elevated levels of short carbon-chain PFCAs in breast milk among Korean women: Current status and potential challenges

Study Purpose: In this study, breast milks were sampled from lactating women and measured for PFASs.

Study Conclusion: Several short chain PFASs were detected at high levels. Their levels of detection were often comparable to levels of PFOS. For PFHpA, the use of cosmetics and non-stick frying pans were identified as significant sources of exposure among lactating women.

 

Nervous System and Behavior

Neurodevelopment covers mainly outcomes in children, including cognitive abilities, cognitive development, ADHD, neurologic disease, autism, IQ, reading skills, and behavior. This section currently has 40 total studies: 29 from the last 6 years. Although a study may find, or not find, an association between PFASs and neurodevelopmental outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

ADHD

The association between prenatal perfluoroalkyl substance exposure and symptoms of attention-deficit/hyperactivity disorder in 8-year-old children and the mediating role of thyroid hormones in the Hokkaido study

Study Purpose: To investigate the impact of maternal PFAS exposure on children's ADHD symptoms, and how this association may vary with thyroid hormone levels.

Study Conclusion: Higher PFAS levels in maternal serum during pregnancy were associated with lower risks of ADHD symptoms at 8 years old. The association was stronger among first-born children in relation to hyperactivity-impulsivity than with regard to inattention. There was little modification by thyroid hormone levels during pregnancy in the association between maternal exposure to PFAS and reduced ADHD symptoms at 8 years old.

No association between maternal and child PFAS concentrations and repeated measures of ADHD symptoms at age 2½ and 5 years in children from the Odense Child Cohort

Study Purpose: The potential impact of exposure to PFAS on childhood ADHD is unclear. The majority of previously conducted studies found no association between maternal PFAS concentrations and ADHD symptoms in offspring, but some studies have observed possible associations with postnatal PFAS exposures, mainly in girls. This study investigates the association between maternal and child serum concentrations of five PFAS and symptoms of ADHD at ages 2.5 years and 5 years.

Study Conclusion: This study did not find evidence of an association between early-life PFAS exposure and the risk of developing systems of ADHD.

The association between maternal perfluoroalkyl substances exposure and early attention deficit hyperactivity disorder in children: a systematic review and meta-analysis

Study Purpose: This review verifies the association between maternal PFAS exposure and ADHD by reviewing existing studies.

Study Conclusion: This study showed that maternal exposure to PFASs was not associated with the prevalence rate of ADHD in children. Researchers observed that exposure type and regional factor may influence the occurrence of ADHD. More epidemiological studies should be encouraged, especially on the exposure type of PFASs, to understand the pathogenesis of ADHD in more depth. Further research should be carried out widely in different regions.

Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies

Study Purpose: This study investigates the association between early life exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), and ADHD in a collaborative study including nine European population-based studies, encompassing 4,826 mother–child pairs.

Study Conclusion: There may be increased prevalence of ADHD in association with PFAS exposure in girls, in children from women who have had multiple children, and in children from low-educated mothers.

Prenatal exposure to perfluoroalkyl substances and associations with symptoms of attention-deficit/hyperactivity disorder and cognitive functions in preschool children

Study Purpose: This study looks at the associations between prenatal exposure to PFASs and symptoms of ADHD and cognitive functioning (language skills, estimated IQ, and working memory) in preschool children, and whether this association varies by sex.

Study Conclusion: The study did not find consistent evidence to conclude that prenatal exposure to PFASs are associated with ADHD symptoms or cognitive dysfunctions in preschool children aged three and a half years. The results showed some associations between PFASs and working memory, particularly negative relationships with nonverbal working memory, but also positive relationships with verbal working memory. The relationships were weak, as well as both positive and negative, which suggest no clear association.

Early-life exposure to persistent organic pollutants (OCPs, PBDEs, PCBs, PFASs) and attention-deficit/hyperactivity disorder: A multi-pollutant analysis of a Norwegian birth cohort

Study Purpose: This study investigates if early-life exposure to persistent organic pollutants is associated with an increase risk of attention-deficit/hyperactivity disorder (ADHD).

Study Conclusion: Early-life exposure to B-HCH and PFOS was associated with increased risk of ADHD, with suggestion of sex-specific effects for PFOS. The unexpected inverse associations between per- and perfluoroalkyl DDT and higher HCB levels and ADHD could be due to live birth bias.

Perfluoroalkyl substances in cord blood and attention deficit/hyperactivity disorder symptoms in seven-year-old children

Study Purpose: This study looks at the association between in utero exposure to PFASs and the development of neurobehavioral symptoms (such as ADHD) in early childhood.

Study Conclusion: Prenatal exposure to PFNA was associated with neurobehavioral symptoms related to ADHD among Asian seven-year-old children.

Behavior

Prenatal exposure to persistent organic pollutants and metals and problematic child behavior at 3-5 years of age: a Greenlandic cohort study

Study Purpose: High levels of persistent organic pollutants (POPs) and heavy metals are found in Arctic populations. POP and heavy mtals are linked to impaired cognitive development. This study examined associations between prenatal POP and metals exposure and problematic child behavior.

Study Conclusion: In this study, they had inconsistent findings on the associations between PFAS and and negative behaviors.

Childhood exposure to per- and polyfluoroalkyl substances (PFAS) and neurobehavioral domains in children at age 8 years

Study Purpose: To examine whether childhood PFAS concentrations are associated with neurobehavior in children at age 8 years and whether child sex modifies this relationship.

Study Conclusion: Findings in this study do not consistently support an association between childhood PFAS serum concentrations and neurobehavior, child sex may play a role in the relationship as well.

Prenatal and childhood exposure to per- and polyfluoroalkyl substances (PFAS) and child executive function and behavioral problems

Study Purpose: In this study, they examine associations of prenatal and childhood PFAS plasma concentrations with parent and teacher assessments of children's behavior problems and executive function abilities at age 6-10.

Study Conclusion: In a birth cohort of U.S. children with PFAS concentrations similar to those of the U.S. general population, prenatal PFAS concentrations were not consistently associated with childhood assessments of behavior and executive function, but we observed cross-sectional associations of childhood PFAS with greater behavioral and executive function problems at ages 6–10. Specifically, PFOA, PFOS, PFHxS, PFNA and PFDA were each associated with more behavioral problems as evaluated by parents using the SDQ, with teacher-rated SDQ scores also suggestively elevated (indicating greater problems) in children with higher PFHxS and PFNA concentrations. Childhood PFOS was associated with greater executive function problems as assessed by parents using the BRIEF, while higher childhood PFHxS was associated with greater teacher-rated executive function problems. We did not observe consistent patterns of sexual dimorphism in associations.

Prenatal exposure to poly- and perfluoroalkyl substances (PFAS) and neurobehavior in US children through 8 years of age: the HOME Study

Study Purpose: Studies of PFAS and ADHD in children are inconsistent. This study examines associations between maternal serum PFAS concentrations and child behavior in mothers and their children.

Study Conclusion: Prenatal PFOS and PFNA were associated with hyperactive-impulsive type ADHD across two tests. PFHxS was associated with increased problems with both externalizing and internalizing behaviors. No associations were noted between PFOA and child neurobehavior.

Behavioral difficulties in 7-year-old children in relation to developmental exposure to perfluorinated alkyl substances

Study Purpose: This study looks at the associations between prenatal, 5 and 7-year-old PFAS exposures and behavioral problems in 7-year-olds.

Study Conclusion: Higher serum PFAS concentrations at ages 5- and 7-years were associated with parent-reported behavioral problems at age 7. No associations were observed between prenatal PFAS concentrations and SDQ scores.

Prenatal Exposure to Perfluoroalkyl Substances and Behavioral Development in Children

Study Purpose: This study explored the relationship between prenatal exposure to several PFASs and behavioral development at the age of 18 months.

Study Conclusion: These findings suggest that higher prenatal exposure to PFOA was related to less externalizing behavior in boys. Results were different for boys and girls. However, more research is needed as this was a small study population.

Autism

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and associations with attention-deficit/hyperactivity disorder and autism spectrum disorder in children

Study Purpose: This study investigates whether prenatal exposure to PFAS was associated with childhood diagnosis of ADHD or autism spectrum disorder (ASD).

Study Conclusion: Prenatal exposure to PFOA was associated with increased risk of autism and ADHD in children. For some PFAs, there were inverse associations. The findings linking PFAS with neurodevelopment are still inconclusive.

Prenatal exposure to per- and polyfluoroalkyl substances in association with autism spectrum disorder in the MARBLES study

Study Purpose: Prenatal exposure to PFASs has shown to potentially impact child brain development, but evidence is still inconsistent. This study looks at whether prenatal exposure to PFAS was associated with increased risk of autism.

Study Conclusion: In this high risk autism group, there was an increased risk of autism in children exposed to PFOA and PFNA.

Modeled prenatal exposure to per- and polyfluoroalkyl substances in association with child autism spectrum disorder: A case-control study

Study Purpose: This study looks at the associations between prenatal maternal exposure to PFAS with child diagnosis of autism.

Study Conclusion: In analyses where modeled prenatal maternal PFAS serum concentrations served as in utero exposure, it was observed that prenatal PFHxS and PFOS exposure were borderline associated with increased odds of child diagnosis of ASD. No associations were observed for other PFAS.

Other

In utero exposure to perfluoroalkyl and polyfluoroalkyl substances and attention and executive function in the offspring: A study in the Danish National Birth Cohort

Study Purpose: PFAS are suspected to affect the neuropsychological function of children, but only few studies have evaluated the association with childhood attention and executive function. To investigate the association between intrauterine exposure to PFAS and offspring attention and executive function.

Study Conclusion: Intrauterine exposure to PFOSA was associated with poorer selective attention, while PFOA was associated with poorer executive function. Given the widespread nature of PFAS exposure, these findings may have public health implications, warranting further investigation.

Perfluorooctanoate and perfluorooctane sulfonate in umbilical cord blood and child cognitive development: Hamamatsu Birth Cohort for Mothers and Children (HBC Study)

Study Purpose: Prenatal exposure to PFAS has been shown to affect offspring behaviors in laboratory animals. Several epidemiological studies investigated associations between prenatal PFAS exposure and child neurodevelopment, but results were inconclusive. This paper examines the associations between cord blood concentrations of PFOA and PFOS and cognitive development in children from 4 to 40 months of age.

Study Conclusion: In this study, cord blood PFOA and PFOS concentrations showed mixed associations with child cognitive functions at specific age but had positive associations with longitudinal changes in cognitive development from 4 to 40 months of age.

Prenatal exposure to per- and polyfluoroalkyl substances, fetal thyroid hormones, and infant neurodevelopment

Study Purpose: PFAS are believed to impair early neurodevelopment and disrupt thyroid hormone levels. However, there are limited epidemiological data on the neurodevelopmental effects in infancy of prenatal PFAS exposure and how thyroid hormones may impact this. This study evaluates the potential associations between prenatal PFAS exposure and early neurodevelopmental deficiencies and how thyroid hormones may affect these associations.

Study Conclusion: PFBS and PFHxS were negatively associated with early neurodevelopment, especially for gross motor development. These associations were partially explained by TSH and FT4 levels.

Impaired gross motor development in infants with higher PFAS concentrations

Study Purpose: In this study, they investigate PFAS concentrations in mothers at 6 points during and after pregnancy and in infants at six months and studied the effects of PFAS status on infant gross motor development at age six months.

Study Conclusion: This study found associations between maternal PFAS concentrations in pregnancy week 18 and infant PFAS concentrations at age six months. While the concentrations declined in the mothers during pregnancy and postpartum, the highest concentrations were seen in infants aged six months. Parity and fish intake were strong predictors of maternal PFAS status, while maternal concentrations of PFAS in pregnancy week 18 and months of exclusive breastfeeding determined the PFAS concentrations in infants at six months. Infants who scored below the median on gross motor development had higher PFAS concentrations than infants with a better gross motor development. A higher maternal fish intake in pregnancy week 18 was additionally associated with a poorer motor score in the infants at six months. Infant gross motor development is a marker of later cognitive outcome and our findings indicate that a high concentration of PFASs in young infants may be a risk factor for impaired neurodevelopment.

Perinatal exposure to endocrine disrupting chemicals and neurodevelopment: How articles of daily use influence the development of our children

Study Purpose: This review focuses on data from human studies and animal studies to examine the impact of EDCs after a gestational or lactational exposure to endocrine disrupting chemicals (EDCs, like PFAS), and how they may impact the immune system and/or neurodevelopment

Study Conclusion: Developmental exposure to endocrine disrupting chemicals (EDCs) can permanently alter developmental programs, including those that wire the brain. Of emerging interest is how these chemicals may also affect the immune response, given the cross-talk between the endocrine and immune systems. As brain development is strongly dependent on hormones, this complicated interplay may have long-lasting neurodevelopmental consequences.

Prenatal perfluoroalkyl substance exposure and neuropsychological development throughout childhood: The INMA Project

Study Purpose: This study evaluates the associations between prenatal PFAS exposure and neuropsychological development in childhood.

Study Conclusion: This study showed no clear-cut evidence of an association between prenatal PFAS exposure and adverse neuropsychological development in children up to the age of 7 years.

Exposure to Perfluoroalkyl Substances During Pregnancy and Fetal BDNF Level: A Prospective Cohort Study

Study Purpose: Brain-derived neurotrophic factor (BDNF) is an important factor in neurodevelopment, but its role in PFAS-induced neurotoxicity is unclear. This study investigates the association between prenatal PFAS exposure and fetal BDNF level in the umbilical cord blood.

Study Conclusion: Prenatal exposure to PFHxS was associated with an increased BDNF level in the umbilical blood, especially in male fetuses.

Chemical Mixture Exposures During Pregnancy and Cognitive Abilities in School-Aged Children

Study Purpose: Gestational exposure to chemical mixtures, which is prevalent among pregnant women, may be associated with adverse childhood neurodevelopment. However, few studies have examined relations between gestational chemical mixture exposure and children's cognitive abilities.

Study Conclusion: In this study, combined prenatal exposure to phenols, some phthalates, pesticides, and PFASs were inversely associated with children's cognition

Prenatal exposure to per- and polyfluoroalkyl substances and cognitive development in infancy and toddlerhood

Study Purpose: PFAS have shown neurobehavioral toxicity in experimental studies. Evidence on associations between prenatal PFAS exposure and child's cognitive development is inconsistent partly due to differences in assessment time points and tools used. This study examines associations of prenatal maternal serum PFAS concentrations with child's cognitive development assessed at multiple time points in infancy and toddlerhood.

Study Conclusion: Prenatal PFOA appears to negatively affect child's cognitive development in toddlerhood in this study population. Because a large number of the children in this study were at risk for atypical development, studies in the general population are needed to confirm findings.

Perfluoroalkyl chemicals in neurological health and disease: Human concerns and animal models

Study Purpose: This study summarized previous literature on PFAS impacts on neurobiological, neuroendocrine, and neurobehavioral outcomes.

Study Conclusion: This study found that there are many mechanisms through which PFASs may enter the brain and interact to impact neurological function.

The association between prenatal exposure to perfluoroalkyl substances and childhood neurodevelopment

Study Purpose: This study looks at the association between prenatal PFAS exposure and child cognitive outcomes at 5 different points in time. The population in this study was prenatally exposed to the World Trade Center disaster, where many pollutants including PFASs were released.

Study Conclusion: These results suggest a sex- and PFAS-specific between relationship between prenatal PFAS exposures and child neurodevelopment.

Childhood perfluoroalkyl substance exposure and executive function in children at 8 years

Study Purpose: This study tests whether prenatal and childhood exposure to PFAS are associated with cognitive abilities at 8 years old and whether this varies between boys and girls.

Study Conclusion: PFNA and PFOA at 8 years, but not 3 years, may be related to poorer executive function.        

Prenatal Exposure to Perfluoroalkyl Substances and IQ Scores at Age 5: A Study in the Danish National Birth Cohort

Study Purpose: This study looks at whether prenatal exposure to PFASs is associated with IQ in children.

Study Conclusion: Overall, there was no consistent evidence to suggest PFAS exposure is associated with child IQ scores at 5 years of age.

Prenatal and childhood exposure to per- and polyfluoroalkyl substances (PFASs) and child cognition

Study Purpose: Per- and polyfluoroalkyl substances (PFASs) are suspected developmental toxicants, but epidemiological evidence on neurodevelopmental effects of PFAS exposure is inconsistent.       

Study Conclusion: Suggested associations of prenatal and childhood PFAS exposure with lower childhood visual motor abilities. Other results were inconsistent, with higher prenatal PFASs associated in some cases with better cognitive outcomes.

Prenatal and childhood perfluoroalkyl substances exposures and children’s reading skills at ages 5 and 8 years

Study Purpose: This study looks at the association between prenatal and early childhood levels of PFAS with children's reading skills at ages 5 and 8 years old.

Study Conclusion: Prenatal and childhood serum PFOA, PFOS and PFNA concentrations were positively associated with better children’s reading skills at ages 5 and 8 years. No association was found between serum PFHxS and reading skills.

Exposure to Perfluorinated Alkyl Substances and Health Outcomes in Children: A Systematic Review of the Epidemiologic Literature

Study Purpose: This study summarized previous studies looking at the relationships between childhood exposure to PFAS and health outcomes in children.

Study Conclusion: There were inconsistent findings on associations between PFAS and neurodevelopmental outcomes.

 

Kidney and Liver Function

 

Urinary System

Kidneys work with other components of the urinary system to filter toxins and waste from the blood and eliminate them from the body. The Kidney section includes information on kidney function, hyperuricemia, gout, and chronic kidney disease as they relate to PFASs. It includes 16 total studies; 11 were published in the last 6 years. Although a study may find, or not find, an association between PFASs and kidney outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Urinary System

Serum concentrations of per-/polyfluoroalkyl substances and its association with renal function parameters among teenagers near a Chinese fluorochemical industrial plant: A cross-sectional study

Study Purpose: Currently, studies on the association between PFAS concentrations and the renal function of residents, especially teenagers, living near fluorochemical production plants, are relatively rare. In this study, local teenagers (11-15) were included.

Study Conclusion: In this study, the serum concentrations of 18 PFAS in 775 teenagers were measured, and an extremely high PFOA concentration was observed, 10-1000 times higher than that in general areas. The prevalence of chronic kidney disease was relatively high, much higher than the general population.

Associations between serum PFOA and PFOS levels and incident chronic kidney disease risk in patients with type 2 diabetes

Study Purpose: This study investigates the associations of PFOA and PFOS exposure and chronic kidney disease among type 2 diabetes patients.

Study Conclusion: This study found a significant negative association between serum PFOS concentrations and incidence chronic kidney disease risk in patients with diabetes. However, we should interpret these findings with caution, as the relationship between kidney function and PFAS concentrations is complex and more studies are needed to further investigate these findings.

Metabolome-wide association study of serum exogenous chemical residues in a cohort with 5 major chronic diseases

Study Purpose: This study investigates the linkages between serum chemical concentrations and 5 chronic diseases including obesity, hyperuricemia, hypertension, diabetes, and dyslipidemia, and further reveals the metabolic perturbations of chronic diseases related to chemical exposure, then gain potential mechanism insight.

Study Conclusion: This study demonstrated a positive association between PFAS exposure and hyperuricemia. The most significant metabolic abnormality was lipid metabolism which was not only positively associated with PFASs, but also increased the risk of hyperuricemia.

Perfluoroalkyl substances (PFASs) exposure and kidney damage: Causal interpretation using the US 2003-2018 National Health and Nutrition Examination Survey (NHANES) datasets

Study Purpose: The objective of this study was to test the hypothesis that increased concentrations of PFASs cause kidney damage.

Study Conclusion: This study evaluated the relationship between increased concentrations of 4 PFASs and kidney damage. The hypothesis of PFAS-induced kidney damage was plausible based on the results. Further studies are required.

Per- and polyfluoroalkyl substances and kidney function: Follow-up results from the Diabetes Prevention Program trial

Study Purpose: To determine associations of plasma PFAS concentrations and glomerular filtration rate (GFR - a measure of kidney function) and evaluate whether a lifestyle intervention changes these associations.

Study Conclusion: Among adults with prediabetes, higher concentrations of PFASs were associated with lower GFR over approximately 14 years. A lifestyle intervention of diet and exercise did not modify this association. Individuals with hypertension may experience a more detrimental effect.

Impact of kidney hyperfiltration on concentrations of selected perfluoroalkyl acids among US adults for various disease groups

Study Purpose: National data from 2003-2016 for US adults were analyze to evaluate the impact of kidney hyperfiltration on the levels of PFASs.

Study Conclusion: This study observed that participants with hypertension had the highest PFAS levels, regardless the filtration rate of their kidneys. Those with anemia had the lowest PFAS levels.

Perfluoroalkyl acids, hyperuricemia and gout in adults: Analyses of NHANES 2009-2014

Study Purpose: This study investigates whether there is an association between levels of PFASs and gout, uric acid levels, or hyperuricemia.

