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

A green analytical method for the simultaneous determination of 17 perfluoroalkyl substances (PFAS) in human serum and semen by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS)

The ubiquity of perfluoroalkyl substances has raised concerns about the unintended consequences of PFAS exposure on human health. In the present study, an eco-friendly ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed for the simultaneous determination of 17 PFAS in human serum and semen samples. QuEChERS salts MgSO4:NaCl 4:1 (w/w) were used for the extraction. The separation of analytes was performed on an ACQUITY BEH C18 column (100 × 2.1 mm, 1.7 μm), using water:methanol 95:5 and methanol as mobile phases A and B, respectively, both containing 2 mM ammonium acetate. Multiple reaction monitoring (MRM) in negative ion mode was used, selecting two transitions for each analyte, except for perfluorobutanoic acid (PFBA) and perfluoropentanoic acid (PFPeA). The analytical method was validated according to the Organization of Scientific Area Committees (OSAC) for Forensic Sciences guidelines and AGREE approach software was used to evaluate the greenness of the method. The developed procedure was applied to the analysis of 10 paired human serum and semen samples, proving the suitability in high throughput laboratories due to the easy preparation and the reduced volume of toxic solvents. Moreover, it allows to perform further investigation on the correlation between serum and semen PFAS concentration, focusing on male reproductive system correlated pathologies, such as male infertility.

Emerging contaminants in food matrices: An overview of the occurrence, pathways, impacts and detection techniques of per- and polyfluoroalkyl substances

Per- and polyfluoroalkyl substances (PFAS) have been used in industrial and consumer applications for ages. The pervasive and persistent nature of PFAS in the environment is a universal concern due to public health risks. Experts acknowledge that exposure to high levels of certain PFAS have consequences, including reduced vaccine efficacy, elevated cholesterol, and increased risk of high blood pressure. While considerable research has been conducted to investigate the presence of PFAS in the environment, the pathways for human exposure through food and food packaging/contact materials (FCM) remain unclear. In this review, we present an exhaustive overview of dietary exposure pathways to PFAS. Also, the mechanism of PFAS migration from FCMs into food and the occurrence of PFAS in certain foods were considered. Further, we present the analytical techniques for PFAS in food and food matrices as well as exposure pathways and human health impacts. Further, recent regulatory actions working to set standards and guidelines for PFAS in food packaging materials were highlighted. Alternative materials being developed and evaluated for their safety and efficacy in food contact applications, offering promising alternatives to PFAS were also considered. Finally, we reported on general considerations and perspectives presently considered.

Associations of per- and polyfluoroalkyl substances with maternal metabolic and inflammatory biomarkers in early-to-mid-pregnancy

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) can disrupt metabolism. Early-to-mid pregnancy is characterized by amplified metabolic processes and inflammation to support maternal adaptations and fetal growth. Thus, we cross-sectionally evaluated whether PFAS are individually and jointly associated with these processes in early-to-mid pregnancy.

METHODS

Pregnant Illinois women (n = 452) provided fasted blood samples at median 17 weeks gestation. We quantified serum perfluorononanoic (PFNA), perfluorooctane sulfonic (PFOS), perfluorooctanoic (PFOA), methyl-perfluorooctane sulfonamide acetic acid (Me-PFOSA-AcOH), perfluorohexanesulfonic (PFHxS), perfluorodecanoic (PFDeA), and perfluoroundecanoic (PFUdA) acid. Key outcomes were plasma glucose, insulin, C-peptide, insulin-like growth factor 1 (IGF-1), adiponectin, leptin, triglycerides, free fatty acids, total cholesterol, high-density lipoprotein (HDL) cholesterol, C-reactive protein, tumor necrosis factor alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and interleukin 6. We calculated homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein (LDL) cholesterol, and very low-density lipoprotein (VLDL). We evaluated associations of PFAS with each metabolic/inflammatory biomarker individually using covariate-adjusted linear regression and jointly using quantile-based g-computation.

RESULTS

In linear regression, all PFAS (except Me-PFOSA-AcOH) were negatively associated with insulin, HOMA-IR, and leptin, whereas all PFAS were positively associated with HDL cholesterol. We also observed negative associations of some PFAS with TNF-α and MCP-1; positive associations with adiponectin and total cholesterol also emerged. Additionally, PFOS was positively, whereas Me-PFOSA-AcOH was negatively, associated with triglycerides and VLDL. Each 25% increase in the PFAS mixture was associated with -31.3% lower insulin (95%CI: -45.8, -12.9), -31.9% lower HOMA-IR (95%CI: -46.4, -13.4), and -9.4% lower leptin (95%CI: -17.3, -0.8), but 7.4% higher HDL cholesterol (95%CI: 4.6, 10.3). For most outcomes, the major contributors to the PFAS mixture often differed compared to single-PFAS analyses.