Study Conclusion: There was an association between select PFAS and self-reported gout. There was also an association between several PFAS and hyperuricemia.

Dynamics of associations between perfluoroalkyl substances and uric acid across the various stages of glomerular function

Study Purpose: Hyperuricemia (elevated uric acid levels) is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. This study looks at the associations between PFAs and uric acid levels across various levels of kidney function.

Study Conclusion: Increasing levels of every measured PFAS except PFHxS was found to increase levels of uric acid.

Perfluoroalkyl substances and kidney function in chronic kidney disease, anemia, and diabetes

Study Purpose: This study looks at the relationship between PFAS and kidney function and how this relationship varies with diabetes and anemia status.

Study Conclusion: PFAS were inversely associated with kidney function in chronic kidney disease patients and diabetics (increased PFAS levels had better kidney function)

Associations between longitudinal serum perfluoroalkyl substance (PFAS) levels and measures of thyroid hormone, kidney function, and body mass index in the Fernald Community Cohort

Study Purpose: This study looks at the association between PFAS and indicators of thyroid disruption, kidney function, and BMI.

Study Conclusion: PFAS levels were associated with altered kidney and thyroid function.

Positive associations of serum perfluoroalkyl substances with uric acid and hyperuricemia in children from Taiwan

Study Purpose: Hyperuricemia (elevated uric acid levels) is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. This study looks at the risk of hyperuricemia after exposure to PFASs

Study Conclusion: PFOA was found to be associated with elevated levels of uric acid in children, especially boys.

 

Liver

The Liver section includes information on liver disease in adults and children, non-alcoholic fatty liver disease, and liver function as they relate to PFASs. It includes 11 total studies; 10 studies were published in the last 6 years. Although a study may find, or not find, an association between PFASs and liver outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Liver

Per- and perfluoroalkyl substances alternatives, mixtures and liver function in adults: A community-based population study in China

Study Purpose: Evidence from animal studies has shown that PFAS alternatives and mixtures may exert toxic liver effects in animals. However, we have very little evidence in humans. 

Study Conclusion: In conclusion, our study found adverse associations of PFAS alternatives and mixtures with liver function in a Chinese adult general population. Our findings add epidemiological evidence for the potential subclinical hepatotoxicity of PFAS. More studies are needed to confirm our findings and address potential toxicological mechanisms.

Exposure to environmental contaminants is associated with altered hepatic lipid metabolism in non-alcoholic fatty liver disease

Study Purpose: This study tests the hypothesis that exposure to environmental contaminants contributes to the initiation and pathology of non-alcoholic fatty liver disease (NAFLD).

Study Conclusion: Females may be more sensitive to the harmful impacts of PFAS. Lipid-related changes following PFAS exposure may be secondary to the interplay between PFAS and bile acid metabolism.

Prenatal Exposure to Perfluoroalkyl Substances Associated with Increased Susceptibility to Liver Injury in Children

Study Purpose: Non-alcoholic fatty liver disease (NAFLD) is increasing among children. It is important to find risk factors for liver injury that can be addresses through prevention methods.

Study Conclusion: The study observed that higher exposure to PFAS during pregnancy was associated with higher liver enzyme levels in children.

Per- and Polyfluoroalkyl Substances and Obesity, Type 2 Diabetes and Non-alcoholic Fatty Liver Disease: A Review of Epidemiologic Findings

Study Purpose: This study reviews evidence for associations between PFASs and the development of obesity, diabetes, and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.

Study Conclusion: There is evidence that supports the association between PFASs and the onset or development of metabolic diseases, including obesity, diabetes, and non-alcoholic fatty liver disease. However, there are inconsistent results in many cases.

Perfluoroalkyl substances and severity of nonalcoholic fatty liver in Children: An untargeted metabolomics approach

Study Purpose: There have been studies looking at the correlation between PFAS exposure and fatty liver disease in adults and rodents, but there are few studies looking at this correlation in children.

Study Conclusion: PFAS exposure was associated with increased risk of nonalcoholic steatohepatitis (NASH) and fibrosis in children diagnosed with non-alcoholic fatty liver disease (NAFLD).

Sex differences in the association between perfluoroalkyl acids and liver function in US adolescents: Analyses of NHANES 2013-2016

Study Purpose: This study was designed to determine whether or not there is association between exposure to PFASs and signs of liver function in adolescents, and whether or not this varies between sexes.

Study Conclusion: This study was found to have sex differences in the association between PFAS levels and signs of liver function.

Selective Associations of Recent Low Concentrations of Perfluoroalkyl Substances with Liver Function Biomarkers: NHANES 2011 to 2014 Data on US Adults Aged ≥20 Years

Study Purpose: This study looks at the association between PFAS levels and liver function signs.

Study Conclusion: Lower levels of PFOA, PFHxS, and PFNA are associated with higher liver functions, but this association is only seen in obese patients.

Liver function biomarkers disorder is associated with exposure to perfluoroalkyl acids in adults: Isomers of C8 Health Project in China

Study Purpose: This study looks at the association between PFAS levels and liver function signs.

Study Conclusion: These results support previous studies showing association between PFAS exposure and liver function biomarkers.

Environmental perfluoroalkyl acid exposures are associated with liver disease characterized by apoptosis and altered serum adipocytokines

Study Purpose: This study looks at the association between environmental PFASs and signs of liver disease.

Study Conclusion: These findings support previous findings that PFASs may cause liver injury.

Changes in markers of liver function in relation to changes in perfluoroalkyl substances - A longitudinal study

Study Purpose: This study looks at the association of PFAS levels and signs of liver function.

Study Conclusion: These findings suggest a relationship between low-dose PFAS exposure and altered liver function.

 

Metabolic and Digestive System

 

Hypertension

The Hypertension section includes information on blood pressure/hypertension as it relates to PFASs. This section has 8 total studies; 7 are published within the last 6 years. Although a study may find, or not find, an association between PFASs and hypertension outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Hypertension

Exposure to toxic metals and per- and polyfluoroalkyl substances (PFAS) and the risk of preeclampsia and preterm birth in the United States: A review

Study Purpose: This article reviews past studies to provide an overview on environmental contaminants (such as PFAS) and the development of preeclampsia and preterm birth among U.S. women.

Study Conclusion: There are inconsistent findings on the relationship between PFASs and preeclampsia and preterm birth.

Per- and Polyfluoroalkyl Substance and Cardio Metabolic Markers in Firefighters

Study Purpose: This study aims to evaluate if PFAS are associated with cardio metabolic markers.

Study Conclusion: PFHxS levels were elevated in firefighters compared to the general population. PFAS levels were not associated with increased cardiometabolic risk measures in this population of firefighters.

Perfluoroalkyl substances are associated with elevated blood pressure and hypertension in highly exposed young adults

Study Purpose: Residents in a large area of North-Eastern Italy were exposed to PFAS via drinking water. Studies on the association between PFAS and blood pressure levels have found inconsistent results. This study looks at the association between PFAS levels and blood pressure and hypertension.

Study Conclusion: These results suggest that PFAS levels are associated with increased blood pressure in highly exposed adults.

Serum levels of per- and polyfluoroalkyl substances alternatives and blood pressure by sex status: Isomers of C8 health project in China

Study Purpose: This study looks at the associations between PFAS levels and blood pressure.

Study Conclusion: In this study, levels of PFASs are associated with higher blood pressure. Women appeared to be more susceptible than men.           

Association between perfluoroalkyl acids and the prevalence of hypertension among US adults

Study Purpose: This study looks at the association of PFAS levels with hypertension and blood pressure in adults

Study Conclusion: PFOA and PFHxS were related with higher risk of hypertension at lower levels and higher levels.

Association between perfluoroalkyl substance concentrations and blood pressure in adolescents

Study Purpose: This study looks at the associations between PFAS levels and hypertension in adolescents.        

Study Conclusion: These results provide evidence that PFOS level increases are associated with increases in diastolic blood pressure.

Gender-specific associations between serum isomers of perfluoroalkyl substances and blood pressure among Chinese: Isomers of C8 Health Project in China

Study Purpose: This study looks at the relationship between a variety of PFAS types and blood pressure.

Study Conclusion: PFASs were associated with elevated blood pressure.

 

Lipids and Obesity

The Lipids and Obesity section includes information on metabolic syndrome, lipids (total cholesterol, triglycerides, HDL, LDL), dyslipidemia, lipoprotein and apolipoprotein, and obesity (including BMI, bariatric surgery, and weight loss) as they relate to PFASs. Lipoprotein and apolipoprotein carry lipids through the body. This section includes 64 total studies; 54 were published in the last 6 years. Although a study may find, or not find, an association between PFASs and lipid/obesity outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Obesity, body fat, and weight loss

Serum levels of perfluoroalkyl substances (PFAS) and body composition - A cross-sectional study in a middle-aged population

Study Purpose: It has been suggested that PFAS are endocrine disruptors with a potential to influence fat mass.

Study Conclusion: PFOS and PFHxS levels did not show any consistent associations with body composition, but PFOA, PFNA, and PFDA were inversely related to multiple measures reflecting the amount of fat, but in women only.

Prenatal exposure to persistent organic pollutants and childhood obesity: A systematic review and meta-analysis of human studies

Study Purpose: This paper presents a review of existing literature on the association between prenatal exposure to persistent organic pollutants (POPs), such as PFAS, and childhood obesity.

Study Conclusion: The current evidence from epidemiological studies suggests that prenatal exposures to DDE and HCB are associated with greater body fatness in childhood. There was insufficient evidence to conclude that prenatal exposure to other POPs, including PFAS, are associated with obesity in children. 

Umbilical cord serum concentrations of perfluorooctane sulfonate, perfluorooctanoic acid, and the body mass index changes from birth to 5 1/2 years of age

Study Purpose: This study investigates whether umbilical cord blood concentrations of PFOS and PFOA are associated with children's risk trajectory for obesity.

Study Conclusion: These findings demonstrate that the effect of prenatal exposure to PFAS is a possible risk for obesity through an increase in BMI, especially for girls.

Temporal trends of concentrations of per- and polyfluoroalkyl substances among adults with overweight and obesity in the United States: Results from the Diabetes Prevention Program and NHANES

Study Purpose: This study aims to determine trends and rate of change of plasma PFAs concentrations in overweight or obese U.S. adults and evaluate if this changes by sex, race/ethnicity, or age.

Study Conclusion: They observed a decreasing trend in plasma PFOS in overweight/obese participants over time. Male and Black participants showed higher PFOS and PFNA than female and white participants.

Associations between exposure to perfluoroalkyl substances and body fat evaluated by DXA and MRI in 109 adolescent boys

Study Purpose: Exposure to PFASs has been associated with changes in BMI and adiposity, but evidence is inconsistent between studies. This study investigates the associations between PFAS exposure and body fat in a cross-sectional study of healthy boys.

Study Conclusion: Overall, we found no consistent associations between PFAS exposure and body fat. This could be due to our cross-sectional study design. Furthermore, we assessed PFAS exposure in adolescence and not in utero, which is considered a more vulnerable time window of exposure.

Perfluoroalkyl and polyfluoroalkyl substances and body size and composition trajectories in midlife women: the study of women's health across the nation 1999-2018

Study Purpose: This study examined associations of serum PFAS concentrations with trajectories of weight, waist circumference, fat mass, and proportion of fat in midlife women.

Study Conclusion: Certain PFAS were positively associated with greater body size and body fat, and higher rates of change over time. PFAS may be a contributing factor to obesity risk.

Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Body Composition from Mid-childhood to Early Adolescence

Study Purpose: This study evaluates the associations of PFAS levels in childhood with body changes through early adolescence.

Study Conclusion: In a large prospective U.S. cohort, children with higher plasma concentrations of PFAS had less accrual of lean mass from mid-childhood to early adolescence. While children with higher plasma concentrations of some PFAS (i.e., PFOS and PFHxS) had less accrual of fat mass, particularly subcutaneous fat mass, children with higher concentrations of other PFAS (i.e., PFDA and PFNA) had greater accrual of visceral fat mass. Thus, early life exposure to some but not all PFAS may be associated with adverse changes in body composition.

Exposure to perfluoroalkyl substances (PFAS) and dyslipidemia, hypertension and obesity in adolescents. The Fit Futures study

Study Purpose: The prevalence of obesity, hypertension, and dyslipidemia has been increasing in children and teenagers across the world. Exposure to environmental pollutants may contribute to this. The aim of this study was to look at the associations between PFASs and dyslipidemia, hypertension, and obesity in a sample of adolescents

Study Conclusion: This study showed a possible link between several PFASs and dyslipidemia, hypertension, and obesity in this adolescent sample.

The Confounder-Mediator Dilemma: Should We Control for Obesity to Estimate the Effect of Perfluoroalkyl Substances on Health Outcomes?

Study Purpose: This article describes possible biases that can be introduced by adjusting for obesity in PFAS studies.

Study Conclusion: This article highlights the complexity of seemingly simple adjustment or stratification analyses, and the need for careful consideration of the confounding and/or mediating role of obesity in PFAS studies.

Exposure to Per- and Polyfluoroalkyl Substances and Adiposity at Age 12 Years: Evaluating Periods of Susceptibility

Study Purpose: PFAS exposure may increase body fatness and obesity risk in children. This study estimates associations of PFAS concentrations with adolescent risk of overweight/obesity.

Study Conclusion: There were positive associations between gestational PFOA and PFHxS levels with stomach fat levels and the risk of obesity in adolescents, while no pattern was seen for postnatal PFAS concentrations.

Gestational perfluoroalkyl substance exposure and body mass index trajectories over the first 12 years of life

Study Purpose: Gestational exposure to PFAS is associated with increased risk of obesity and cardiometabolic disease. This study explores that association.

Study Conclusion: These results suggest that gestational PFOA exposure may be associated with BMIs related to adult obesity and cardiometabolic disease, while PFOS and PFHxS exposure is associated with lower BMI in the first 12 years of life.

PFAS exposure and overweight/obesity among children in a nationally representative sample

Study Purpose: PFASs are associated with cardiovascular disease, but their relationship with obesity, a risk factor for cardiovascular disease, is not known. This study explores the relationship between PFAS and overweight/obesity and abdominal obesity in children.

Study Conclusion: Findings show that there may be an associated between elevated PFOA and overweight/obesity among children.

Prenatal Exposures to Perfluoroalkyl Acids and Associations with Markers of Adiposity and Plasma Lipids in Infancy: An Odense Child Cohort Study

Study Purpose: Maternal PFAS concentrations have been associated with offspring obesity and dyslipidemia (abnormal levels of cholesterol and other lipids) in childhood and adulthood, but this association has not been studied in infancy. This study looks as the associations between maternal PFAS concentrations and signs of obesity and lipid metabolism in infancy.

Study Conclusion: Prenatal PFAS levels were associated with greater signs of obesity and higher total cholesterol in infancy.

Per- and Polyfluoroalkyl Substances and Obesity, Type 2 Diabetes and Non-alcoholic Fatty Liver Disease: A Review of Epidemiologic Findings

Study Purpose: This study reviews evidence for associations between PFASs and the development of obesity, diabetes, and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.

Study Conclusion: There is evidence that supports the association between PFASs and the onset or development of metabolic diseases, including obesity, diabetes, and non-alcoholic fatty liver disease. However, there are inconsistent results in many cases.

Isomers of perfluoroalkyl substances and overweight status among Chinese by sex status: Isomers of C8 Health Project in China

Study Purpose: Studies on the associations of PFASs with overweight/obesity have mixed results. This study examines the relationship between BMI, waist circumference, and overweight and PFASs.

Study Conclusion: This study suggests that PFASs are associated with overweight or increased waist circumference, and these associations are stronger in women. PFOA had the strongest association.

Decreased plasma levels of perfluoroalkylated substances one year after bariatric surgery

Study Purpose: This study determines the levels of PFASs before and after bariatric surgery, and to assess whether weight loss and protein levels could influence one another.

Study Conclusion: Bariatric surgery did not influence the changes of PFAS levels before and after the operation.

Prenatal exposure to persistent organic pollutants and child overweight/obesity at 5-year follow-up: a prospective cohort study

Study Purpose: Prenatal exposure to some pollutants, such as PFASs, may influence offspring weight gain. This study looks at the relationship between prenatal exposure to PFASs and child overweight/obesity.

Study Conclusion: Increasing PFAS levels were associated with greater risk of child overweight/obesity at 5 years.

Perfluoroalkyl Substances during Pregnancy and Offspring Weight and Adiposity at Birth: Examining Mediation by Maternal Fasting Glucose in the Healthy Start Study

Study Purpose: Prenatal PFAS exposure has been associated with lower birth weight; however, impacts on body weight in later life is not well known. This study looks at the associations between maternal PFAS concentrations and offspring weight and percent body fat at birth, as well as to estimate associations between PFAS concentrations and maternal blood glucose and lipid levels.

Study Conclusion: Prenatal exposure to some PFASs was associated with lower birthweight and percent body fat at birth.

Prenatal Exposure to Perfluoroalkyl Substances and Body Fatness in Girls

Study Purpose: This study looks at the association between exposure to PFAS during pregnancy and female children's percent body fat at age 9.

Study Conclusion: Prenatal exposure to PFOA and PFOS was associated with girls' percent body fat.

Early-life exposures to persistent organic pollutants in relation to overweight in preschool children

Study Purpose: Some pollutants, such as PFASs, are suspected to be related to causing obesity. This study looks at the associations of maternal and child levels of PFASs with the risk of childhood overweight.

Study Conclusion: In this study, there were associations between maternal PFOS and PFOA levels and overweight risk in preschool children.

Prenatal Exposure to Perfluoroalkyl Substances and Adiposity in Early and Mid-Childhood

Study Purpose: This study looks at the associations of prenatal exposure to PFASs with obesity in early and mid-childhood.

Study Conclusion: Prenatal exposure to PFASs was associated with small increases in weight measurements in mid-childhood, but only among girls.

Lipids: cholesterol and triglycerides

Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: A mixture-based approach

Study Purpose: PFAS have been consistently associated with cardio-metabolic traits. Occupational exposures to multiple PFAS with health outcomes have been poorly investigated. The aim of the present study was to examine these associations among former workers involved in PFAS production.

Study Conclusion: The results showed a clear association between serum PFAS levels and markers of cardiovascular risk and support the importance of clinical surveillance of cardiovascular risk factors in population with a high exposure to PFAS, especially in the occupational setting.

The association between blood PFAS concentrations and clinical biochemical measures of organ function and metabolism in participants of the Canadian Health Measures Survey (CHMS)

Study Purpose: This study tests the association between human blood levels of PFAS and measures of organ and metabolic function among a nationally representative sample of 6768 participants in Canada.

Study Conclusion: At the concentrations found in a large sample of the Canadian population, we found that selected PFAS were associated with biochemical markers of liver, kidney and thyroid function, and lipid, calcium and glucose metabolism. We also found associations between several PFAS and GGT, a marker of all-cause mortality. The observed associations on average were generally small and need to be interpreted with caution, but they may possibly be important at a population level and in population subgroups, who may have higher than average exposure. More research is needed.

Changes in plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with changes in plasma lipids - A longitudinal study over 10 years

Study Purpose: Associations between PFAS and increased blood lipids have been reported primarily from cross-sectional studies. The aim of this study was to investigate associations between multiple PFAS and blood lipids.

Study Conclusion: In this study with three measurements over 10 years of both plasma PFAS and lipids, increasing levels of PFAS were associated with changes in plasma lipids.

The effects of Cl-PFESAs exposure on blood lipids – A community-based large population study in Guangzhou

Study Purpose: In this study, they investigate the association between CI-PFESAs, a PFAS alternative in China, and blood lipid profiles in community residents.

Study Conclusion: This study found a positive association between Cl-PFESAs and total cholesterol, triglycerides, and LDL cholesterol, as well as a negative association between Cl-PFESAs and dyslipidemia. An exposure-response relationship was suggested between PFAS alternatives and lipids.

Why is elevation of serum cholesterol associated with exposure to perfluoroalkyl substances (PFAS) in humans? A workshop report on potential mechanisms

Study Purpose: There may be an association between PFAS exposure and elevated cholesterol. A workshop was held in 2019 to discuss possible mechanisms behind this. In this report, they summarize data, discussion among attendees, and recommendations for further research.

Study Conclusion: The mechanisms behind the association of serum cholesterol with exposure to PFAS have not been determined.

Lipid responses to environmental perfluoroalkyl substance exposure in a Taiwanese Child cohort

Study Purpose: The purpose of this study was to assess changes in lipids in children after exposure to PFASs and suggest potential health effects.

Study Conclusion: This study found that some PFASs were associate with lipid changes. The PFOS level was most correlated with lipid alterations. The results of these lipid alterations suggest possible effects on hepatic lipid metabolism, metabolic disorders, and PFAS interactions in the body.

Early-life associations between per- and polyfluoroalkyl substances and serum lipids in a longitudinal birth cohort

Study Purpose: Exposures to PFASs may affect metabolic outcomes, including lipid concentrations in blood. This study estimates associations between PFAS and lipid concentrations at birth and at several points in childhood.

Study Conclusion: These findings suggest that childhood PFAS exposures may be associated with elevated serum lipid concentrations. This is a public health concern because a detrimental lipid profile in childhood is a risk factor for later development of hyperlipidemia and cardiovascular disease.

Systemic PFOS and PFOA exposure and disturbed lipid homeostasis in humans: what do we know and what not?

Study Purpose: This review presents the main issues on regulation of lipids by PFOS and PFOA, emphasizing underlying mechanisms in the body.

Study Conclusion: There is a difference between the mechanisms in lipid regulation in mice versus humans, which may be due to doses of PFASs.

Perfluoroalkyl substances (PFASs) and mercury in never-pregnant women of fertile age: association with fish consumption and unfavorable lipid profile

Study Purpose: This study examines concentrations of PFASs and lifestyle factors that may contribute to higher levels of pollutants in women of fertile age who have never been pregnant.

Study Conclusion: The majority of the women in this study had a mixture of seven different PFASs and mercury detected in their blood. PFAS concentrations were higher in older women and associated with fish intake.

The association between perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto region, Italy

Study Purpose: Residents of northeastern Italy were exposed for decades to high concentrations of PFASs via drinking water. Elevated lipid levels during pregnancy can have long-lasting effects on pregnant women and the developing fetus. This study looks at the association between PFASs and lipid levels in highly exposed pregnant women.

Study Conclusion: These results suggest that the associations between PFAS concentrations and lipid levels in pregnant women may differ by trimester of pregnancy. In the first trimester, patterns are like those in non-pregnant women, while they differ in late pregnancy.

Serum perfluoroalkyl substances in relation to lipid metabolism in Chinese pregnant women

Study Purpose: Exposure to PFASs could affect lipid levels, but studies on these effects in pregnant women are limited. This study looks at the association between PFASs and lipid levels in pregnant women.

Study Conclusion: Exposure to PFASs may influence lipid levels in pregnant women.

Associations between perfluoroalkyl substances and lipid profile in a highly exposed young adult population in the Veneto Region

Study Purpose: Residents of a large area of North-Eastern Italy were exposed for decades to drinking water contaminated by PFAS. This study looks at the association between PFAS levels and lipid levels and how the amount of PFAS changes this association in this heavily exposed population.

Study Conclusion: The largest jumps in cholesterol levels occurred at the lower ranges of PFAS concentrations.

Prenatal exposure to perfluoroalkyl substances and cord plasma lipid concentrations

Study Purpose: The effects of PFAS exposure on lipid levels in newborns is unknown. This study looks at the health effects of prenatal exposure to PFAS on umbilical cord lipid levels.

Study Conclusion: These findings suggest that prenatal exposure to PFAS may disrupt lipid levels and metabolism in newborns.

Serum albumin mediates the effect of multiple per- and polyfluoroalkyl substances on serum lipid levels

Study Purpose: Previous studies looking at the association between PFAS exposure and lipid levels have mainly focused on individual PFASs; the influence of multiple PFAS exposure on lipids is not clear. This study looks at the combined effects of multiple PFASs on lipid levels.

Study Conclusion: PFAS exposure was associated with lipid levels.

Associations between perfluoroalkyl substances and serum lipids in a Swedish adult population with contaminated drinking water

Study Purpose: Exposure to PFAS have been shown to affect lipid levels in past studies. This study looks at the association between lipid levels and PFAS, and if these associations with PFAS remained in a comparison based on residency in areas with differing exposure to PFAS.

Study Conclusion: This study provides more evidence of an association between PFAS and lipid levels, especially for PFHxS.

The Association Between Perfluoroalkyl Substances and Lipids in Cord Blood

Study Purpose: PFAS were suspected to have been released during the collapse of the World Trade Center on 9/11. Evidence suggests that PFAS may alter lipid levels. This study looks at the association between umbilical cord PFAS levels and lipids in a group prenatally exposed to the WTC disaster.

Study Conclusion: These findings support an association between exposure to PFAS and altered lipid levels.

Roles of gender and obesity in defining correlations between perfluoroalkyl substances and lipid/lipoproteins

Study Purpose: This study looks at the relationship between PFASs and total cholesterol, LDL, HDL, and triglycerides and how gender and obesity change these relationships.

Study Conclusion: PFAS affected lipids such as LDL and total cholesterol more in obese individuals.

Associations between lipid/lipoprotein levels and perfluoroalkyl substances among US children aged 6-11 years

Study Purpose: Levels of lipids have been associated with exposure to PFASs. This study looks at the associations between PFASs and lipid levels in children aged 6-11 years.

Study Conclusion: PFOS and PFNA was related with total cholesterol levels in children and PFASs may be related to non-HDL cholesterol in children.

Metabolic syndrome

Do perfluoroalkyl substances aggravate the occurrence of obesity-associated glucolipid metabolic disease?

Study Purpose: This article summarizes the literature on PFAS and obesity-related glucolipid metabolic disease, as well as experimental evidence.

Study Conclusion: Cross-sectional studies have reported that PFAS exposure increases the risk of GLMD, although this type of study cannot conclude causation. The occurrence of GLMD is also closely connected with obesity. However, there are few studies on this topic and more are needed.

Do perfluoroalkyl substances aggravate the occurrence of obesity-associated glucolipid metabolic disease?

Study Purpose: This article summarizes the literature on PFAS and obesity-related glucolipid metabolic disease, as well as experimental evidence.

Study Conclusion: Cross-sectional studies have reported that PFAS exposure increases the risk of GLMD, although this type of study cannot conclude causation. The occurrence of GLMD is also closely connected with obesity. However, there are few studies on this topic and more are needed.

Perfluorooctane sulfonate alternatives and metabolic syndrome in adults: New evidence from the Isomers of C8 Health Project in China

Study Purpose: Cl-PFESAs are alternatives to PFOS, a widely used PFAS. Despite evidence in the laboratory of metabolic toxicity, no study has explored associations of Cl-PFESAs with metabolic syndrome in a human population. To help address this gap, this study measured 32 PFAS, including Cl-PFESAs, in serum from 1228 adults participating in the cross-sectional Isomers of C8 Health Project in China.

Study Conclusion: These results suggest that exposure to Cl-PFESAs was associated with metabolic syndrome, though additional studies are needed to more definitively address potential health concerns of these PFOS alternatives.

To which extent are per-and poly-fluorinated substances associated to metabolic syndrome?

Study Purpose: This study assesses current literature investigating the association between exposure to PFAS and metabolic syndrome.

Study Conclusion: Based on this analysis, the current small body of evidence does not support an association between PFAS and metabolic syndrome. However, due to the small number of studies and differences between studies, results should be interpreted with caution. More studies are needed.

Prenatal exposure to persistent organic pollutants as a risk factor of offspring metabolic syndrome development during childhood

Study Purpose: This review looks at the role of prenatal exposure to persistent pollutants in offspring who develop metabolic syndrome in childhood, the latest research on metabolic syndrome, epidemiological and experimental findings on metabolic syndrome, and modes of action of persistent pollutants.

Study Conclusion: Even though the studies in this review had many strengths, one major weakness was the usage of different combinations of MetS criteria to measure the outcomes. These findings elucidate the urgent need to solidify the pediatric MetS definition. An accurate definition will permit scientists to measure the MetS as a health outcome properly and allow clinicians to diagnose pediatric MetS and provide individualized treatment appropriately.

Associations of Perfluoroalkyl Substances with Prevalence of Metabolic Syndrome in Highly Exposed Young Adult Community Residents-A Cross-Sectional Study in Veneto Region, Italy

Study Purpose: This study investigates the associations between PFAS serum levels and the prevalence of metabolic syndrome among highly exposed young adults in north-eastern Italy stemming from PFAS water contamination.

Study Conclusion: These results did not support a consistent association between PFAS and metabolic syndrome.

Association between exposure to perfluoroalkyl substances and metabolic syndrome and related outcomes among older residents living near a Science Park in Taiwan

Study Purpose: The largest Science Park in Taiwan discharges wastewater containing PFASs into the Keya River, and a high concentration of PFASs have been found in this river and its aquatic life. This study looked at residents living near the river and evaluated the association of PFASs with metabolic syndrome and lipid levels.

Study Conclusion: These results showed that there were no associations between PFASs and metabolic syndrome. PFAS levels were associated with lipid levels. Certain PFASs were associated with increased uric acid levels, especially in males.

Other

Prenatal and postnatal exposure to PFAS and cardiometabolic factors and inflammation status in children from six European cohorts

Study Purpose: In this study, they test the hypothesis that early life exposure to PFAS is associated with poor metabolic health in children. They studied the association between prenatal and postnatal PFAS mixture exposure and cardiometabolic health in children, and the role of inflammatory proteins.

Study Conclusion: This study supports the hypothesis that prenatal, rather than postnatal, PFAS exposure might contribute to unfavorable lipid profiles and adiposity in childhood.

Exposure to legacy and novel perfluoroalkyl substance disturbs the metabolic homeostasis in pregnant women and fetuses: A metabolome-wide association study

Study Purpose: This study evaluates the associations between metabolites in maternal and infant cord serum and exposure to several PFASs.

Study Conclusion: This study identified metabolites and pathways in pregnant women and fetuses associated with exposure to several PFASs.

Associations of Perfluoroalkyl substances with blood lipids and Apolipoproteins in lipoprotein subspecies: the POUNDS-lost study

Study Purpose: This study looks at the association between PFAS levels and lipoprotein (transports fats and lipids in blood) and apolipoprotein levels (transport fat and cholesterol in body).

Study Conclusion: These findings suggest that PFAS levels are associated with blood lipids and polyproteins, which may elevate cardiovascular risk.

Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors

Study Purpose: PFASs may increase metabolic risks, but there are not many studies on the topic. This study looks at the associations between PFASs and total cholesterol, triglycerides, and hypertension.

Study Conclusion: This study found rising PFAS levels associated with lower triglyceride levels. There was no clear link between cholesterol or hypertension and PFASs.

Perfluoroalkyl substances and changes in body weight and resting metabolic rate in response to weight-loss diets: A prospective study

Study Purpose: Whether PFASs may interfere with body weight regulation is mostly unknown. This study looks at the associations of PFAS exposure with changes in body weight and resting metabolic rate in diet-induced weight-loss setting.

Study Conclusion: In this diet-induced weight-loss setting among overweight and obese individuals, higher levels of PFAS were associated with greater weight regain, especially in women.

Perfluoroalkyl substances, bone density, and cardio-metabolic risk factors in obese 8–12-year-old children: A pilot study

Study Purpose: PFASs have been associated with negative bone and metabolic changes in adults; however, these associations are understudied in children. This study looks at the relationships of PFASs with bone health in children.

Study Conclusion: PFAS exposure in obese children may play a role in adverse skeletal and cardiovascular risk profiles.

Serum perfluoroalkyl substances and cardiometabolic consequences in adolescents exposed to the World Trade Center disaster and a matched comparison group

Study Purpose: Children who lived or attended school near the World Trade Center disaster site were exposed to many substances, including PFASs. This study looks at the relationship of PFAS levels with lipid levels and weight.

Study Conclusion: There is a potential high risk of atherosclerosis (plaque buildup) and cardiovascular diseases in these children as a result of PFAS exposure.

 

Diabetes

The Diabetes section includes information on prediabetes, type 2 diabetes, type 1 diabetes, gestational diabetes, and glucose homeostasis/insulin sensitivity as they relate to PFASs. It includes 34 total studies; 31 are published within the last 6 years. Although a study may find, or not find, an association between PFASs and diabetes outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Type 1 Diabetes

Prenatal exposure to perfluoroalkyl substances modulates neonatal serum phospholipids, increasing risk of type 1 diabetes

Study Purpose: This study examines the effects during pregnancy on markers of type 1 diabetes risk in children.

Study Conclusion: Findings suggest that PFAS exposure during pregnancy contributes to the risk and development of type 1 diabetes in offspring.

Type 2 Diabetes

Per- and polyfluoroalkyl substances and incident diabetes in midlife women: the Study of Women's Health Across the Nation (SWAN)

Study Purpose: It has been suggested that there are diabetogenic effects of PFAS. However, there is limited evidence in longer-term studies. This paper examines the association between serum PFAS concentrations and incident diabetes in the Study of Women's Health Across the Nation Multi-Pollutant Study (SWAN-MPS).

Study Conclusion: This study suggests that PFAS may increase diabetes risk in midlife women. Reduced exposure to these ‘forever and everywhere chemicals’ may be an important preventative approach to lowering population-wide diabetes risk.

Exposure to novel and legacy per- and polyfluoroalkyl substances (PFASs) and associations with type 2 diabetes: A case-control study in East China

Study Purpose: This study evaluates the effects of PFAS exposure on type 2 diabetes by estimating the associations of PFAS levels in humans with the risk of type 2 diabetes.

Study Conclusion: In conclusions, the correlations between PFASs and glycemic markers and lipid levels indicate that PFAS exposure could be a factor in type 2 diabetes development.

Serum concentrations of per-/polyfluoroalkyl substances and risk of type 2 diabetes: A case-control study

Study Purpose: In this study, type 2 diabetics and individuals comparable but without type 2 diabetes were compared to explore associations between serum PFASs and type 2 diabetes risk.

Study Conclusion: Our findings suggested that there are associations between exposure to PFASs and risk of T2DM. Further mechanism research is worthy to be conducted to elucidate the mode of action of different PFASs on T2DM at different exposure levels.

Per- and polyfluoroalkyl substances and calcifications of the coronary and aortic arteries in adults with prediabetes: Results from the diabetes prevention program outcomes study

Study Purpose: PFAS are endocrine disrupting chemicals that have been associated with cardiovascular risk factors including elevated body weight and hypercholesterolemia. This study investigates the contribution of PFAS to the development of arterial calcification in prediabetics.

Study Conclusion: In this study, prediabetic adults with higher levels of some PFASs had higher risk of coronary and thoracic aorta calcification. PFAS exposure may be a risk factor for adverse cardiovascular health among high-risk populations.

Per- and polyfluoroalkyl substance plasma concentrations and metabolomic markers of type 2 diabetes in the Diabetes Prevention Program trial

Study Purpose: PFASs have been linked to type 2 diabetes in previous studies. In this study, they test whether PFAS concentrations were associated with metabolites shown to predict type 2 diabetes in a trial of individuals at high risk of type 2 diabetes.

Study Conclusion: PFAS concentrations were associated with metabolites linked to type 2 diabetes. Further research is needed.

Plasma metabolites associated with exposure to perfluoroalkyl substances and risk of type 2 diabetes: A nested case-control study

Study Purpose: This study examines if PFAS metabolite patterns were associated with risk of developing type 2 diabetes.

Study Conclusion: PFAS could be associated with two groups of lipids with unknown relations to type 2 diabetes development, which could explain conflicting associations found between PFAS and type 2 diabetes risk.

Pre- and post-diagnostic blood profiles of perfluoroalkyl acids in type 2 diabetes mellitus cases and controls

Study Purpose: To explore associations between pre- and post-diagnostic PFAA blood profiles and T2DM and assess factors associated with longitudinal changes in PFAAs in T2DM cases and controls.

Study Conclusion: The study did not find evidence of association between PFAS and type 2 diabetes. Changes in PFAS concentrations over time were not influenced by development of type 2 diabetes.

Impact of the co-occurrence of obesity with diabetes, anemia, hypertension, and albuminuria on concentrations of selected perfluoroalkyl acids

Study Purpose: This study evaluates the occurrence of obesity with diabetes, anemia, albuminuria, and hypertension on concentrations of PFAS.

Study Conclusion: Obesity is associated with lower concentrations of PFAS. As compared to those who have no diseases, anemia, albuminuria, and diabetes were associated with lower concentrations of PFAS and hypertension was associated with higher concentrations of PFAS.

Per- and Polyfluoroalkyl Substances and Obesity, Type 2 Diabetes and Non-alcoholic Fatty Liver Disease: A Review of Epidemiologic Findings

Study Purpose: This study reviews evidence for associations between PFASs and the development of obesity, diabetes, and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.

Study Conclusion: There is evidence that supports the association between PFASs and the onset or development of metabolic diseases, including obesity, diabetes, and non-alcoholic fatty liver disease. However, there are inconsistent results in many cases.

Associations of Perfluoroalkyl and Polyfluoroalkyl Substances with Incident Diabetes and Microvascular Disease          

Study Purpose: This study looks at which PFASs are associated diabetes and microvascular disease. This study also tests whether a lifestyle intervention can change this association and decrease concentrations.

Study Conclusion: Some PFASs were associated with diabetes and microvascular disease. Exercise and diet may reduce the association between PFASs and diabetes.

Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study

Study Purpose: This study looks at the association between PFAS levels and type 2 diabetes risk.

Study Conclusion: In participants without type 2 diabetes, long-term PFAS exposure was associated with lower insulin resistance.

Plasma Concentrations of Perfluoroalkyl Substances and Risk of Type 2 Diabetes: A Prospective Investigation among U.S. Women

Study Purpose: This study aimed to examine the associations between PFAS exposures and development type 2 diabetes.

Study Conclusion: Background exposures to PFASs in the later 1990s were associated with higher type 2 diabetes risk during following years.

PFOA is associated with diabetes and metabolic alteration in US men: National Health and Nutrition Examination Survey 2003-2012

Study Purpose: This study looks at the relationship between PFAS and diabetes prevalence.

Study Conclusion: These results provide evidence that levels of PFOA may be associated with diabetes in men and with total cholesterol in adults.

Perfluoroalkyl substances and beta cell deficient diabetes

Study Purpose: PFAS are shown to preserve pancreatic islet cells (related to insulin production). This study looks at the relationship between PFAS levels and diabetes--type 1 and type 2.

Study Conclusion: PFAS levels were negatively associated with diabetes. The inverse relationship was strongest for type 1 diabetes.

Gestational Diabetes

Association between per- and polyfluoroalkyl substances and risk of gestational diabetes mellitus

Study Purpose: PFAS exposure might contribute to the incidence of gestational diabetes. This study aims to perform an analysis to identify the association between PFAS and the risk of gestational diabetes (GDM).

Study Conclusion: This study conducted an analysis of existing literature to investigate the association between PFAS exposure and GDM and found that PFOA levels were associated with a higher risk of GDM. Further studies are needed to better understand this relationship and a potential mechanism.

A pathway level analysis of PFAS exposure and risk of gestational diabetes mellitus

Study Purpose: This study summarizes the literature that supports a pathway between PFAS exposure and development of gestational diabetes.

Study Conclusion: Epidemiology studies have shown that PFAS were positively associated with the thyroid hormone TSH and negatively associated with the thyroid hormones T3 and T4. PFASs were generally associated with glucose and insulin levels in pregnancy. This study proposes that dysregulation of thyroid function and glucose metabolism may be a missing component in the accurate estimation of PFAS on the risk of GDM.

Environmental exposure to perfluoroalkyl substances in early pregnancy, maternal glucose homeostasis and the risk of gestational diabetes: A prospective cohort study

Study Purpose: This study investigates the association between PFAS exposure and glucose homeostasis in pregnancy.

Study Conclusion: Exposure to PFAS may affect glucose homeostasis in pregnancy and increase the risk of gestational diabetes, especially in normal weight women.

Persistent organic pollutants and maternal glycemic outcomes in a diverse pregnancy cohort of overweight women

Study Purpose: This study looks at the associations between exposure to persistent organic pollutants (such as PFASs) and prenatal fasting glucose levels, insulin, and insulin resistance during pregnancy in overweight women.

Study Conclusion: Rising PFAS levels were associated with lower fasting glucose levels in overweight women in this study. However, this was a small study and more research is needed on this topic.

Concentrations of perfluoroalkyl and polyfluoroalkyl substances and blood glucose in pregnant women

Study Purpose: Evidence on the association between exposure to PFASs and blood glucose concentrations in pregnant women is inconsistent. This study looks at the association between PFAS exposure and the concentrations of fasting glucose levels and one hour plasma glucose levels after a oral glucose tolerance test in pregnant women.

Study Conclusion: PFAS exposure was associated with increased risk of high 1-hour plasma glucose levels among pregnant women, but there was no association for fasting glucose levels.

Structure-based investigation on the association between perfluoroalkyl acids exposure and both gestational diabetes mellitus and glucose homeostasis in pregnant women

Study Purpose: This study looks at the association between PFAS and gestational diabetes and glucose levels in pregnant women.

Study Conclusion: This study showed an association between certain PFASs and both gestation diabetes risk and reduced blood glucose regulation in pregnant women.

Perfluoroalkyl substances and glycemic status in pregnant Danish women: The Odense Child Cohort

Study Purpose: This study looks at associations between PFASs and blood glucose levels in pregnant women based on their risk of gestational diabetes.

Study Conclusion: PFHxS and PFNA concentrations were associated with impaired glucose levels in vulnerable pregnant women and exposure to PFAS might increase the risk of developing gestational diabetes.