IMPLICATIONS

Individual and joint PFAS exposures were associated with markers of maternal metabolism and inflammation in pregnancy. Further investigation is needed to elucidate possible mechanisms and consequences of these findings.

Associations of Serum Perfluoroalkyl Substances and Placental Human Chorionic Gonadotropin in Early Pregnancy, Measured in the UPSIDE Study in Rochester, New York

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are widely detected in pregnant women and associated with adverse outcomes related to impaired placental function. Human chorionic gonadotropin (hCG) is a dimeric glycoprotein hormone that can indicate placental toxicity.

OBJECTIVES

Our aim was to quantify the association of serum PFAS with placental hCG, measured as an intact molecule (hCG), as free alpha-(hCG α ) and beta-subunits (hCG β ), and as a hyperglycosylated form (h-hCG), and evaluate effect measure modification by social determinants and by fetal sex.

METHODS

Data were collected from 326 pregnant women enrolled from 2015 to 2019 in the UPSIDE study in Rochester, New York. hCG forms were normalized for gestational age at the time of blood draw in the first trimester [multiple of the median (MoM)]. Seven PFAS were measured in second-trimester maternal serum. Multivariate imputation by chained equations and inverse probability weighting were used to evaluate robustness of linear associations. PFAS mixture effects were estimated by Bayesian kernel machine regression.

RESULTS

Perfluorohexane sulfonic acid (PFHxS) [hCG β : 0.29 log MoM units per log PFHxS; 95% confidence interval (CI): 0.08, 0.51] and perfluorodecanoic acid (PFDA) (hCG: - 0.09 ; 95% CI: - 0.16 , - 0.02 ) were associated with hCG in the single chemical and mixture analyses. The PFAS mixture was negatively associated with hCG α and positively with hCG β . Subgroup analyses revealed that PFAS associations with hCG differed by maternal race/ethnicity and education. Perfluoropentanoic acid (PFPeA) was associated with hCG β only in Black participants (- 0.23 ; 95% CI: - 0.37 , - 0.09 ) and in participants with high school education or less (- 0.14 ; 95% CI: - 0.26 , - 0.02 ); conversely, perfluorononanoic acid (PFNA) was negatively associated with hCG α only in White participants (- 0.15 ; 95% CI: - 0.27 , - 0.03 ) and with hCG β only in participants with a college education or greater (- 0.19 ; 95% CI: - 0.36 , - 0.01 ). These findings were robust to testing for selection bias, confounding bias, and left truncation bias where PFAS detection frequency was < 100 % . Two associations were negative in male (and null in female) pregnancies: Perfluoroundecanoic acid (PFUnDA) with hCG α , and PFNA with h-hCG.

CONCLUSIONS

Evidence was strongest for the association between PFHxS and PFDA with hCG in all participants and for PFPeA and PFNA within subgroups defined by social determinants and fetal sex. PFAS mixture associations with hCG α and hCG β differed, suggesting subunit-specific types of toxicity and/or regulation. Future studies will evaluate the biological, clinical and public health significance of these findings. https://doi.org/10.1289/EHP12950.

Interspecies comparison of metabolism of two novel prototype PFAS

As a result of proposed global restrictions and regulations on current-use per-and polyfluoroalkyl substances (PFAS), research on possible alternatives is highly required. In this study, phase I in vitro metabolism of two novel prototype PFAS in human and rat was investigated. These prototype chemicals are intended to be safer-by-design and expected to mineralize completely, and thus be less persistent in the environment compared to the PFAS available on the market. Following incubation with rat liver S9 (RL-S9) fractions, two main metabolites per initial substance were produced, namely an alcohol and a short-chain carboxylic acid. While with human liver S9 (HL-S9) fractions, only the short-chain carboxylic acid was detected. Beyond these major metabolites, two and five additional metabolites were identified at very low levels by non-targeted screening for the ether- and thioether-linked prototype chemicals, respectively. Overall, complete mineralization during the in vitro hepatic metabolism of these novel PFAS by HL-S9 and RL-S9 fractions was not observed. The reaction kinetics of the surfactants was determined by using the metabolite formation, rather than the substrate depletion approach. With rat liver enzymes, the formation rates of primary metabolite alcohols were at least two orders of magnitude higher than those of secondary metabolite carboxylic acids. When incubating with human liver enzymes, the formation rates of single metabolite carboxylic acids, were similar or smaller than those experienced in rat. It also indicates that the overall metabolic rate and clearance of surfactants are significantly higher in rat liver than in human liver. The maximum formation rate of the thioether congener exceeded 10-fold that of the ether in humans but were similar in rats. Overall, the results suggest that metabolism of the prototype chemicals followed a similar trend to those reported in studies of fluorotelomer alcohols.