Association of serum levels of perfluoroalkyl substances with gestational diabetes mellitus and postpartum blood glucose

Study Purpose: This study looks at the association between PFAS exposure with risk of gestational diabetes and postpartum blood glucose levels.

Study Conclusion: Results suggest negative effects of maternal exposure to certain PFAS compounds on blood glucose levels.

Perfluoroalkyl substances, glucose homeostasis, and gestational diabetes mellitus in Chinese pregnant women: A repeat measurement-based prospective study

Study Purpose: This study aims to explore the associations of exposure to PFASs with glucose levels and gestational diabetes.

Study Conclusion: Findings show that exposure to PFASs might have influences on glucose homeostasis and gestational diabetes.

Exposure to organophosphorus and organochlorine pesticides, perfluoroalkyl substances, and polychlorinated biphenyls in pregnancy and the association with impaired glucose tolerance and gestational diabetes mellitus: The MIREC Study

Study Purpose: Studies have reported increases in rates of gestational diabetes over recent decades. Environmental chemicals may increase the risk of diabetes by impacting glucose metabolism. This study looks at the associations between pesticides, PFASs, and PCBs measured in early pregnancy and impaired glucose tolerance and gestational diabetes.

Study Conclusion: There were no associations found between PFASs and gestational diabetes or impaired glucose tolerance during pregnancy.

Other

Associations between both legacy and alternative per- and polyfluoroalkyl substances and glucose-homeostasis: The Isomers of C8 health project in China

Study Purpose: This study investigates associations of PFAS alternatives and PFOA and PFOS with glucose-homeostasis markers and explore associations of 13 PFAS with the outcomes.

Study Conclusion: Legacy and alternative PFASs were associated with glucose-homeostasis markers. 6:2 Cl-PFESA was the primary contributor. Sex-specific associations were also identified.

Exposure to Perfluoroalkyl Substances and Glucose Homeostasis in Youth

Study Purpose: Exposure to PFAS may increase the risk of type 2 diabetes. This study examines associations between PFAS exposure and glucose metabolism in youth.

Study Conclusion: Youth exposure to PFHxS was associated with dysregulated glucose metabolism in females, which may be due to changes in beta-cell function. These associations appeared during puberty and were most pronounced post-puberty.

Exposure to Perfluoroalkyl Substances and Glucose Homeostasis in Youth

Study Purpose: Exposure to PFAS may increase the risk of type 2 diabetes. This study examines associations between PFAS exposure and glucose metabolism in youth.

Study Conclusion: Youth exposure to PFHxS was associated with dysregulated glucose metabolism in females, which may be due to changes in beta-cell function. These associations appeared during puberty and were most pronounced postpuberty.

Life-course exposure to perfluoroalkyl substances in relation to markers of glucose homeostasis in early adulthood

Study Purpose: This study investigates associations of PFAS exposure with glucose homeostasis in adulthood.

Study Conclusion: In this study, PFAS exposure was associated with decreased insulin sensitivity and increased pancreatic beta-cell function in young adults.

Dysregulated lipid and fatty acid metabolism link perfluoroalkyl substances exposure and impaired glucose metabolism in young adults

Study Purpose: This study looks at the association between PFAS exposure and altered metabolic pathways that are linked to increased cardiometabolic risk in young adults.

Study Conclusion: Certain mechanisms of PFAS on the body could reduce glucose metabolism in young adults.

Perfluoroalkyl substances, metabolomic profiling, and alterations in glucose homeostasis among overweight and obese Hispanic children: A proof-of-concept analysis

Study Purpose: This study looks at the associations between PFASs and glucose levels in high-risk overweight and obese Hispanic children.

Study Conclusion: This study found that higher PFAS exposure was associated with changes in glucose levels in Hispanic youth.

Longitudinal Associations of Exposure to Perfluoroalkylated Substances in Childhood and Adolescence and Indicators of Adiposity and Glucose Metabolism 6 and 12 Years Later: The European Youth Heart Study

Study Purpose: This study looks at the long-term relationship between exposure to PFAS during childhood and teenage years on indicators of body fatness and glucose metabolism in teenage years and young adulthood.

Study Conclusion: This study found evidence that childhood exposure to PFOS and PFOA was associated with greater body fatness at 15 and 21 years of age and signs of impaired glucose metabolism at 15 years of age, respectively.

 

Cancers

Cancer occurs when cells grow uncontrollably and can affect many parts of the body. Cancer includes information on cancers of the kidney, testes, thyroid, breast, and liver as they relate to PFASs. Most studies on cancer and PFASs have focused on breast cancer. Many other cancers need to be studied. As cancer papers are published, they will be updated here. This section has 18 total studies; 16 were published in the last 6 years. Although a study may find, or not find, an association between PFASs and cancer outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Breast Cancer

Elevated levels of perfluoroalkyl substances in breast cancer patients within the Greater Manila Area

Study Purpose: This study measures endocrine disrupting chemicals (EDCs), including PFAS, in Filipino women with and without breast cancer.

Study Conclusion: Three PFAS (PFDoA, PFDA, PFHxA) showed significant associations with breast cancer based on odds ratios. There were higher concentrations of PFAS in women residing in one part of the country, which provides evidence for regional disparities in PFAS exposure in the Philippines.

Endocrine disrupting chemicals and breast cancer: a systematic review of epidemiological studies

Study Purpose: This study reviews literature about associations between endocrine disrupting chemicals and breast cancer

Study Conclusion: This study identified exposures that could elevate the risk of breast cancer. Because EDCs are persistent in the environment and accumulate in the body, more research is needed on long-term impacts. Additionally, since food is often a route of exposure to EDCs, more research is needed on food and food packaging and links to breast cancer development.

A cross-sectional study of the association between perfluorinated chemical exposure and cancers related to deregulation of estrogen receptors

Study Purpose: This study examines the association between PFAS and estrogen related cancers (breast, prostate, ovarian, and uterine) and explored if non-occupational exposure was associated with increased odds of developing these cancers.

Study Conclusion: PFASs were associated with increased odds of ovarian and breast cancers. PFOA was more correlated with breast cancer and PFHS more with ovarian cancer.

A case-control study of perfluoroalkyl substances and the risk of breast cancer in Taiwanese women

Study Purpose: Breast cancer is a common cancer worldwide; however, the incidence of breast cancer is increasing in younger women. This study investigates whether PFAS and breast cancer are associated.

Study Conclusion: This study found that PFAS were associated with the breast cancer risk of estrogen receptor positive tumors in young Taiwanese women.

In utero exposure to poly- and perfluoroalkyl substances (PFASs) and subsequent breast cancer

Study Purpose: This study looks at levels of PFASs and risk of breast cancer.

Study Conclusion: High EtFOSAA and high maternal cholesterol increased risk of breast cancer. Maternal PFOS levels were associated with decreased daughters' breast cancer risk.

Breast cancer risk and serum levels of per- and poly-fluoroalkyl substances: a case-control study nested in the California Teachers Study

Study Purpose: This study looks at the risk of breast cancer associated with exposure to PFASs.

Study Conclusion: These results do not suggest that PFAS levels are related to breast cancer risk.

Polymorphism in xenobiotic and estrogen metabolizing genes, exposure to perfluorinated compounds and subsequent breast cancer risk: A nested case-control study in the Danish National Birth Cohort

Study Purpose: This study estimates the effect of changes in genes associated with hormone pathways on the risk of developing breast cancer.

Study Conclusion: These results suggest that changes in certain genes that are involves with estrogen can control the influence of PFOSA exposure on the development of breast cancer.

Other Types of Cancer

Per-/polyfluoroalkyl substance concentrations in human serum and their associations with liver cancer

Study Purpose: The effects of PFAS exposure on human liver cancer risk are still not known. In this study, 203 liver cancer patients and 203 individuals without liver cancer were recruited and their serum samples were collected between 2019 and 2021. 

Study Conclusion: In this study, PFAS exposure was measured in 406 randomly recruited subjects, including 203 cases and 203 controls. Meanwhile, we quantified the associations between serum PFAS concentrations and tumor markers as well as the incidence of LC. PFOS was the predominant PFASs in human serum, followed by PFOA and 6:2 Cl-PFESA. It was found that increased serum PFOS and 6:2 Cl-PFESA levels are correlated with increased AFP and CEA levels. We also observed that PFOS and 6:2 Cl-PFESA concentrations in human serum were significantly associated with the incidence of LC, demonstrating the evidence that exposure to PFASs can lead to a higher risk of LC.

Risk of Cancer in a Community Exposed to Per- and Poly-Fluoroalkyl Substances

Study Purpose: PFAS emissions from the plastic coating industry in southern New Hampshire have contaminated at least 65 square miles of drinking water. Prior research indicates that mean blood serum levels of PFOA in residents of the exposed community are 2x greater than the US average. This study investigates incidence rate of cancer compared to similarly sized New England towns.

Study Conclusion: Merrimack, NH residents experienced significantly higher risk of at least 4 types of cancer over 10 years between 2005 and 2014. Results indicate that further research is warranted to elucidate if southern NH residents experience increased risk for various types of cancer due to exposure to PFAS contamination.

Cancer incidence in a Swedish cohort with high exposure to perfluoroalkyl substances in drinking water

Study Purpose: The use of firefighting foams at a military airport resulted in high levels of PFAS in the drinking water distributed to 1/3 of households in Ronneby, Sweden, from the 1980s to 2013. 

Study Conclusion: Analysis of this large cohort exposed to high levels of PFAS, dominated by PFHxS and PFOS, revealed no evidence for an overall increased risk of cancer. A moderately increased risk of kidney cancer was observed, in accordance with previous findings after PFAS exposure dominated by PFOA.

Occurrence and distribution of per- and polyfluoroalkyl substances (PFASs) in human livers with liver cancer

Study Purpose: This study investigates PFAS distribution and occurrence in 55 liver tissues with tumors and 55 without.

Study Conclusion: The results showed that 21 PFAS could be detected in liver tissues from liver cancer patients. PFBA, PFHxS, PFHpS, and PFOS were the predominant PFAS. The concentrations of PFOA, PFTrDA, and PFBS showed significant differences in tumor and non-tumor liver samples, and this may have been a consequence of oxidative stress. Furthermore, the participants aged 45–60 years showed higher PFASs concentrations in than the other aged people. Regarding gender, the liver levels of most PFASs were higher in males than in females. More research is needed.

Serum Concentrations of Per- and Polyfluoroalkyl Substances and Risk of Renal Cell Carcinoma

Study Purpose: This study investigates the association between PFOA and other PFAS and renal cell carcinoma at concentrations in the general population.

Study Conclusion: Our findings add substantially to the weight of evidence that PFOA is a renal carcinogen and may have important public health implications for the many individuals exposed to this ubiquitous and highly persistent chemical.

Critical Review on PFOA, Kidney Cancer, and Testicular Cancer

Study Purpose: The review covers prior studies on PFOA and cancers of the kidney and testes.

Study Conclusion: This study found an increase in cancer risk of the kidney and testes with increased PFOA concentrations. While these associations are likely causal, these results are limited by the small number of studies on this subject, overlapping study populations in studies, and lack of measured PFOA concentrations in several studies.

PFAS and cancer, a scoping review of the epidemiologic evidence

Study Purpose: This study reviews evidence relating to PFAS and cancer to highlight directions for future research.

Study Conclusion: There is inconsistent evidence on the association between cancer and PFAS.

Endocrine Disrupting Chemicals and Thyroid Cancer: An Overview
Study Purpose: This study looks at prior literature on the association between chemicals such as PFAS and thyroid cancer.
Study Conclusion: There was no evidence that PFAS have a carcinogenic effect on the thyroid gland in humans.

 

Immune System and Hormones

 

Immunity

A healthy immune system can provide an effective response to infections and diseases within the body. The immune section includes studies on infections, asthma, inflammatory markers, antibodies, allergies, cytokines, adipokines, adipocytokines, atopic dermatitis, and immunotoxicity as they relate to PFASs. Information related to vaccines can be found in the COVID and Vaccines tab. Cytokines include interferon, interleukin, and growth factors, which are secreted by certain cells in the immune system and regulate processes within the body. Adipokines or adipocytokines, similarly, are cell signaling proteins, but are secreted in adipose tissue. Atopic dermatitis is also known as eczema and makes skin red and itchy. This section currently has 36 total studies: 32 from the last 6 years. Although a study may find, or not find, an association between PFASs and immune outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Asthma

PFAS (per- and polyfluoroalkyl substances) and asthma in young children: NHANES 2013-2014

Study Purpose: PFAS may affect the immune system to increase the risk of allergic and respiratory disease. However, there are substantial gaps in the knowledge about the relationship between PFAS and outcomes such as asthma in children. This study examines the associations between PFAS exposure and childhood asthma.

Study Conclusion: There was weak association with increased asthma prevalence in US children.

Association between prenatal exposure to perfluoroalkyl substances and asthma in 5-year-old children in the Odense Child Cohort

Study Purpose: PFAS has been associated with immune suppression and may contribute to the development of asthma. This study investigates the association between prenatal exposure to PFAS and asthma in 5-year-old children.

Study Conclusion: There was no association between prenatal exposure to PFAS and doctor-diagnosed asthma or wheeze.

Association between prenatal exposure to perfluoroalkyl substances and asthma-related diseases in preschool children

Study Purpose: The studies on PFAS and asthma in children have had inconsistent results. This study aimed to evaluate whether and to what extent prenatal PFAS exposure is associated with childhood asthma.

Study Conclusion: This study found no associations were found between prenatal exposure to PFAS and asthma in preschool children.

Maternal levels of perfluoroalkyl substances (PFASs) during pregnancy and childhood allergy and asthma related outcomes and infections in the Norwegian Mother and Child (MoBa) cohort

Study Purpose: PFAS have been inconsistently associated with asthma and allergic diseases and increased number of infections in early childhood. This study examines the association of PFAS measured in pregnancy with childhood asthma, allergies, and common infectious diseases up to age 7 years.

Study Conclusion: Maternal PFAS levels during pregnancy showed little association with asthma or allergy related outcomes. Findings from this study suggest PFAS affects the immune system, especially with airway infections, such as bronchitis and pneumonia.

Allergies

Perfluoroalkyl substances are linked to incident chronic spontaneous urticaria: A nested case-control study

Study Purpose: This study aims to investigate the association of serum PFASs with incidence chronic spontaneous urticaria (CSU), or hives, in adults.

Study Conclusion: This study found an association of serum PFAS with incidence CSU and identified PFBA and PFHpA as two potentially effective compounds and proposed a possible mediation effect of IL-4.

Exposure to perfluoroalkyl substances and allergic outcomes in children: A systematic review and meta-analysis

Study Purpose: PFAS may contribute to the development of allergies in children, but evidence is inconclusive. This study compares the evidence from many studies on the topic.

Study Conclusion: This review suggests that PFAS exposure could potentially be associated with eczema, atopic dermatitis, and allergic rhinitis during childhood, but not with childhood asthma or wheeze.   

Effect of prenatal exposure to per- and polyfluoroalkyl substances on childhood allergies and common infectious diseases in children up to age 7 years: The Hokkaido study on environment and children's health

Study Purpose: Studies have reported prenatal exposure to PFAS decreased the risk of allergies, while increasing the risk of infectious diseases at ages 2 and 4 years. However, it is unclear whether the effects of PFAS on allergies and infectious diseases continue until a reliable age of diagnosing allergies. This study investigates the effects of PFAS exposure and the prevalence of allergies and infectious diseases in children up to age 7.

Study Conclusion: Prenatal exposure to PFOS, PFNA, PFUnDA, PFDoDA, and PFTrDA were associated with reduced risks of wheeze, eczema, and rhino-conjunctivitis, and with increased risks of pneumonia and respiratory syncytial virus (RSV) infection. This inverse association between allergic symptoms and increased risks of infectious diseases is thought to be due to the immunosuppressive effects of PFAS.

Serum perfluoroalkyl substances (PFAS) and risk of asthma and various allergies in adolescents. The Tromsø study Fit Futures in Northern Norway

Study Purpose: This study investigates possible associations between asthma and other allergies with exposure to PFASs.

Study Conclusion: There are several associations between PFASs and asthma, as well as between PFOS and nickel allergy.   

Effects of prenatal exposure to perfluoroalkyl acids on prevalence of allergic diseases among 4-year-old children

Study Purpose: This study examines whether prenatal PFAS exposure is associated with allergies in 4-year-olds.

Study Conclusion: Prenatal exposure to PFDoDA and PFTrDA may suppress the immune system leading to allergic diseases in 4-year-old children.

Atopic dermatitis

Prenatal perfluorooctanoic acid exposure is associated with early onset atopic dermatitis in 5-year-old children

Study Purpose: To investigate the association between prenatal PFAS exposure and earlier onset of atopic dermatitis in children in a 5 year study.

Study Conclusion: Findings suggest that children with higher prenatal PFOA exposure may have a higher risk of developing atopic dermatitis earlier.

Prenatal perfluorooctanoic acid exposure and glutathione s-transferase T1/M1 genotypes and their association with atopic dermatitis at 2 years of age

Study Purpose: This study investigates the association between gene and environmental interactions and childhood atopic dermatitis.

Study Conclusion: In-utero PFOA exposure and the GSTT1/M1 null genotype were associated with atopic dermatitis. There could be genetic susceptibility to atopic dermatitis development.

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and childhood atopic dermatitis: a prospective birth cohort study

Study Purpose: PFASs have been reported to suppress immune function. However, previous studies on prenatal exposure to PFASs and allergic disorders in offspring did not have consistent results. This study examines the association between prenatal exposure to PFASs and childhood atopic dermatitis in children up to 2 years of age.

Study Conclusion: Prenatal exposure to PFOS, PFDA, PFDoA, and PFHxS increased the risk of atopic dermatitis in female children over the first two years of life.

Adipokines, cytokines, and adipocytokines

Early-life exposure to perfluoroalkyl substances in relation to serum adipokines in a longitudinal birth cohort

Study Purpose: PFAS exposure has been linked to metabolic health outcomes like obesity, and changes in adipokines may be one of the underlying mechanisms behind these changes.

Study Conclusion: Serum PFHxS at birth was associated with increased leptin receptor at  birth, and childhood PFAS were associated with decreased leptin and resisting and increased leptin receptor at age 9. Given the associations of PFAS exposure with adipokine levels and metabolic functions, future studies should include assessment of adipokines when examining PFAS-associated metabolic alterations.

Exposure to perfluoroalkylated substances (PFAS) in relation to fitness, physical activity, and adipokine levels in childhood: The European youth heart study

Study Purpose: PFAS can alter metabolism by disrupting cell pathways, where adipokines play a role. Adiponectin and leptin are influenced by and have influence on energy storage and how you use energy. PFAS and adipokines could be mediated by fitness and fat mass.

Study Conclusion: Results may indicate favorable leptin levels with increasing PFAS, although the results could be due to factors related to socioeconomics.

Early Life Exposures to Perfluoroalkyl Substances in Relation to Adipokine Hormone Levels at Birth and During Childhood

Study Purpose: This study examines the associations between PFAS exposures and concentrations of adipokine hormones from birth to adolescence.

Study Conclusion: These findings suggest adipokine hormone dysregulation in early life could be due to PFAS exposure.

Environmental perfluoroalkyl acid exposures are associated with liver disease characterized by apoptosis and altered serum adipocytokines

Study Purpose: This study tests the hypothesis that PFAS are associated with disruptions in the liver in humans and decreased pro-inflammatory cytokines.

Study Conclusion:  PFAS were associated with increased evidence of liver cell death and decreased tumor necrosis factor (TNF) levels. This supports that PFAS may cause liver injury.

Prenatal exposure to perfluoroalkyl substances and adipocytokines: the HOME Study

Study Purpose: Gestational PFAS exposure has been associated with decreased birthweight. This study investigates if PFAS exposure is associated with fetal metabolic markers (leptin and adiponectin).

Study Conclusion: Despite previous studies reporting associations with reduced birthweight, gestational PFAS levels were no associated with infant adipocytokine levels.    

Association of prenatal exposure to perfluoroalkyl substances with cord blood adipokines and birth size: The Hokkaido Study on environment and children's health

Study Purpose: There is a possible association between prenatal PFAS exposure and neonatal adipokines and birth size, but there are not many studies on this topic. This study looks at the associations of prenatal PFAS exposure with adipokines and birth size.

Study Conclusion: Results suggest that prenatal PFAS exposure could alter adiponectin levels in infants and decrease birth size.

Associations of serum perfluoroalkyl acid levels with T-helper cell-specific cytokines in children: By gender and asthma status

Study Purpose: Experiments have suggested that PFAS may alter immune function and could increase allergic inflammation. This study looks at the association between PFAS levels and signs of immune function and to determine if gender changes this.

Study Conclusion: Increased serum PFAS levels may alter the immune system, which could contribute to the development of asthma that may impact males greater than females.

Infections and infectious diseases

Associations of exposure to perfluoroalkyl substances individually and in mixtures with persistent infections: Recent findings from NHANES 1999-2016

Study Purpose: Certain viruses and parasites can cause persistent infections. Some studies indicate PFASs may suppress the immune system. This study tests whether PFAS exposures might increase susceptibility to persistent infections.

Study Conclusion: These results suggest PFAS exposure may increase susceptibility to persistent infections, particularly among adolescents.

Exposure to perfluoroalkyl substances during fetal life and hospitalization for infectious disease in childhood: A study among 1,503 children from the Odense Child Cohort

Study Purpose: This study investigates the association between maternal levels of PFASs during pregnancy and the child's rate of hospitalization due to common infectious diseases between birth and 4 years of age.

Study Conclusion: These results agree with prior studies, where maternal levels of PFOS and PFOA were associated with the number of days those children experienced fever, suggesting that PFOS and PFOA may affect the prevalence of infectious diseases even in low-exposed populations.

Association between prenatal exposure to perfluoroalkyl substances and respiratory tract infections in preschool children

Study Purpose: PFAS is considered to negatively affect immune function; however, the effects of PFAS exposure on respiratory tract infections (RTIs) in children is unclear.

Study Conclusion: Children with higher prenatal PFBS were more vulnerable to respiratory tract infections in early life, which may be due to suppression of IgG production.

Association between prenatal exposure to perfluorinated compounds and symptoms of infections at age 1-4 years among 359 children in the Odense Child Cohort

Study Purpose: To see if higher prenatal PFAS exposure might affect the number of infections in early childhood.

Study Conclusion: The study observed a positive association between prenatal exposure to PFOS and PFOA and the prevalence of fever, which may be a sensitive marker of infection.

Other

Perfluoroalkyl substances exposure and immunity, allergic response, infection, and asthma in children: review of epidemiologic studies

Study Purpose: Increased exposure to PFAS potentially affects infant and child health through immunosuppresion. This review assessed the effects of PFAS fetal, infant, and childhood exposures upon the development of immune function during early life.

Study Conclusion: This review summarizes more recent findings on PFAS effects on infant childhood immune health. Evidence of immunosuppresion, diminished vaccine efficacy, and increased risk of infections, allergies, asthma, and atopic dermatitis were described following in utero, infant, and early childhood PFAS exposure. Further study is needed to understand the mechanisms behind this.

Perfluoroalkyl substances and immune cell counts in adults from the Mid-Ohio Valley (USA)

Study Purpose: This study looked at the association between 4 PFASs and circulating levels of several types of immune cells

Study Conclusion: These results suggest an association between PFHxS and, less consistently, for PFOA and PFOS, and total lymphocytes. The increase in lymphocyte count appeared to be evenly distributed across lymphocyte subsets since associations with their percentages were not significant.

Perfluoroalkyl substances, airways infections, allergy and asthma related health outcomes - implications of gender, exposure period and study design
Study Purpose: Exposure to PFAS is inconsistently associated with asthma, allergic diseases, and airways infection in early childhood. This study aimed to investigate the effect of childhood exposure to PFAS on asthma and allergy related outcomes and on airway infections before and during puberty.
Study Conclusion: There is evidence of associations between PFAS and atopic dermatitis and lower respiratory tract infections. There is no clear pattern in associations.    

Plasma perfluoroalkyls are associated with decreased levels of proteomic inflammatory markers in a cross-sectional study of an elderly population

Study Population: PFAS are associated with altered immune responses in children, but effects in elderly are unknown.

Study Conclusion: Findings suggest that PFAS are related to decreased levels of several proteomic markers of inflammation in the elderly.          

Alternatives of perfluoroalkyl acids and hepatitis B virus surface antibody in adults: Isomers of C8 Health Project in China

Study Purpose: The immunosuppressive effects of PFAS alternatives are unknown. This study investigates the relationship of serum PFAS and PFAS alternatives with the hepatitis B virus antibodies in adults.

Study Conclusion: Exposure to PFAS alternatives are associated with lower Hepatitis B virus antibodies in adults. This relationship seems to be stronger in 6:2 PFESA than PFOS.

Prenatal exposure to perfluoroalkyl substances, immune-related outcomes, and lung function in children from a Spanish birth cohort study

Study Purpose: Prenatal exposure to PFASs has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent. This study looked at the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7.

Study Conclusion: This study suggests that different PFAS may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS could be associated with a reduced risk of respiratory and immune issues, in particular asthma and eczema. However, exposure to PFOA may be associated with reduced lung function in young children.

Exposure to per- and polyfluoroalkyl substances leads to immunotoxicity: Epidemiological and toxicological evidence

Study Purpose: A review of epidemiological and toxicological studies.

Study Conclusion: The results of epidemiological studies, supported by findings from toxicological studies, provide strong evidence that humans exposed to PFOA and PFOS are at risk for immunosuppression. Results suggest that exposure to per- and polyfluoroalkyl substances leads to immunotoxicity.

Serum perfluoroalkyl substances and lung function in adolescents exposed to the World Trade Center disaster

Study Purpose: The effects of childhood exposure to PFAS on lung function are still mostly unknown. Previous research indicates that children living or going to school near the World Trade Center disaster were exposed to high levels of PFASs. To explore the effects of PFAS exposure on lung function, PFASs were measured in children from the World Trade Center Health Registry and matched to a control group, not exposed.

Study Conclusion: PFAS were not associated with lung function or asthma in this study.

A critical review of perfluorooctanoate and perfluorooctanesulfonate exposure and immunological health conditions in humans

Study Purpose: This article reviews previous studies on the association between exposure to PFOS and PFOA and immune-related health conditions.

Study Conclusion: The available information is not consistent, and a conclusion cannot be made on exposure to PFOA and PFOS and immune-related health conditions.

 

COVID and Vaccines

COVID and Vaccines includes information on PFAS exposure and COVID-19 (severity, relation with water pollutants, mortality, and vitamin D disruption) and vaccine response for the flu, tetanus, diphtheria, Rubella, Measles, and Mumps. COVID-19 and PFAS is not well studied at this point in time. As papers are published in this area, they will be updated here. This section has 21 total studies; 15 were published in the last 6 years. Although a study may find, or not find, an association between PFASs and COVID-19/vaccine outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

COVID-19 and COVID-19 Risk Factors

Susceptibility to COVID-19 after High Exposure to Perfluoroalkyl Substances from Contaminated Drinking Water: An Ecological Study from Ronneby, Sweden

Study Purpose: There is concern that environmental contaminants, such as PFAS, may play a role in the clinical course of COVID-19. The objective of this was to determine if exposure to highly PFAS-contaminated water was associated with an increased incidence of COVID-19 in Ronneby, Sweden, during the first year of the pandemic.

Study Conclusion: The results suggest a potential link between high PFAS exposure and susceptibility to COVID-19 that warrant further research.

Association between urinary per- and poly-fluoroalkyl substances and COVID-19 susceptibility

Study Purpose: This study examines the association between PFAS exposure and COVID-19 susceptibility as well as investigates metabolic dysregulation associated with PFAS exposure in COVID-19 patients.

Study Conclusion: Elevated exposure to PFASs was associated with increased risk of COVID-19 infection. PFAS-associated metabolites were shown to be involved in mitochondrial function and immune activity.

Exposure to Perfluoroalkyl Substances and Mortality for COVID-19: A Spatial Ecological Analysis in the Veneto Region (Italy)

Study Purpose: This study evaluates if in the Veneto region of Italy, where residents were exposed to PFAS contaminated water for decades, there was higher mortality for COVID-19.

Study Conclusion: There was a higher mortality risk for COVID-19 in the population heavily exposed to PFAS compared to other parts of Italy. This may be explained by immunosuppresion, bioaccumulation in lung tissue, or pre-existing disease related to PFAS.

Severity of COVID-19 at elevated exposure to perfluorinated alkylates

Study Purpose: This study looks at the association between PFAS exposure and COVID-19 severity.

Study Conclusion: This study found that elevated PFBA levels were associated with an increased risk of more severe COVID-19; however, this study is not yet published.     

Drinking water pollutants may affect the immune system: concerns regarding COVID-19 health effects

Study Purpose: This study explores major contaminants in drinking water that are known to be immunotoxic, exploring sources and drinking water routes and emphasizing the known mechanisms of action that could likely compromise immune response in humans, particularly regarding people exposed to COVID-19.

Study Conclusion: Based on this literature review, metals, plastic components, plasticizers, and PFASs may have the potential to exacerbate COVID-19 respiratory symptoms; however, epidemiological studies are still required to confirm these effects between the pollutants and the virus.

Endocrine disruption of vitamin D activity by perfluoro-octanoic acid (PFOA)

Study Purpose: Vitamin D levels have been associated with COVID-19 outcomes. This study is not directly associated with COVID, however, this study looks at evidence supporting the interference of PFOA on vitamin D.

Study Conclusion: These results provide evidence of disruption on Vitamin D activity by PFOA through competition and inhibiting vitamin D-responsive genes in cells.

Vaccines and vaccine response

Serum vaccine antibody concentrations in adults exposed to per- and polyfluoroalkyl substances: A birth cohort in the Faroe Islands

Study Purpose: This study evaluates the associations between exposure to PFASs and serum antibody concentrations in adults vaccinated at 28 years old.

Study Conclusion: The present study longitudinally-investigated potential immunotoxic effects of PFASs in adults as assessed via any changes in PFAS-associated deficient vaccine responses. Overall, limited evidence was shown for associations between PFAS exposures and decreased antibody concentrations. Potential inverse trends of recent PFAS exposure with lower de novo vaccine responses to hepatitis type A and B at ages 28 years were noted; these mandate further investigation. Lastly, sex-specific associations with vaccine responses were observed for prenatal and early-life exposures to PFASs.

Serum Perfluoroalkyl Substances, Vaccine Responses, and Morbidity in a Cohort of Guinea-Bissau Children

Study Purpose: This study looks at the association between infant PFAS exposure and antibody responses to measles vaccines.

Study Conclusion: These findings support that PFAS exposure decreases vaccine antibodies to measles before and after vaccination.

Internal exposure to perfuoroalkyl substances (PFASs) and biological markers in 101 healthy 1‑year‑old children: associations between levels of perfuorooctanoic acid (PFOA) and vaccine response

Study Purpose: This study looks at the association between vaccine-specific antibodies and PFAS exposure in children.

Study Conclusion: These findings support that PFAS exposure decreases vaccine antibodies, but only PFOA showed these effects in this study.

Rubella immunity and serum perfluoroalkyl substances: Sex and analytic strategy

Study Purpose: PFASs have been associated with decreased immunity to childhood tetanus and diphtheria immunizations. This study examines whether PFAS levels are associated with reduced immunity to rubella immunization.

Study Conclusion: There was an association between reduced rubella immunity and PFOA in men but not women.

Estimated exposures to perfluorinated compounds in infancy predict attenuated vaccine antibody concentrations at age 5-years

Study Purpose: This study looks at the association between vaccine-specific antibodies and PFAS exposure in children.

Study Conclusion: These findings support the idea that the developing immune system is vulnerable to PFAS during infancy. This vulnerability appears to be greatest during the first 6 months after birth, where PFAS exposures are affected by breastfeeding.

Serum Vaccine Antibody Concentrations in Adolescents Exposed to Perfluorinated Compounds

Study Purpose: PFAS exposure is associated with lower antibody levels against certain childhood vaccines at 7 years old. This study looks at this association at 13 years old.

Study Conclusion: Findings from this study are similar to previous findings, that antibody levels to vaccinations decrease at higher PFAS exposure levels.

Association between perfluoroalkyl substance exposure and asthma and allergic disease in children as modified by MMR vaccination

Study Purpose: This study looks at whether PFAS exposure is associated with childhood asthma and allergies. MMR vaccinations in early life may be protective against asthma and allergies, so it is taken into account.

Study Conclusion: PFAS exposure at age 5 was associated with a higher risk of asthma in MMR-unvaccinated children, but not among MMR-vaccinated children.

Perfluoroalkyl substance serum concentrations and immune response to FluMist vaccination among healthy adults

Study Purpose: This study looks at immune response to a flu vaccine and PFAS levels.

Study Conclusion: Findings from this study do not support a reduced immune response to the flu vaccine among healthy adults in relation to their PFAS levels.

 

Autoimmune

Autoimmune includes type 1 diabetes, celiac disease, inflammatory bowel disease (IBD/IBS), and ulcerative colitis. Currently, there are not many studies in this section. As papers are published in this area, we will include them here. There are 6 total studies, all published within the last 6 years. Although a study may find, or not find, an association between PFASs and autoimmune outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Autoimmune

Plasma concentrations of perfluoroalkyl substances and risk of inflammatory bowel diseases in women: A nested case control analysis in the Nurses' Health Study cohorts

Study Purpose: The purpose of this study is to examine the association between plasma PFAS concentrations and risk of IBD (inflammatory bowel disease) among women in two studies.

Study Conclusion: These results do not support the hypothesis that elevated PFAS exposure is associated with higher risk of ulcerative colitis. 

Perfluoroalkyl substances are increased in patients with late-onset ulcerative colitis and induce intestinal barrier defects ex vivo in murine intestinal tissue

Study Purpose: Environmental factors are believed to contribute to inflammatory bowel disease. This study investigates whether high levels of PFAS are associated with late-onset inflammatory bowel disease and disturbances of the bile acid pool. This study also explores the effect of PFOA on intestinal barrier function in murine tissue.

Study Conclusion: PFAS levels are increased in patients with late-onset ulcerative colitis and may contribute to the disease by inducing a dysfunctional intestinal barrier.

Prenatal exposure to perfluoroalkyl substances modulates neonatal serum phospholipids, increasing risk of type 1 diabetes

Study Purpose: This study examines the effects during pregnancy on markers of type 1 diabetes risk in children.

Study Conclusion: Findings suggest that PFAS exposure during pregnancy contributes to the risk and development of type 1 diabetes in offspring.

Persistent organic pollutant exposure and celiac disease: A pilot study

Study Purpose: This study looks at the association between pollutants and celiac disease.

Study Conclusion: PFOS and PFOA exposure may increase the risk of developing celiac disease.

Inflammatory bowel disease and biomarkers of gut inflammation and permeability in a community with high exposure to perfluoroalkyl substances through drinking water

Study Purpose: PFASs have been associated to affect the gut, which could influence the development of inflammatory bowel disease. This study looks at the association of PFAS and clinically diagnosed inflammatory bowel disease in a population with high PFAS exposure.

Study Conclusion: The study found no consistent evidence to support that PFAS exposure is a risk factor for inflammatory bowel disease.

PFOA and ulcerative colitis

Study Purpose: This study examines if ulcerative colitis patients had higher levels of PFOA than the general population of Crohn's disease patients.

Study Conclusion: There were higher PFOA levels in ulcerative colitis patients compared to Crohn's disease patients or the general population, in contrast to other PFAS.

 

Hormones

Hormones includes information on male reproductive hormones (like testosterone), female reproductive hormones (such as estrogen), menopause, menstruation, and puberty as they relate to PFASs. This section has 27 total studies; 21 were published within the last 6 years. Although a study may find, or not find, an association between PFASs and autoimmune outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Puberty

Prospective associations of mid-childhood plasma per- and polyfluoroalkyl substances and pubertal timing

Study Purpose: Exposure to PFAS may disrupt pubertal timing. This study assesses associations between PFAS plasma concentrations in mid-childhood and markers of pubertal timing in male and female adolescents.

Study Conclusion: In this study, they found a higher plasma concentration of select PFAS at mid-childhood to be associated with later puberty in girls, but not boys.

Exposure to Perfluoroalkyl Substances during Fetal Life and Pubertal Development in Boys and Girls from the Danish National Birth Cohort

Study Purpose: This study looks at the associations between prenatal exposure to several PFASs and aspects of puberty in boys and girls.

Study Conclusion: These findings suggest that there are sex-specific associations of altered puberty and development with prenatal exposure to PFASs.

Menopause and post-menopause

Per- and Polyfluoroalkyl Substances (PFAS) and Hormone Levels during the Menopausal Transition

Study Purpose: PFAS are widespread and may affect sex hormones and accelerate reproductive aging in midlife women. This study examines associations between PFAS concentrations and serum concentrations of FSH, estradiol, testosterone, and sex hormone-binding globulin from 1999-2016.

Study Conclusion: This study observed positive associations of PFOA and PFOS with FSH and inverse associations of PFNA and PFOA with estradiol in midlife women during the menopausal transition, consistent with findings that PFAS affect reproductive aging.

Associations of Perfluoroalkyl Substances with Incident Natural Menopause: The Study of Women's Health Across the Nation

Study Purpose: This study looks at the association between PFASs and natural menopause.

Study Conclusion: This study suggests that PFAS levels are associated with earlier natural menopause.

Quantitative bias analysis for epidemiological associations of perfluoroalkyl substance serum concentrations and early onset of menopause

Study Purpose: This study looks at the epidemiologic association between PFAS and altered timing of menopause might be explained by reverse causality

Study Conclusion: This study found that much of the portion of the association between PFAS levels and early onset of menopause in women is reverse of what was expected. Early onset menopause affects PFAS levels.

Pregnancy

Exposure to perfluoroalkyl substances was associated with estrogen homeostasis in pregnant women

Study Purpose: Past studies have suggested that PFAS can act as endocrine disruptors. This study investigates the effects of serum PFAS on estrogen homeostasis during pregnancy.

Study Conclusion: This study explored associations between serum PFAS and estrogen homeostasis in Chinese pregnant women. Several serum PFAS were found to be associated with estrogen levels, suggesting that exposure to PFAS might disturb estrogen homeostasis during pregnancy. Exposure to PFAS have potential to cause a range of adverse health effects in mothers and fetuses by disturbing estrogen homeostasis and more studies are needed.

Joint effects of prenatal exposure to per- and poly-fluoroalkyl substances and psychosocial stressors on corticotropin-releasing hormone during pregnancy

Study Purpose: Prenatal exposure to PFASs has been associated with adverse pregnancy outcomes. Previous studies have suggested that join exposure to environmental chemicals and social stressors may lead to disparities in preterm birth. Elevated corticotropin-releasing hormone during mid-pregnancy may represent one biologic mechanism linking chemical and nonchemical stress exposures to preterm birth.

Study Conclusion: This cross-sectional study is the first to examine the relationship between PFAS exposure and CRH levels in mid-gestation. We found that these associations were stronger among women who experienced stress, which aligns with previous findings that chemical and nonchemical stressor exposures can have joint effects on health outcomes.

Perfluoroalkyl Chemicals, Menstrual Cycle Length, and Fecundity: Findings from a Prospective Pregnancy Study

Study Purpose: This study looks at the association between PFASs and menstrual cycle length and fertility.

Study Conclusion: Female preconception levels of PFOA and PFDeA were associated with changes in cycle length. Short and long cycles were associated with reduced fertility. There was some evidence that elevated levels of PFNA, PFOA, PFDeA, and PFOSA were associated with lower probability of pregnancy in some scenarios, but not all.

Sex and reproductive hormones

Environmental exposure to per- and polyfluoroalkyl substances mixture and male reproductive hormones

Study Purpose: This study assesses the associations of PFAS mixtures with male reproductive hormones.

Study Conclusion: These findings provide evidence that PFAS mixtures may reduce E2 levels and certain PFASs may have negative effects on Leydig cells in young men. Additional studies are needed to confirm these findings.

Perfluoroalkyl substances and sex hormones in postmenopausal women: NHANES 2013-2016

Study Purpose: This study looks at the associations between serum PFAS concentrations and sex hormone levels in postmenopausal women.

Study Conclusion: This study indicates that n-PFOA and PFHxS were associated with higher levels of several sex hormone indicators in postmenopausal women.

The Influence of Persistent Organic Pollutants on Thyroidal, Reproductive and Adrenal Hormones After Bariatric Surgery

Study Purpose: This study looks at the associations between environmental pollutants (such as PFASs) and thyroid, reproductive, and adrenal hormones in a population treated with bariatric surgery.

Study Conclusion: These results suggest that environmental pollutants may have an influence on hormones after bariatric surgery. Because this study was small, more research is needed.

Prenatal exposure to perfluorodecanoic acid is associated with lower circulating concentration of adrenal steroid metabolites during mini puberty in human female infants. The Odense Child Cohort

Study Purpose: This study looks at the associations between maternal PFAS levels in early pregnancy and levels of androgens and gonadotropins (both sex hormones) in infants within the first few months of life.

Study Conclusion: Prenatal PFDA exposure was associated with lower DHEA levels and possibly lower androstenedione and DHEAS levels in female infants.

Perfluorooctanoic acid alters progesterone activity in human endometrial cells and induces reproductive alterations in young women

Study Purpose: This study looks at the relationship between PFASs and hormonal endometrium regulation.

Study Conclusion: These results suggest that PFAS disrupt progesterone-mediated endometrial function.