Influence of maternal endocrine disrupting chemicals exposure on adverse pregnancy outcomes: A systematic review and meta-analysis

Maternal endocrine disrupting chemicals (EDCs) exposure, the common environmental pollutants, was capable of involving in adverse pregnancy outcomes. However, the evidence of their connection is not consistent. Our goal was to comprehensively explore the risk of EDCs related to adverse pregnancy outcomes. One hundred and one studies were included from two databases before 2023 to explore the association between EDCs and adverse pregnancy outcomes including miscarriage, small for gestational age (SGA), low birth weight (LBW) and preterm birth (PTB). We found that maternal PFASs exposure was positively correlated with PTB (OR:1.13, 95% CI:1.04-1.23), SGA (OR:1.10, 95% CI:1.04-1.16) and miscarriage (OR:1.09, 95% CI:1.00-1.19). The pooled estimates also showed maternal PAEs exposure was linked with PTB (OR:1.16, 95% CI:1.11-1.21), SGA (OR:1.20, 95% CI:1.07-1.35) and miscarriage (OR:1.55, 95% CI:1.33-1.81). In addition, maternal exposure to some specific class of EDCs including PFOS, MBP, MEHP, DEHP, and BPA was associated with PTB. Maternal exposure to PFOS, PFOA, PFHpA was associated with SGA. Maternal exposure to BPA was associated with LBW. Maternal exposure to MMP, MEHP, MEHHP, MEOHP, BPA was associated with miscarriage. Maternal PFASs, PAEs and BPA exposure may increase adverse pregnancy outcomes risk according to our study. However, the limited number of studies on dose-response hampered further explanation for causal association.

Prenatal per- and polyfluoroalkyl substances (PFAS) exposure in relation to preterm birth subtypes and size-for-gestational age in the LIFECODES cohort 2006-2008

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are a group of synthetic chemicals widely used in consumer and industrial products. Numerous studies have linked prenatal PFAS exposures to increased risks of adverse pregnancy outcomes such as preterm birth (PTB) and small-for-gestational age (SGA).However, limited evidence is available for the effects of PFAS on PTB subtypes and large-for-gestational age (LGA).

OBJECTIVE

To examine the associations of PFAS with PTB [overall, placental (pPTB), spontaneous (sPTB)], BW Z-score, and size-for-gestational age (SGA, LGA).

METHODS

Our nested case-control study included 128 preterm cases and 373 term controls from the LIFECODES cohort between 2006 and 2008 (n = 501). Plasma concentrations of nine PFAS were measured in early pregnancy samples. Logistic regression was used to assess individual PFAS-birth outcome associations, while Bayesian Kernel Machine Regression (BKMR) was used to evaluate the joint effects of all PFAS. Effect modification by fetal sex was examined, and stratified analyses were conducted to obtain fetal sex-specific estimates.

RESULTS

Compared to term births, the odds of pPTB were higher from an interquartile range increase in perfluorodecanoic acid (PFDA) (OR = 1.60, 95% CI: 1.00-2.56), perfluorononanoic acid (PFNA) (OR = 1.67, 95% CI: 1.06-2.61), and perfluoroundecanoic acid (PFUA) (OR = 1.77, 95% CI: 1.00-3.12), with stronger associations observed in women who delivered males. BKMR analysis identified PFNA as the most important PFAS responsible for pPTB (conditional PIP = 0.78), with increasing ORs at higher percentiles of PFAS mixture. For LGA, positive associations were observed with PFDA and perfluorooctanoic acid in females only, and with PFUA in males only. BKMR analysis showed increasing, but null effects of PFAS mixture on LGA.

CONCLUSIONS

The effect of prenatal exposure to single and multiple PFAS on PTB and LGA depended on fetal sex. Future studies should strongly consider examining PTB subtypes and sex-specific effects of PFAS on pregnancy outcomes.

Trimester-specific hemodynamics of per- and polyfluoroalkyl substances and its relation to lipid profile in pregnant women

Per- and polyfluoroalkyl substances (PFAS) are persistent organic pollutants widely detected in blood from pregnant women, yet limited study evaluated the trimester-specific variance of serum PFAS, and even less is known for the window of vulnerability to lipids metabolism interrupting effects of PFAS during pregnancy. We quantified 16 legacy, 3 emerging PFAS, and lipid biomarkers in 286 serum samples from 118 pregnant women. All target PFAS, except perfluorotridecanoic acid (PFTrDA), in maternal serum showed moderate to low temporal irregular variability across gestation (average intraclass correlation coefficients ≥ 0.57), while the generalized estimating equations showed a significant declining trend in the serum levels during pregnancy (p for trend < 0.05). The decline of 6:2 chlorinated polyfluorinated ether sulfonate in maternal serum was the greatest with a change of - 21.63% from 1st to 2nd trimester, which indicated a possible higher accumulation of this emerging PFAS in fetal compartment. Multiple linear regression, multiple informant model and Bayesian kernel machine regression showed a higher vulnerability in the 1st trimester to effects of PFAS exposure on serum lipids of pregnant women. The results highlighted the importance of the study timing of PFAS exposure during pregnancy.