Association between in utero perfluoroalkyl substance exposure and Anti-Müllerian hormone levels in adolescent females in a British cohort

Study Purpose: This study looks at the association between in utero PFAS exposure and Anti-Mullerian hormone (AMH; a reproductive hormone) in female adolescents.

Study Conclusion: These findings suggest there is no association between in utero PFAS exposure and AMH levels in female adolescents.

Association of perfluoroalkyl substances exposure with reproductive hormone levels in adolescents: By sex status

Study Purpose: This study looks at the effect of PFASs on reproductive hormones in adolescents.

Study Conclusion: This study suggested that higher levels of PFASs are associated with lower testosterone and higher estradiol levels, and associations of PFASs with reproductive hormones were stronger in males than in females.

Association of perfluoroalkyl substances exposure in utero with reproductive hormone levels in cord blood in the Hokkaido Study on Environment and Children's Health

Study Purpose: Exposure to PFASs may disrupt reproductive function in animals and humans. This study looks at the associations of prenatal exposure to PFASs with cord blood reproductive hormones.

Study Conclusion: These results suggest that reproductive hormones may be affected by in utero exposure to PFOS and PFOA.

Perfluoroalkyl Substances, Sex Hormones, and Insulin-like Growth Factor-1 at 6-9 Years of Age: A Cross-Sectional Analysis within the C8 Health Project

Study Purpose: Exposure to some PFASs may alter levels of sex hormones and insulin-like growth factor-1 (IGF-1) in animals. IFG-1 is a hormone that helps promote normal bone and tissue growth and development. Human studies in this area are limited. This study looks at the relationship between PFAS levels and estradiol, total testosterone, and IGF-1 in children who lived near a PFOA contaminated site.

Study Conclusion: These findings suggest that PFASs are associated with lower levels of IGF-1 and sex hormones in children.

Menstruation

Prenatal exposure to mixtures of persistent endocrine disrupting chemicals and early menarche in a population-based cohort of British girls

Study Purpose: In this study, they investigate the association between prenatal exposure to endocrine disrupting chemicals, including PFASs, PCBs, and pesticides with early menarche among female offspring.

Study Conclusion: The results of this study suggest the overall effect of prenatal exposure to persistent exposure to mixtures of endocrine disrupting chemicals is not associated with early menarche.

Plasma Perfluoroalkyl and Polyfluoroalkyl Substances Concentration and Menstrual Cycle Characteristics in Preconception Women

Study Purpose: This study looks at the association between PFAS exposure and menstrual cycle characteristics in women planning to become pregnant.

Study Conclusion: Certain PFASs are associated with abnormal menstruation.

Other

Associations between six common per- and polyfluoroalkyl substances and estrogens in neonates of China

Study Purpose: This study investigates the associations of PFASs and estrogen concentrations in newborns.

Study Conclusion: This study found associations between some PFASs and estrogen in newborns, but additional studies are needed to fully understand the effects of PFASs on estrogens.

Determinants of serum concentrations of perfluoroalkyl acids (PFAAs) in school children and the contribution of low-level PFAA-contaminated drinking water

Study Purpose: This study examines the health effects following low-dose PFAS exposure in school children.

Study Conclusion: 5th grade girls who reported onset of menstruation had lower PFHxS and PFOA levels than other girls.

 

Thyroid

The Thyroid section includes information on thyroid function and/or thyroid hormone levels in newborns, children, and mothers. It also includes studies examining hyper and hypothyroidism, hypothyroxinemia, and thyroid function following high PFAS exposure via water. This section has 35 total papers: 28 from the last 6 years. Although a study may find, or not find, an association between PFASs and thyroid outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Hypothyroidism and hyperthyroidism

High exposure to perfluorinated compounds in drinking water and thyroid disease. A cohort study from Ronneby, Sweden

Study Purpose: PFOS and PFHxS were found in the drinking water in Ronneby, Sweden. This study looks at the association between PFAS exposure in Ronneby and the incidence of thyroid disease.

Study Conclusion: There was no excess risk of hyperthyroidism among those with contaminated water.

Maternal and neonatal thyroid function and hormones

Maternal Perfluoroalkyl Substances, Thyroid Hormones, and DIO Genes: A Spanish Cross-sectional Study

Study Purpose: This study examines the relationship between first-trimester maternal PFAS and thyroid hormone levels and the role played by genetic polymorphisms in this association.

Study Conclusion: This study found higher PFOA levels to be associated with lower TT3 levels. Genes analyzed in this study did not appear to impact this association.

Umbilical cord serum perfluoroalkyl substance mixtures in relation to thyroid function of newborns: Findings from Sheyang Mini Birth Cohort Study

Study Purpose: This study looks at the possible associations of fetal exposure to PFAS individually and in mixtures with thyroid function in newborns.

Study Conclusion: This study observed thyroid disruption with some PFAS and mixtures of PFAS in cord blood.

Prenatal exposure to perfluoroalkyl substances and thyroid hormone concentrations in cord plasma in a Chinese birth cohort

Study Purpose: This study looks at the associations between prenatal PFAS exposure and thyroid hormone levels in umbilical cord blood.

Study Conclusion: This study suggests that prenatal exposure to many PFASs was associated with thyroid hormone levels in umbilical cord blood. Different PFASs had varied effects on fetal thyroid hormones.

Exposure to Perflouroalkyl acids and fetal and maternal thyroid status: a review

Study Purpose: This study looks at past studies on the relationship between prenatal and postnatal exposure to PFASs and thyroid hormones in mothers and/or infants.

Study Conclusion: Results of this study show a relationship between elevated PFAS concentrations and higher TSH levels, but lower T4 and/or T3 levels. Associations of infant thyroid hormones with PFAS concentrations were not consistent.

Perfluoroalkyl and polyfluoroalkyl substances and maternal thyroid hormones in early pregnancy

Study Purpose: This study aims to look at the relationship between PFAS and thyroid hormones in early pregnancy.

Study Conclusion: Several PFAS were associated with effects on maternal thyroid hormones in pregnant women, especially among women who were TPOAb positive.

Prenatal exposure to per- and polyfluoroalkyl substances and maternal and neonatal thyroid function in the Project Viva Cohort: A mixtures approach

Study Purpose: This study investigates the relationship between exposure to multiple PFAS during early pregnancy with maternal and neonatal thyroid function.

Study Conclusion: These findings support that there may be effects of prenatal exposure to multiple PFAS on maternal and neonatal thyroid function, but the overall effect may vary depending on the PFAS exposed to.

Maternal serum perfluoroalkyl substance mixtures and thyroid hormone concentrations in maternal and cord sera: The HOME Study

Study Purpose: This study looks at that association, using mixture modeling to assess the associations with individual PFAS, interactions among PFAS chemicals, and mixtures of PFAS.

Study Conclusion: These findings suggest that maternal PFAS levels in the second trimester of pregnancy are not strongly associated with thyroid hormones in mothers or infants.

Associations of Exposure to Perfluoroalkyl Substances With Thyroid Hormone Concentrations and Birth Size

Study Purpose: Thyroid function in pregnancy is necessary for fetal growth. Exposure to PFAS may decrease birth size and disrupt maternal and infant thyroid function, but the relationship is not completely clear. This study looks at the relationship between PFAS and birth size. It also looks at associations between PFAS and thyroid hormone concentrations.

Study Conclusion: Several PFAS were associated with increased thyroid hormones and lower birth sizes.

Perfluoroalkyl Substances and Maternal Thyroid Hormones in Early Pregnancy; Findings in the Danish National Birth Cohort

Study Purpose: The goal of this study was to look at maternal thyroid hormone levels and free T4 levels against PFAS chemicals in the first and second trimesters of pregnancy.

Study Conclusion: There were some associations between high exposure to PFAS and thyroid hormone levels in early pregnancy.

Association between perfluoroalkyl substance exposure and thyroid hormone/thyroid antibody levels in maternal and cord blood: The Hokkaido Study

Study Purpose: This study looks at the association between prenatal exposure to PFAS and the expression of thyroid hormones and thyroid antibodies in maternal and cord blood.

Study Conclusion: These results suggest that the thyroid disrupting effects of PFAS exposure and the susceptibility varies depending on maternal thyroid antibody levels.

Perfluoroalkyl and polyfluoroalkyl substances and fetal thyroid hormone levels in umbilical cord blood among newborns by pre-labor caesarean delivery

Study Purpose: Epidemiological evidence on the relationship between PFAS and thyroid hormone levels in cord blood is limited. This study aims to examine the association between cord blood PFAS concentrations and thyroid hormone levels in pre-labor cesarean deliveries.

Study Conclusion: These findings suggest that prenatal exposure to certain PFAS may disrupt fetal thyroid function; however, this may vary between sexes.

Maternal Plasma per- and Polyfluoroalkyl Substance Concentrations in Early Pregnancy and Maternal and Neonatal Thyroid Function in a Prospective Birth Cohort: Project Viva (USA)

Study Purpose: Prenatal exposure to some PFASs may disrupt maternal and neonatal function, which is needed for normal growth and neurodevelopment. This study looks at associations of PFAS exposure during early pregnancy with maternal and neonatal thyroid hormone levels.

Study Conclusion: Prenatal exposure to some PFASs during early pregnancy was inversely associated with maternal free T4 index and neonatal T4 in male infants. These results support the idea that prenatal exposure to PFASs influences thyroid function in both mothers and infants.

Exposure to perfluoroalkyl substances and thyroid function in pregnant women and children: A systematic review of epidemiologic studies

Study Purpose: Thyroid hormones are important for brain development during the fetal period and childhood. Several studies have assessed a possible association between exposure to PFAS and thyroid outcomes during the early stages of life. This study reviews this evidence.

Study Conclusion: There was an association between maternal or teenage male exposure to some PFAS and TSH levels based on current studies.

Placental Transfer of Perfluoroalkyl Substances and Associations with Thyroid Hormones: Beijing Prenatal Exposure Study

Study Purpose: This study looked at PFASs and thyroid hormone levels in maternal and infant cord blood samples around delivery.

Study Conclusion: Results suggest that prenatal exposure to PFASs could disrupt thyroid hormone levels in infants.

Infants, children, and the thyroid

Prenatal exposure to endocrine-disrupting chemicals and thyroid function in neonates: A systematic review and meta-analysis

Study Purpose: Thyroid homeostasis is necessary for normal brain development. Exposure to endocrine disrupting chemicals (EDCs), such as PFAS, is associated with compromised maternal thyroid homeostasis, and may lead to adverse neurodevelopmental outcomes in newborns. Therefore, a review was conducted to better understand the relationship between maternal exposure to EDCs and neonatal thyroid hormones was performed. 

Study Conclusion: Based on the current evidence, these results suggest that global EDC exposure has no significant influence on neonatal thyroid hormone levels. However, prenatal exposure to organochlorines and PFAS is negatively associated with neonatal TT4 level. Prenatal PCB-153 exposure is positively associated with neonatal TSH level. Consequently, we recommend that larger-scale cohort studies should be established to identify the relationship between prenatal EDC exposure and neonatal thyroid hormones. 

The Relationship Between Perfluoroalkyl Substances Concentrations and Thyroid Function in Early Childhood: A Prospective Cohort Study

Study Purpose: Exposure to PFAS has been suggested to affect thyroid function, but information on PFAS exposure and thyroid function in early childhood is limited.

Study Conclusion: A relationship between early-life exposure to PFAS and thyroid function was found. Early-life exposure to PFAS was associated with decreased TSH and increased fT4 or T3 levels among preschool-age children.

Association between exposure to persistent organic pollutants during pregnancy and thyroid function during childhood: a pilot longitudinal study and literature review

Study purpose: long term consequences of PFAS on thyroid function are not entirely known. This study looks at the associations between PFAS exposure and birth and thyroid function a few months after birth.

Study Conclusion: These results suggest that the PFAS levels at birth are not associated with TSH levels later in life.

Exposure to perfluoroalkyl substances (PFAS) and associations with thyroid parameters in First Nation children and youth from Quebec

Study Purpose: This study evaluated levels of PFAS in relation to concentrations of TSH, free T4, and thyroglobulin.

Study Conclusion: High exposures to PFNA may disrupt thyroid function in children.       

Perfluoroalkyl substances in serum from South Korean infants with congenital hypothyroidism and healthy infants--Its relationship with thyroid hormones

Study Purpose: Exposure to PFASs may disrupt thyroid function, though the effects of individual PFAS is still unknown. This study looked at exposure to PFAS in infants and levels of thyroid hormones.

Study Conclusion: There was no clear association between most PFASs and thyroid hormones.

Adult and general thyroid function and hormones

Chlorinated Polyfluorinated Ether Sulfonates and Thyroid Hormone Levels in Adults: Isomers of C8 Health Project in China
Study Purpose: Cl-PFESAs are a replacement for PFOS, however recent studies have shown that these replacements could interfere with thyroid function in animals. In this study, they focus on PFOS, PFOA, 6:2 Cl-PFESA, and 8:2 Cl-PFESA in the general adult population.

Study Conclusion: This study provided epidemiological evidence that exposure to Cl-PFESAs was associated with thyroid hormone levels in the general adult population, and the aforementioned dose–response associations were nonlinear. Our findings also support previous observational results of PFOS and PFOA in relation to thyroid hormone levels.

Associations between perfluoroalkyl substances and thyroid hormones after high exposure through drinking water
Study Purpose: This study looks at the possible association of thyroid hormones in relation to serum levels of PFAS in a Swedish general population, exposed through contaminated drinking water.

Study Conclusion: This study found no consistent results to support an association of PFAS with thyroid hormones.

Exposure to perfluoroalkyl substances and associations with serum thyroid hormones in a remote population of Alaska Natives

Study Purpose: This study aims to assess the relationship between PFAS levels and thyroid function.

Study Conclusion: Serum PFASs are associated with circulating thyroid hormone concentrations in a remote population of Alaska Natives. The effects of PFAS exposure on thyroid hormone levels may differ between sexes.

Association between perfluoroalkyl substances exposure and thyroid function in adults: A meta-analysis

Study Purpose: Epidemiological studies suggest that PFASs can disrupt thyroid hormones, though the association between PFAS exposure and thyroid function is not conclusive. This article is an analysis of several studies that investigates the association between PFASs exposure and thyroid function.

Study Conclusion: This review suggests that higher PFAS levels are associated with lower total T4 levels.

Other

Varied thyroid disrupting effects of perfluorooctanoic acid (PFOA) and its novel alternatives hexafluoropropylene-oxide-dimer-acid (GenX) and ammonium 4,8-dioxa-3H-perfluorononanoate (ADONA) in vitro

Study Purpose: In this study, the thyroid disrupting effects of PFOA and its alternatives GenX and ADONA with both rat thyroid cells and primary normal human thyroid cells.

Study Conclusion: Taken together, the data reveals that the thyroid disrupting effects is increased in the order of GenX>PFOA>ADONA.

The Impact of Smoking on the Association between Perfluoroalkyl Acids (PFAS) and Thyroid Hormones: A National Health and Nutrition Examination Survey Analysis

Study Purpose: This study looks at the effects of PFAS exposure on thyroid function. It also looks at the differences of these effects between smokers and non-smokers.

Study Conclusion: This study found that increased PFAS exposure was associated with increased free T4 levels in non-smokers, while no association was found in smokers.

Associations between longitudinal serum perfluoroalkyl substance (PFAS) levels and measures of thyroid hormone, kidney function, and body mass index in the Fernald Community Cohort

Study Purpose: This study looks at the association between PFAS and indicators of thyroid disruption, kidney function, and BMI.

Study Conclusion: PFAS levels were associated with altered kidney and thyroid function.

 

Bone and Joint Health

 

Osteoporosis

Osteoporosis includes information on bone health, bone disruption, osteoporosis and bone density, and vitamin D activity as they relate to PFASs. This section has 10 total studies; 9 were published in the last 6 years. Although a study may find, or not find, an association between PFASs and osteoporosis outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Osteoporosis

Associations of Maternal Serum Perfluoroalkyl Substances Concentrations with Early Adolescent Bone Mineral Content and Density: The Health Outcomes and Measures of the Environment (HOME) Study

Study Purpose: PFAS may impair bone strength, but there are few studies on the topic. This study assesses associations of individual PFAS and their mixture during pregnancy with child bone mineral content and bone mineral density at 12 years old.

Study Conclusion: This study found that maternal PFAS concentrations during pregnancy may be associated with lower bone mineral accrual and strength in early adolescence.

PFAS and potential adverse impacts on bone and adipose tissue through interactions with PPAR-gamma

Study Purpose: This paper discusses potential health significance of PFAS based on interactions with PPARalpha, one of the mechanisms believed to be behind PFAS health effects.

Study Conclusion: PFAS exert toxic effects through interaction with nuclear receptors, including PPAR, and may play a role in increased adipogenesis and decreased bone quality. Chemicals that target PPARs may lead to changes in cell differentiation and bone development that contribute to metabolic disorder and bone weakness.

Endocrine disrupting chemicals and bone

Study Purpose: This review of literature aims to summarize recent discoveries of effects of commonly found environmental chemicals on bone.

Study Conclusion: This review provides accumulating evidence of bone disrupting effects of endocrine disrupting chemicals, such as PFASs and BPA.

Bone Disruption and Environmental Pollutants

Study Purpose: This review of literature aims to report the current status of knowledge about the effects of endocrine disrupting chemicals (EDCs) on bone health.

Study Conclusion: Because many of the studies are from animal studies, more research is needed to better understand the association between PFASs/EDCs and bone health.

Serum concentrations of perfluoroalkyl substances and their association with osteoporosis in a population in Jeddah, Saudi Arabia

Study Purpose: This study looks at the association between PFAS levels and osteoporosis.

Study Conclusion: These results suggest that exposure to PFOA, PFOS, PFNA, PFHxS, and PFUnDA was associated with osteoporosis in this population.

Endocrine disruption of vitamin D activity by perfuorooctanoic acid (PFOA)

Study Purpose: This study looks at the possible ways PFOA might interfere with Vitamin D.

Study Conclusion: The study findings suggest that PFOA has negative effects on the expression of genes involved in calcium transfer.

Endocrine disruption of vitamin D activity by perfluorooctanoic acid (PFOA)

Study Purpose: This study looks at the possible ways PFOA might interfere with Vitamin D.

Study Conclusion: Our findings suggest that PFOA has negative effects on the expression of genes involved in calcium transfer, which would disturb calcium absorption in the intestine, resulting in a negative feedback on the parathyroid glands.

Perfluoroalkyl substances and bone health in young men: a pilot study

Study Purpose: Studies have indicated that PFAS can accumulate in bones. This study looked at the association between PFAS exposure and bone health in young men in an area with high PFAS pollution.

Study Conclusion: Results suggest an increased osteoporosis risk in young men exposed to PFAS.

Per- and Polyfluoroalkyl Substance Plasma Concentrations and Bone Mineral Density in mid-childhood: A cross-sectional study (Project Viva, United States)

Study Purpose: To learn more about factors affecting children's bone mineral density may help reduce the chance of osteoporosis later in life.

Study Conclusion: The study observed that children with greater plasma concentrations of select PFASs had lower aBMD z-scores during mid-childhood.

Per- and Polyfluoroalkyl Substance Plasma Concentrations and Bone Mineral Density in Mid-childhood: A Cross-Sectional Study (Project Viva, United States)

Study Purpose: Learning more about factors affecting children's bone mineral density may help reduce the chance of osteoporosis later in life.

Study Conclusion: We found that children with greater plasma concentrations of select PFASs had lower z-scores during mid-childhood.

Perfluoroalkyl substances in human bone: concentrations in bones and effects on bone cell differentiation

Study Purpose: This study investigates PFAS levels and their possible link to bone.

Study Conclusion: This study found PFASs present in bone, which may have the potential to affect human bone cells partly at environmentally relevant concentrations.

 

Arthritis

Arthritis includes information on osteoarthritis. Currently, there are not many studies in this section. As papers are published in this area, we will include them here. This section has 4 total studies; one published within the last 6 years. Although a study may find, or not find, an association between PFASs and arthritis outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all sexes, ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

Arthritis

Per-/polyfluoroalkyl substance concentrations in human serum and their associations with immune markers of rheumatoid arthritis

Study Purpose: It is unclear whether exposure to PFAS affects the risk of rheumatoid arthritis. In this study, nine PFAS were determined in human serum collected from 280 health populations and 294 rheumatoid arthritis patients in a cohort in China.

Study Conclusion: PFOS and PFOA were correlated with immune marker levels, which indicates that exposure to the relatively high concentration of PFAS may increase the risk of rheumatoid arthritis. The effects of 6:2 Cl-PFESA need further study. These results demonstrate that exposure to PFASs is immunotoxic and increases the risk of RA, but more studies are needed.

The influences of perfluoroalkyl substances on the rheumatoid arthritis clinic

Study Purpose: The impact of PFAS on the development of rheumatoid arthritis is unclear. This study explores that association.

Study Conclusion: Some PFAS chemicals are related to the disease activity of rheumatoid arthritis. This study speculates that PFAS may be an important environmental factor that contributes to the onset of rheumatoid arthritis and may lead to immune disorders in genetically predisposed individuals, leading to the onset or progression of rheumatoid arthritis.

Association of Osteoarthritis with Perfluorooctanoate and Perfluorooctane Sulfonate in NHANES 2003–2008

Study Purpose: PFASs are linked to health impacts that may be related to osteoarthritis. This study looks at whether PFOA and PFOS exposure are associated with the prevalence of osteoarthritis, and whether associations vary between men and women.

Study Conclusion: Higher concentrations of PFOA were associated with osteoarthritis in women, but not men. PFOS was also associated with osteoarthritis in women only.

Association of osteoarthritis with serum levels of the environmental contaminants perfluorooctanoate and perfluorooctane sulfonate in a large Appalachian population

Study Purpose: PFOA and PFOS affect metabolism, inflammation, and other factors related to the development of osteoarthritis. This study looks at the association of osteoarthritis with PFOA and PFOS in a large adult population from PFOA contaminated water districts in Ohio.

Study Conclusion: This study found an association between higher PFOA levels and more reported diagnosis of osteoarthritis. Higher PFOS levels were associated with less reported diagnosis of osteoarthritis.

 

General Health and Other Topics

General and Other covers studies that do not fit into the other categories listed or that deal with general topics of health. Some included studies are not PFAS exposure/health outcome measurements, rather, studies that may be of interest. These topics include: congenital heart defects, levels in food, dietary patterns, household dust, effects in pets, soil and groundwater in Eastern New York, biomonitoring, type of flooring, children’s health, personal care products, health and social concerns among affected communities, PFAS removal, and stroke as they relate to PFASs. This section currently has 49 total studies. Although a study may find, or not find, an association between PFASs and these outcomes, this does not mean it is, or is not, definitively a causative agent. Findings in studies are not necessarily generalizable among all ethnicities/races, smokers/non-smokers, and geographic areas; this should be considered when interpreting these results. Differences in findings between studies could be due to the population studied (demographics, geography, diet, etc.), size of the studies, differences in PFAS concentrations between studies, when samples were taken, or other factors.

 

General Health

Healthy eating index and diet diversity score as determinants of serum perfluoroalkyl acid (PFAA) concentrations in a national survey of Swedish adolescents

Study Purpose: Food is an important source of PFAS exposure for the general adult population, but we have little information on its importance for adolescents. Associations between serum PFAS concentrations and adolescent diet were determined in a nationally representative adolescent population from Sweden.

Study Conclusion: In this study, they conclude that Swedish adolescents that adhere to a more diverse and healthy diet appear to be more highly exposed to PFAS than those eating less healthy. Additional research is needed.

Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial

Study Purpose: Elevated levels of blood perfluoroalkyl and polyfluoroalkyl substances (PFASs) have been associated with a range of adverse health outcomes. Firefighters have been exposed to PFASs in firefighting foams and have previously been shown to have higher PFAS levels in blood samples than the general population. No interventions have been shown to reduce PFAS levels. The goal of this study is to examine the effect of blood or plasma donations on PFAS levels in firefighters in Australia.

Study Conclusion: Plasma and blood donations caused greater reductions in serum PFAS levels than observation alone over a 12-month period. Further research is needed to evaluate the clinical implications of these findings.

The relationship between multiple perfluoroalkyl substances and cardiorespiratory fitness in male adolescents

Study Purpose: This study used national data from 2003-2004 to investigate the relationship between PFAS levels and cardiorespiratory fitness in 13-19 year-old adolescents.

Study Conclusion: In summary, in a representative sample of the US population, higher exposure to PFASs, mainly PFNA, was negatively related to cardiorespiratory fitness. These correlations were mainly found in males. Given the results of this study, we suggest the implementation of universal serum PFAS screening in adolescents. Further research is needed to explore the dose–response relationship between PFNA exposure and CRF and to reveal its underlying mechanism.

Per- and Polyfluoroalkyl Substances and Risk of Myocardial Infarction and Stroke: A Nested Case–Control Study in Sweden

Study Purpose: PFAS are widespread and persistent pollutants that have been associated with elevated cholesterol levels. However, data on incident cardiovascular disease (CVD) is lacking. This study investigated the association of exposure to PFAS with risk of myocardial infarction and stroke and, subsidiary, with baseline blood lipids.

Study Conclusion: This study indicated that exposure to PFAS, although associated with increased cholesterol levels, did not associate with an increased risk of myocardial infarction, stroke, or their composite end point. The findings improve our knowledge on potential health effects of environmental contaminants in the CVD context.

Environmental pollutant exposure associated with altered early-life gut microbiome: Results from a birth cohort study

Study Purpose: Recent studies have shown that the gut microbiota interacts with environmental pollutants, but the effect of early exposure on the neonatal microbiome remains unknown. This study investigates the association between maternal exposure to environmental pollutants and changes in early-life gut microbiome development.

Study Conclusion: This study shows that maternal exposure to pollutants--at the late gestational period and during birth--associates with alterations in the infant's microbiome development. Also, early-life stressors were found to aggravate the pollutant effect on the microbiome. Microbiome alterations found in fecal samples from breastfed infants suggest exposure via breastmilk.

Association between the total plasma isomers of per- and polyfluoroalkyl substances and erythrograms in young and middle-aged Taiwanese populations

Study Purpose: This study explores the relationship between PFAS exposure and erythrocytes.

Study Conclusion: The results imply that PFOA/PFOS isomers may increase the weight and volume of Hb/RBC and that some isomers may have an additive effect on the Hb levels. However, it is also possible PFAS detected at a higher concentration may be due to its binding to higher levels of Hb. Further study is needed.

Internal exposure to perfluoroalkyl substances (PFAS) in vegans and omnivores

Study Purpose: To examine the relationship of PFAS levels and cholesterol levels in vegans and omnivores, a study was designed with 36 vegans and omnivores in Germany.

Study Conclusion: Lower levels of PFOS and PFNA, but not PFOA and PFHxS were observed in vegans compared to omnivores. Food frequency information allowed the identification of relevant food groups contributing to the levels of these PFAS. The strong impact of a vegan diet on levels of lipids, especially LDL cholesterol, were confirmed by this study. The association of PFAS and LDL cholesterol was found to be negligible.

Exposure to Perfluoroalkyl Chemicals and Cardiovascular Disease: Experimental and Epidemiological Evidence

Study Purpose: This study is a review of studies examining the hypothesis that exposure to PFAS is associated with increased risk of cardiovascular events or alteration in cardiovascular structure and function. This also analyzes recent scientific evidence linking exposure to PFAS to altered platelet function, which represents a possible explanation for an excess of arterial thrombosis in PFAS exposed populations.

Study Conclusion: Cumulating evidence indicates that the cardiovascular system may be the target of PFAS toxicity by increasing the risk of atherosclerosis-related thromboembolic events. Several studies indicate that metabolic disorders, including hyperlipidemia, diabetes mellitus, obesity and increased blood pressure may translate into increased cardiovascular events in the exposed populations, possibly through the endocrine disrupting activity of PFAS.

Mixture effects of prenatal exposure to per- and polyfluoroalkyl substances and polybrominated diphenyl ethers on maternal and newborn telomere length

Study Purpose: This study examined associations between prenatal exposure to PFAS, PBDEs, and maternal and newborn telomere length.

Study Conclusion: Our results indicate that prenatal exposure to PFAS and PBDE mixtures is modestly associated with longer telomere length among newborns. In our study, these associations were observed only when restricting to maternal–fetal unit pairs. This has implications for disease risk across the life course, as newborn telomere length is predictive of telomere length later in life [11] and telomere lengthening has been associated with increasing cancer risk later in adulthood [48]. Future studies are needed to elucidate the long term health effects of environmental exposure-induced telomere lengthening.

Impact of the increasing concentrations of selected perfluoroalkyl acids on the observed concentrations of red blood cell folate among US adults aged ≥20 years

Study Purpose: This study estimates associations between the concentrations of red blood cell folate and the concentrations of PFASs for US adults aged 20 and older.

Study Conclusion: Increasing concentrations of select PFASs are associated with decreased levels of red blood cell folate. The degree to which concentrations of red blood cell folate decrease depends on the size of the PFAS.

Dietary patterns and PFAS plasma concentrations in childhood: Project Viva, USA

Study Purpose: Diet is thought to account for most adult exposure to PFASs. Children are particularly vulnerable to adverse health effects of PFAS and may have different eating habits than adults. However, studies of dietary patterns and PFAS in children are limited.

Study Conclusion: This study examined food intake in association with PFASs in children and identified dietary determinants that may be sources of PFAS exposure.

Per-and Polyfluoroalkyl Substances in Human Serum Samples of Selected Populations from Ghana

Study Purpose: The aims of this study were to assess serum concentrations of PFASs in select groups from Ghana, including workers engaged in the repair of electronics.

Study Conclusion: The PFAS concentrations observed in the study are low compared to other populations. Electronics workers had significantly higher PFOA concentrations than other participants.

Per- and polyfluoroalkyl substances and calcifications of the coronary and aortic arteries in adults with prediabetes: Results from the diabetes prevention program outcomes study

Study Purpose: This study investigates the contribution of PFAS to the development of arterial calcification in prediabetics.

Study Conclusion: In this study, prediabetic adults with higher levels of some PFASs had higher risk of coronary and thoracic aorta calcification. PFAS exposure may be a risk factor for adverse cardiovascular health among high-risk populations.

The concentration of several perfluoroalkyl acids in serum appears to be reduced by dietary fiber

Study Purpose: Fiber-rich food intake has been associated with lower levels of PFASs in some studies. This study looks at the relation of PFAS levels to intake of fiber.

Study Conclusion: These results suggest that dietary fiber intake increases the excretion of PFOA, PFOS, and PFNA.

Perfluoroalkyl substances and likelihood of stroke in persons with and without diabetes

Study Purpose: The goal of this study is to evaluate the relationship of PFASs with stroke, and whether diabetes influences this relationship.

Study Conclusion: In this study, an inverse relationship was associated with PFHxS/PFOS and stroke among those with diabetes. The data suggest that PFASs do not increase the risk of stroke among persons with or without diabetes.

Children's Health

PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents

Study Purpose: Residents of northeast Italy were exposed to highly contaminated drinking water for decades. This study evaluated associations in this population between serum PFAS concentrations and metabolic outcomes.

Study Conclusion: This study supports the association between PFAS concentration and serum lipid levels, which is stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.

Association between maternal serum concentration of perfluoroalkyl substances (PFASs) at delivery and acute infectious diseases in infancy

Study Purpose: PFAS are persistent compounds that have been recognized as important immune hazards by animal studies. However, human studies regarding the impact on infant infections are inconsistent. This study investigates the associations between prenatal exposure to PFAS and acute infectious diseases including common cold, bronchitis/pneumonia, and diarrhea in early childhood.

Study Conclusion: Exposure to PFASs was associated with increased risks of diarrhea during the first year of life, and these effects were stronger among the breastfed infants. Due to the small sample size, our results should be interpreted with caution and additional studies on larger populations are needed to confirm our findings.

Early-Life Exposure to Per- and Poly-Fluorinated Alkyl Substances and Growth, Adiposity, and Puberty in Children: A Systematic Review

Study Purpose: This is a review of literature that assesses the effects of early-life PFAS exposure on prenatal and postnatal growth, adiposity, and puberty in children and adolescents. 

Study Conclusion: Further investigation is warranted to clarify PFAS-induced effects on growth and physical development in consideration of the critical time-window of exposure, concomitant exposure to chemical mixtures including various PFAS types, and possible non-monotonic dose-response relationship for growth and adiposity trajectories.

Gestational exposure to perfluoroalkyl substances and congenital heart defects: A nested case-control pilot study

Study Purpose: This study is the first to test associations between gestational PFAS exposure and the risk of congenital heart defects.

Study Conclusion: These findings suggest that gestational exposure to most PFAS was associated with greater risks for septal and conotruncal defects. However, a larger study is needed to confirm these findings.

Gestational and childhood exposure to per- and polyfluoroalkyl substances and cardiometabolic risk at age 12 years

Study Purpose: To study whether there is any connection between prenatal and early childhood PFAS exposure and heart health risk in adolescence.

Study Conclusion: Exposure to PFOA and PFHxS during gestation, compared to childhood, was more strongly associated with unfavorable cardiometabolic risk scores at age 12 years in this cohort of children with higher gestational PFOA exposure. Gestational and childhood PFOS and PFNA exposure were generally not associated with cardiometabolic risk scores at age 12 years. Gestational exposure to the four PFAS was aggregately associated with unfavorable cardiometabolic risk.

Associations between perfluoroalkyl acids in serum and lead and mercury in whole blood among US children aged 3-11 years

Study Purpose: Data for US children aged 3-11 during 2013-2014 were analyzed for values of blood lead and mercury in association with PFAS levels.

Study Conclusion: Because PFASs and lead/mercury are known to be neurotoxins and endocrine disruptors, exposure to both may lead to increased neuro-developmental deficits.

Urine concentrations of perfluoroalkyl acids in children and contributions of dietary factors: a cross-sectional study from Shanghai, China

Study Purpose: In this study, the specific urine levels of 10 PFAAs were obtained from 189 children (age 8-12 years) from two primary schools located in urban and suburban areas of Shanghai in 2019, and the contributions of dietary factors were investigated.

Study Conclusion: In this study, school children showed prevalent exposure to short-chain PFAAs such as PFHxA, PFHpA, PFBS, and several traditional long-chain PFAAs. Frequent consumption of red meats, tubers, sugared beverages, fish and seafood, and eggs contributed to higher concentrations of PFAAs, while frequent consumption of poultry and soy milk contributed to lower PFAA concentrations.

Perfluorooctanoic acid (PFOA) or perfluorooctane sulfonate (PFOS) and DNA methylation in newborn dried blood spots in the Upstate KIDS cohort

Study Purpose: This study examines relationships between PFOA and PFOS with DNA changes among nearly 600 infants.

Study Conclusion: There was limited evidence of an association between high concentrations of PFOA/PFOS and DNA changes in newborns in this study.

Exposure to Perfluorinated Alkyl Substances and Health Outcomes in Children: A Systematic Review of the Epidemiologic Literature

Study Purpose: This study summarized previous studies looking at the relationships between childhood exposure to PFAS and health outcomes in children.

Study Conclusion: There were inconsistent findings on associations between PFAS and neurodevelopmental outcomes.

Early-life exposome and lung function in children in Europe: an analysis of data from the longitudinal, population-based HELIX cohort

Study Purpose: This study looks at possible associations between prenatal and postnatal environmental exposures that may affect lung function in children.

Study Conclusion: Our results suggest that prenatal exposure to PFASs (perfluorononanoate and perfluorooctanoate) and postnatal exposure to copper, ethylparaben, DEHP and DINP metabolites, and house crowding are associated with a lower Forced Expiratory Volume (FEV₁) in childhood.

Other

Perfluoroalkyl acid and bisphenol-A exposure via food sources in four First Nation communities in Quebec, Canada

Study Purpose: The objective of this study was to document PFAS and BPA exposure in First Nations communities in Quebec compared to the general Canadian population to examine the associations between dietary consumption and chemical exposure. 

Study Conclusion: These results highlight the importance of better documenting food-processing and packaging methods, particularly for dairy products, and their contribution to endocrine disruptors exposures as well as to promote minimally processed and unpackaged foods to provide healthier food environments for youth in Indigenous communities and beyond.

Gestational Perfluoroalkyl Substance Exposure and DNA Methylation at Birth and 12 Years of Age: A Longitudinal Epigenome-Wide Association Study

Study Purpose: This study examines associations of gestational PFAS exposure with longitudinal DNA methylation measures at birth and in adolescence using the Health Outcomes and Measures of the Environment (HOME) Study.

Study Conclusion: In this study, PFAS was associated with differences in several DNA sites at bitrh and at 12 years of age in or near genes linked to some PFAS-associated health outcomes.

Perfluoroalkyl substances influence DNA methylation in school-age children highly exposed through drinking water contaminated from firefighting foam: a cohort study in Ronneby, Sweden

Study Purpose: A potential mechanism of toxicity for PFAS is through epigenetic changes, such as DNA methylation. No study has evaluated how PFAS influence DNA methylation among children of school age. In this study with school-age children exposed to PFAS-contaminated drinking water, they aimed to investigate whether exposure to PFAS was associated with alteration in DNA methylation and epigenetic age acceleration.

Study Conclusion: In conclusion, we found that PFAS exposure was associated with DNA methylation at specific genomic positions and regions in children at school age. Most DMPs and DMRs were hypermethylated in the high-exposure group compared to the control group.

Association of exposure to prenatal perfluoroalkyl substances and estrogen receptor 1 polymorphisms with the second to fourth digit ratio in school-aged children: The Hokkaido study

Study Purpose: This study investigated whether ESR1 polymorphisms modify the effects of prenatal PFAS exposure on 2D:4D. 

Study Conclusion: This study demonstrated that prenatal exposure to PFAS is associated with higher (feminized) 2D:4D, and that children with the AA genotype at rs9340799 or rs2077647 showed higher 2D:4D when exposed to PFOA or PFDoDA. These associations were apparent only among males. These findings suggest that prenatal exposure to PFAS affects 2D:4D and ESR1 polymorphisms modify the effects of prenatal exposure to PFAS on 2D:4D.

Association between maternal per- and polyfluoroalkyl substance exposure and newborn telomere length: Effect modification by birth seasons

Study Purpose: Telomere length is a marker of biological aging and disease that may be affected by prenatal exposure to environmental pollutants. This study explored the individual and combined effects of maternal PFAS exposure on newborn telomere length.

Study Conclusion: Maternal PFAS exposure showed little association with newborn telomere length. The results suggested that birth season may effect the association between PFOA exposure and newborn telomere length.

Cross-sectional associations between serum PFASs and inflammatory biomarkers in a population exposed to AFFF-contaminated drinking water

Study Purpose: The goal of this study is to estimate associations between serum PFAS and markers of inflammation among adults in a population exposed to aqueous film forming foam-contaminated drinking water.

Study Conclusion: This study observed preliminary evidence of altered inflammatory profiles among adults with elevated serum concentrations of PFAS due to contaminated drinking water. 

Mixed effects of perfluoroalkyl and polyfluoroalkyl substances exposure on cognitive function among people over 60 years old from NHANES

Study Purpose: Literature on the relationship between PFAS and cognitive function are inconsistent and the effects of PFAS on cognitive function are still unclear. We aimed to evaluate the effects of PFAS on cognitive function.

Study Conclusion: This study demonstrated that PFAS mixture at a low level of exposure might have a protective effect on cognitive function in the US general population. Additional cohort studies that measure the concentration of serum PFAS and cognitive function in the general population annually are needed to
confirm the relationship between PFAS exposure and cognitive function.

Perfluoroalkyl Substances and Abdominal Aortic Calcification

Study Purpose: The goal of this study is to evaluate if serum PFAS were associated with abdominal aortic calcification.

Study Conclusion: These findings do not provide support for a relationship of PFAS exposure to AAC, although the results show a need for gender-specific consideration in a larger dataset.

Assessment of exposure to perfluoroalkyl substances (PFASs) in dogs by fur analysis

Study Purpose: This study evaluates dog exposure to PFASs by analyzing fur samples.

Study Conclusion: PFOA and PFBuA had the highest concentrations in dog fur. The correlation between PFAS concentration and health of dogs must be studied further.

Use of glioma to assess the distribution patterns of perfluoroalkyl and polyfluoroalkyl substances in human brain

Study Purpose: This study conducted an assessment of PFAS in brain glioma tissues.

Study Conclusion: This study is the first to report PFAS in human brain glioma. These trends of PFAS in brain glioma were similar to those in health autopsy brain tissues and their concentrations increased with age.

Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco

Study Purpose: Chemical exposures can affect telomere lengths, which has been associated with outcomes such as cancer. Firefighters are exposed to many hazardous chemicals and have higher rates of certain cancers. As a potential biomarker of effect, this study assesses associations between chemical exposures and telomere length in female firefighters and office workers in San Francisco.

Study Conclusion: Our findings suggest positive associations between PFAS and telomere length in women workers, with larger effects seen among firefighters compared to office workers. The OPFR metabolites BDCPP and BCEP are also associated with telomere length in firefighters and office workers. Associations between chemical exposures and telomere length reported here and by others suggest mechanisms by which these chemicals may affect carcinogenesis and other adverse health outcomes.

Understanding the Impact of Perfluorinated Compounds on Cardiovascular Diseases and Their Risk Factors: A Meta-Analysis Study

Study Purpose: Many studies have reported the association between PFAS exposure with the risk of developing cardiovascular diseases. However, these findings are still debated. Thus, this review analyzes the association of PFAS with CVDs and their risk factors in humans by systematic review and meta-analyses.

Study Conclusion: Although the risk of PFOA and PFOS were positively associated with cardiovascular disease and its risk factors, more observational studies shall be carried out to identify long-term effects of PFAS in cardiovascular disease development in patients.

Exposure, health effects, sensing, and remediation of the emerging PFAS contaminants – Scientific challenges and potential research directions

Study Purpose: In this discussion, researchers discuss challenges in studying PFAS.

Study Conclusion: Increasing awareness of the issues surrounding PFAS accumulation and exposure has led to widespread recognition that contamination from these chemicals is a major emerging environmental and health threat to communities across the country. Research into the effects of PFAS on the environment and human health and into determining best practices for detection and remediation are urgently needed to address the challenges of PFAS contamination. PFAS-related research is a fast-moving, dynamic, and cross-cutting area of study, and Connecticut and New York are two of the states that have established their own programs to investigate and prevent PFAS exposure. Our multi-disciplinary team, in conjunction with other regional efforts, is working to set the standard for future PFAS research and to encourage a broad range of scientific experts to bring research initiatives into play on a national scale.

Per-and polyfluoroalkyl substances (PFAS) in livestock and game species: A review

Study Purpose: This reviews information on PFASs in livestock and game as a source of dietary exposure in humans.

Study Conclusion: Due to limited information on the topic, the health effects of livestock consumption is still unknown.

Study protocol for a randomised controlled trial examining the effect of blood and plasma donation on serum perfluoroalkyl and polyfluoroalkyl substance (PFAS) levels in firefighters

Study Purpose: This is a randomised controlled trial of current and former Australian firefighters in the Metropolitan Fire Brigade/Fire Rescue Victoria, and contractors, with previous occupational exposure to PFAS and baseline elevated PFOS levels. The study is investigating whether whole blood donation every 12 weeks or plasma donation every 6 weeks will significantly reduce PFAS levels, compared with a control group.

Study Conclusion: This is a randomised controlled trial of current and former Australian firefighters in the Metropolitan Fire Brigade/Fire Rescue Victoria, and contractors, with previous occupational exposure to PFAS and baseline elevated PFOS levels. The study is investigating whether whole blood donation every 12 weeks or plasma donation every 6 weeks will significantly reduce PFAS levels, compared with a control group. We have used covariate-adaptive randomisation to balance participants’ sex and blood PFAS levels between the three groups and would consider a 25% reduction in serum PFOS and PFHxS levels to be potentially clinically significant after 12 months of whole blood or plasma donation. A secondary analysis of health biomarkers is being made of changes between screening and week 52 in all three groups.

Reverse osmosis and nanofiltration membranes for highly efficient PFASs removal: overview, challenges and future perspective

Study Purpose: This review provides outlook on advances in reverse osmosis and nanofiltration technologies for PFAS removal.

Study Conclusion: RO and NF membranes have started being used in water purification for PFAS removal, with promising results. However, they are not able yet to assure PFAS levels under the established guidance limits for drinking water. Problems still persist in fouling control, which hinders abilities for this to be applied at large scales.

Per-and polyfluoroalkyl substances (PFASs) in Swedish household dust and exposure of pet cats

Study Purpose: PFASs are in a wide range of products and have been found in indoor environments, and there is evidence that exposure to PFAS can have adverse effects. Pet cats have a high dust intake due to their grooming behavior and have been shown to be a suitable species for assessment of toddler's exposure. In this study, they used paired household dust and cat serum samples to establish whether dust is a relevant exposure pathway to PFASs.

Study Conclusion: This study found that dust could be an exposure pathway for the ingestion of some PFASs for cats, and the serum levels of PFASs could be of relevance for the cat's health.

PFAS soil and groundwater contamination via industrial airborne emission and land deposition in SW Vermont and Eastern New York State, USA

Study Purpose: This study aimed to understand the extent to which airborne PFAS emissions can impact soil and groundwater. This was conducted by sampling areas of conserved forest near Bennington, Vermont and Hoosick Falls, NY.

Study Conclusion: PFAS soil sampling revealed significant addition of PFOA in areas local to and downwind of factories that emitted PFAS to the atmosphere during baking of wet dispersions. The presence of elevated PFOA in groundwater seeps and springs within the green Mountain National Forest in the downwind region supports that air-emitted PFAS can cause groundwater contamination over large areas downwind of emission sites.

Household low pile carpet usage was associated with increased serum PFAS concentrations in 2005-2006

Study Purpose: This study aimed to examine the associations between serum pfas concentrations and the type of flooring among the general US population aged 12 years and older.

Study Conclusion: These results are representative of the general US population at the time of the survey, and show that type of flooring may affect PFAS exposure. This study found that low pile carpeting was associated with increased serum concentrations of PFHxS and MeFOSAA.

Per-and polyfluoroalkyl substances in serum and associations with food consumption and use of personal care products in the Norwegian biomonitoring study from the EU project EuroMix

Study Purpose: This study, conducted in Norway, examined the PFAS concentrations and associations with diet and use of personal care products.

Study Conclusion: The participants of the study were exposed to PFASs through their diet and personal care product use. Several PFASs were found to be associated with fish consumption. Sunscreen, mouthwash, and lip gloss/lip balm were found to be associated with some PFASs.

Health and social concerns about living in three communities affected by per- and polyfluoroalkyl substances (PFAS): A qualitative study in Australia

Study Purpose: In Australia, concentrations of PFASs have been found in environments close to sites where firefighting foams were historically used for firefighting. This has resulted in significant community concern about the potential long-term health effects of these chemicals. This study describes residents' perceptions and experiences of PFAS in three Australian towns where exposure has occurred.

Study Conclusion: 180 residents attended 15 focus groups in the three communities. They included 69 First Nations People. Study participants were concerned about potential physical health effects of exposure to PFAS, such as cancer clusters, unexplained deaths, potential exacerbation of existing health conditions, and the future health of their children. They expressed feelings of stress and anxiety about living with uncertainty related to the possible health and the socio-economic impacts of PFAS contamination in their communities. While research has concentrated on the physical health effects of PFAS, more attention needs to be given to the immediate psychosocial impacts of living in an affected community.

Community

 

Community Advisory Panel

As part of this study, UAlbany and the New York State Department of Health have established a Community Advisory Panel (CAP). CAP members are voluntary, unpaid individuals from the Village of Hoosick Falls and Newburgh communities. The CAP for each community advises us on our study progress and communication of study progress and results, relays community questions and concerns, and encourages community outreach and participation. The CAPs are a critical partner in this study!

We will post upcoming CAP meetings and the registration link under the “Upcoming Events” section of our main study page and on our Facebook page. All CAP meetings are open to the public.

 

Community Advisory Panel Members

City of Newburgh

  • Jack Caldwell
  • Anthony Grice
  • Edward Lawson, Jr., JD, MBA
  • Genie Polycarpe
  • Linda Romano, BSN, RN, Health Science Educator

Village of Hoosick Falls and Hoosick Area

  • Loreen Hackett
  • Emily Marpe

Town of Petersburgh

  • Kathy and Ira Share
Community Advisory Panel Meetings
2.2.2021 CAP Meeting Video Recording, Agenda, and Transcript
3.2.2021 CAP Meeting Video Recording, Agenda, and Transcript
4.22.2021 CAP Meeting Video Recording, Agenda, and Transcript
6.15.2021 CAP Meeting Video Recording, Agenda, and Transcript
9.22.2021 CAP Meeting Video Recording, Agenda, and Transcript
11.3.2021 CAP Video Meeting Recording, Agenda, and Transcript

Todas las reuniones del PFAS PAC y las presentaciones de la comunidad están disponibles en español y criollo haitiano en el menú extendido.

Tout reyinyon PFAS CAP ak prezantasyon kominotè yo disponib nan lang panyòl ak kreyòl Ayisyen anba desann meni.

PFAS Study Participation

 

How To Participate in the Study

If you live in the Hoosick Falls Area or in the City of Newburgh, you may be invited to take part in the national Multi-site PFAS Health Study. Maps of study boundaries for the two communities are below. About 1,000 adults and 300 children from these communities will be randomly selected to join the study. Please consider taking part if you receive an invitation letter. The more people who participate, the more we’ll learn about how PFAS in drinking water affects health.

Eligible adults and children are being asked to complete a health clinic visit and to provide a blood and urine sample to learn more about chemicals such as per- and polyfluoroalkyl substances (PFAS) and health. All personal information collected as part of this study will be kept private and secure. Please consider taking part to get your free, confidential test results and gift cards as a thank you for your participation.

Why is the study important?

This is the first national study to look at PFAS and human health effects including:

  • Increased cholesterol levels
  • Changes in liver enzymes
  • Decreased vaccine response in children
  • Behavioral and developmental outcomes in children
  • Increased risk of high blood pressure or preeclampsia in pregnant women
  • Small decreases in infant birth weights

What we learn by working with other researchers nationwide will benefit all communities across New York State and the U.S. Researchers will look closely at the role PFAS may play in various health outcomes by analyzing results from blood tests, health-related laboratory tests and assessments, medical, exposure histories and children’s educational records. Researchers will also collect information about cancers, but the size of the study is not large enough to effectively evaluate the relationship between PFAS exposure and cancer.

Who is eligible to participate?

People must be invited to participate. People living in the Hoosick Falls Area or in the City of Newburgh will be randomly selected and mailed an invitation packet. People who are invited and interested should follow the instructions in their invitation packet to see if they are eligible to take part in the study. Those who are eligible must be:

Adults, 18 years or older, who received an invitation packet and who:

  • Lived in Newburgh or the Hoosick Falls Area and used drinking water with documented PFAS contamination between 2005 and 2016 in these communities
  • Never worked or trained as a firefighter or volunteer firefighter
  • Never worked at an industrial facility that used PFAS chemicals in the manufacturing process

Children, ages 4 through 17 years with a parent or guardian’s permission, who received an invitation packet and who:

  • Lived in Newburgh or the Hoosick Falls Area and drank local water between 2005 and 2016 or;
  • Were born to or breastfed by a mother who meets the adult eligibility described above
What are the next steps if I participate and am eligible?

If you are eligible, we will schedule your health clinic visit. You will also receive an appointment information packet in the mail with instructions and directions to the health clinic. Our staff will call you to remind you about your appointment one or two days before your appointment.

Can I take part in the study as an individual or a family member?

Yes. Participants may be eligible to take part in the study as an adult or as a family member. Families may also enroll one or more child to participate.

Do I need to speak English or be a US Citizen to participate?

No. You do not need to be a United States citizen to participate. If you speak a language other than English, we can provide a translation for you.

What health information is collected?

Participants will be scheduled for a health clinic visit where trained health professionals will:

  • Collect and test blood and urine samples
  • Take body measurements
  • Ask about your medical and exposure history
  • Conduct a behavioral assessment of child participants.
  • Ask permission to access previous blood testing information and medical records as well as educational records for child participants.

Blood and urine will be tested for PFAS levels and health markers such as cholesterol, immune system, kidney, liver, and thyroid function. We will ask about some diseases like diabetes and cancer. We will also explore if certain metals combined with PFAS exposure are related to developmental outcomes in children and neurological outcomes in adults. Everyone who participates in the Multi-site PFAS Health Study will be included in this effort. We may also ask permission to access newborn screening samples already on file with New York State to test them for PFAS exposure. More information about measuring PFAS in newborn dried blood spots.

Can participants choose which parts of the study they want to do?

Yes. Participants may choose the parts of the study that they wish to complete.

What are the costs and benefits of participating?

The Multi-site PFAS Study is paid for by the Agency for Toxic Substances and Disease Registry at no cost to participants. Those who choose to participate will receive their individual test results and reports. In addition, participants will earn a gift card for each study element they complete.

Can participants change their mind after they enroll?

Yes. Participants may stop taking part in the entire study or parts of the study any time by notifying study staff.

How are participants’ information being used?

Information collected will be used to prepare group-level reports that compare exposures and health outcomes within these communities and with those of other areas being studied. Participants will not be able to be identified in any presentations, reports or articles made public.

Will participants get their individual results?

Yes. Confidential, individual test results will be shared with participants when results are available along with letters to help them interpret the information.

Common Questions

For questions related to participating in the study, please refer to the New York State Department of Health Frequently Asked Questions About the Multi-site PFAS Health Study.

How-To Prepare For Your Clinic Visit
Will transportation be provided to the health clinic?

We will provide local transportation to anyone who requests it.

Before your visit
  • Don’t eat 8 hours before your appointment
  • Take your medications, unless your doctor says otherwise
What to expect at your visit

With your permission, our trained professional health clinic staff will be prepared to complete the following for each adult and child participant:

  • Measure height, weight, waist, hip, and blood pressure.
  • Receive your urine sample that was collected that morning.
  • Collect a fasting blood sample from a vein in your arm.
  • Complete a health questionnaire about your exposure and medical history. Families will be asked to complete a questionnaire for each child.
  • If you are a parent, we will also ask you to complete an assessment of your child’s attention and behavior.
  • Conduct a behavioral assessment for each child. These tests should not be tiring for your child.
  • If you participated in a previous New York State Department of Health PFAS blood testing program, we will ask for your consent to access your previous blood testing information and to use any leftover sample for additional analyses.
What questions will I be asked at my health clinic visit?
  • For adults and children, we will ask about your health, your drinking water, your family health history, and your job/school history.
  • For adults only, we will ask about health behaviors such as use of alcohol and tobacco.
  • If you do not know or do not remember an answer to any of the questions asked, you can simply say so.
Can I complete the health clinic questionnaire by telephone?

We prefer to conduct interviews face-to-face at the health clinic visit for quality control purposes. If you are not able to finish the interview at the health clinic visit, we can arrange to complete it later with one of our trained study staff.

Can someone else complete the health clinic questionnaire for me?

No. It is important that we collect this information from adult participants directly. For child participants, parents or guardians will be asked to complete these questions for each child.

If needed, a household member may assist you during the interview. Language interpreters will also be available for participants wishing to complete the interview in a language other than English.

What not to expect at your visit
  • Drug or genetic testing
Children participants at your visit

If your child is participating, we will need the following information:

  • Bring child’s first morning urine sample
  • Be ready to talk about medical, school history, and drinking water habits
  • Bring a list of all medications
  • Bring any previous PFAS blood testing results
  • Your child should take medications, unless your doctor says otherwise

If your child is participating, the process will be the same as adults with two additions:

  • A parent or guardian must be with the child who can answer questions about the birth mother’s pregnancy
  • Children age 4 years and older will be asked to complete behavioral tests like:
    • Playing memory games
    • Sorting items into categories
    • Solving puzzles
    • Reacting to photos and pictures
  • This process should take 2-2.5 hours

Note: While you wait, we’ll have crayon and coloring books for young children. Feel free to bring electronic devices, games, or books from home. As a thank you, you will receive a gift card for each part of the study you complete.

How long will the health clinic visit take?

The visit to the health clinic will take about up to 1-1 ½ hours per adult and between 2-2 ½ hours for families with children. Families may be scheduled a second visit to complete testing.

Why must participants sign written consent forms?

We are required to have a signed consent before we measure the levels of the chemicals in blood and urine, collect your health data or access your records. Participants may be asked to sign and return multiple consent forms.

What will you test for in my blood and urine?

We will test your blood for various PFAS chemicals along with metals (such as lead,  mercury, and cadmium levels). We will also test your blood for health markers like cholesterol, liver enzymes, kidney function, sex, and thyroid hormones. These markers will help us learn more about how PFAS affect health. These are common markers used by health care providers to assess health.

Your urine sample will be stored and may be used later as part of this research study.

How will my personal information be handled?

Your personal information is protected by New York State and Federal laws. This research is covered under a Certificate of Confidentiality, which means your identity cannot be revealed without your consent. All personal information collected as part of this study will be kept private and secure:

  • A unique participant ID will conceal (de-identify) each participant’s identity, using a code number instead of their name for all study information and test results
  • All personal information will be locked in a secure study office and maintained on a password-protected network with restricted access only to those study staff who are trained to protect privacy and who need access that information for study purposes
  • No personal, identifiable information will be shared. Only de-identified information will share with other scientists using the assigned participant IDs.

As mandated by the New York State Public Health Law, all measured levels of lead and elevated levels of mercury, and cadmium above certain limits are reportable to the New York State Department of Health Heavy Metals Registry. All information reported to the registry is kept confidential.

Common Questions

For questions related to participating in the study, please refer to the New York State Department of Health Frequently Asked Questions About the Multi-site PFAS Health Study.

Still have questions?

 

Events

 

Future Events

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Past Events

Resources

What are PFAS?
Per- and Polyfluorinated Substances (PFAS)

PFAS are a group of chemicals used to make coatings and products that can resist heat, water, oil, grease, and stains. These coatings can be found in many products, such as clothing, furniture, adhesives, food packaging, non-stick cooking surfaces, and electrical wire insulation. Many PFAS, including PFOS and PFOA, are a concern because they do not break down in the environment, they can contaminate drinking water, and they can buildup in fish and wildlife.

PFAS have been found in bodies of water and in many types of animals, both aquatic and on land.

PFAS Exposure

PFAS exposure can occur by consuming PFAS-contaminated water or food. Use of products containing PFAS may also lead to exposure. Common items with PFAS can include:

  • Food packaging: microwave popcorn, fast food wrappers, takeout containers
  • Household items: makeup, floss, waxes, paints, stains
  • Stain-resistant products: carpets, rugs, and furniture
  • Non-stick cookware, such as Teflon pans
  • Outdoor gear or clothing with water repellent coatings
  • Firefighting foams
How PFAS Affect Our Health

Human health effects from exposure to low levels of PFAS are uncertain. Studies in animals exposed to higher levels of PFAS indicate that some PFAS may affect growth and development, reproduction, thyroid function, immunity, and liver function. Studies on the effects of PFAS exposure can also be found under the Research tab. More research is necessary, however, to further assess the human health effects of exposure to varying levels of PFAS.

Other great resources offering information on PFAS include:

PFOA Alternatives

GenX is a chemical substitute for PFOA. Studies are being conducted and released on this chemical. More information can be found here.

Guidance for Medical Professionals
National Academies of Sciences Engineering Medicine

Please visit the National Academies website for more information.

Additional Research Projects
How is the Multi-site PFAS Health Study different from other blood testing programs conducted in the Newburgh and Hoosick Falls Area communities?

The purpose of this study is to learn more about PFAS levels and health effects in study participants from across the United States. Participants will be asked to complete a health clinic visit that includes health evaluations along with blood testing to explore if PFAS could be related to health outcomes. Data collected will be combined with those from other participants in California, Colorado, Massachusetts, Michigan, New Jersey, and Pennsylvania to create a larger study population. Other NYS Department of Health blood testing programs in the Newburgh and Hoosick Falls Area have focused on measuring PFAS levels in participants related to drinking water with PFOA or PFOS contamination.

Hoosick Falls Medical Monitoring Program

The Hoosick Falls Medical Monitoring Program is being conducted as part of the Hoosick Falls Settlement. Please visit the Hoosick Falls PFOA Settlement website for more information.

PFAS Biomonitoring

The NYSDOH Biomonitoring program measured how much PFAS you have been exposed to and compared PFAS blood levels in the village of Hoosick Falls and Hoosick area, and the City of Newburgh and to levels in the general population. If you would like to request a copy of your previous test results, please call NYSDOH at 518-402-7950.

PFAS Exposure Assessment

The CDC and ATSDR are assessing the PFAS exposure in communities near current or former military installations. The exposure assessment will compare PFAS levels in blood and urine from the City of Newburgh to levels in the general population. The CDC and ATSDR will also identify and assess environmental factors that affect exposure. If you have any questions or concerns on the exposure assessment, contact Luis Rivera-Gonzalez, PHD, MS, ATSDR Division of Community Health Investigations Eastern Branch by phone at 732-906-6933 or email at [email protected].

The National Institute for Occupational Safety and Health (NIOSH) for Firefighters

The National Firefighter Registry (NFR) will be a large database of health and occupational information on firefighters that can be used to analyze and track cancer and identify occupational risk factors for cancer. While the enrollment system and questionnaire are still being developed, there is a plan to collect information about firefighters’ use of Aqueous Film Forming Foam (AFFF).

You can subscribe to the NFR Quarterly e-Newsletter to receive a free electronic newsletter with updates about the NFR.

 

Related Links

PFAS Action Response Team (MPART)

Michigan’s MPART has a resource for identifying AFFF-containing PFAS.

Fire Fighter Cancer Cohort Study

The Fire Fighter Cancer Cohort Study specifically includes a component studying firefighters’ PFAS exposure. It is currently being conducted with fire service partners in Tucson, Amado, and Sahuarita, Arizona; Boston, Massachusetts; Palm Beach County, Florida; and Toms River, New Jersey.

Join our Contact List!

We plan to begin preparing and sending semi-annual newsletters on information about the study, findings, and more! If you would like to receive this, please enter your name and email address below.

Additionally, there may be future opportunities to participate in the study. If you would like to be contacted about future study participation, please enter your information below.

Any information you provide will be confidential. Any emails or messages you receive will be related to the study only. You may opt out of emails or messages at any time.

 

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