Finding a way out? Comprehensive biotransformation study of novel fluorinated surfactants

In this study the environmental fate of two novel trifluoromethoxy-substituted surfactants with respectively an ether or thioether linkage were investigated, of which the design aimed for less persistency and complete mineralization. Long-term microbial transformation studies under aerobic conditions in activated sludge-wastewater medium were performed for 126 days. A semi-closed experimental system with a trapping sorbent was selected to avoid losses of possible volatile transformation products (TPs). The changes in the concentration of the surfactants and their expected TPs were monitored by target analysis using liquid chromatography-tandem mass spectrometry. Significant decrease in the concentration of the surfactants was observed over the incubation period. The main detected TPs were short-chained carboxylic acids (CAs), including a CA with two fluorinated carbon atoms representing the last product prior to mineralization. High stability of these CAs and lack in the formation of inorganic fluoride over the incubation time was however observed. Consequently, unequivocal final mineralization of the investigated surfactants could not be confirmed. Regarding the mass balance, the total amount of detected substances achieved only 30-37% of the expected concentration at the end of the incubation time. The reason of the incomplete mass balance should be further investigated.

Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively.

METHODS

In the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. =  > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage.

RESULTS

PFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants.

CONCLUSION

PFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.

Geographic and demographic variability in serum PFAS concentrations for pregnant women in the United States

BACKGROUND

While major pathways of human PFAS exposure are thought to be drinking water and diet, other pathways and sources have also been shown to contribute to a person's cumulative exposure. However, the degree of contribution of these other sources to PFAS body burdens is still not well understood and occurrence data for PFAS in conssumer products and household materials are sparse. Questionnaire data concordant with biomonitoring may improve understanding of associations between other PFAS exposure pathways and exposure in human populations.

OBJECTIVE

This study aims to better understand maternal and early-life exposures to PFAS from various potential sources and pathways in the context of household and community level characteristics.

METHODS

PFAS data from the National Children's Study (NCS) Vanguard Data and Sample Archive Access System were analyzed from serum of 427 pregnant women residing in 7 counties throughout the United States. Location and self-reported questionnaire responses were used to analyze variability in serum concentrations based on demographics, housing characteristics, behaviors, and geography. Spatial mapping analyses incorporated publicly available data to further hypothesize potential sources of exposure in two NCS counties.

RESULTS

Location was associated with serum concentrations for all PFAS chemicals measured. Questionnaire responses for race/ethnicity, income, education level, number of household members, drinking water source, home age, and fast-food consumption were associated with PFAS levels. Statistical differences were observed between participants with the same questionnaire responses but in different locations. Spatial mapping analyses suggested that participants' proximity to local point sources can overshadow expected trends with demographic information.

SIGNIFICANCE

By increasing understanding of maternal and early-life PFAS exposures from various potential sources and pathways, as well as highlighting the importance of proximity to potential sources in identifying vulnerable populations and locations, this work reveals environmental justice considerations and contributes to risk management strategies that maximize public health protection.

IMPACT

This work increases understanding of maternal and early-life PFAS exposures, reveals environmental justice considerations, and contributes to study design and risk management strategies.

PFAS Exposures and the Human Metabolome: A Systematic Review of Epidemiological Studies

Purpose of Review

There is a growing interest in understanding the health effects of exposure to per- and polyfluoroalkyl substances (PFAS) through the study of the human metabolome. In this systematic review, we aimed to identify consistent findings between PFAS and metabolomic signatures. We conducted a search matching specific keywords that was independently reviewed by two authors on two databases (EMBASE and PubMed) from their inception through July 19, 2022 following PRISMA guidelines.

Recent Findings

We identified a total of 28 eligible observational studies that evaluated the associations between 31 different PFAS exposures and metabolomics in humans. The most common exposure evaluated was legacy long-chain PFAS. Population sample sizes ranged from 40 to 1,105 participants at different stages across the lifespan. A total of 19 studies used a non-targeted metabolomics approach, 7 used targeted approaches, and 2 included both. The majority of studies were cross-sectional (n = 25), including four with prospective analyses of PFAS measured prior to metabolomics.

Summary

Most frequently reported associations across studies were observed between PFAS and amino acids, fatty acids, glycerophospholipids, glycerolipids, phosphosphingolipids, bile acids, ceramides, purines, and acylcarnitines. Corresponding metabolic pathways were also altered, including lipid, amino acid, carbohydrate, nucleotide, energy metabolism, glycan biosynthesis and metabolism, and metabolism of cofactors and vitamins. We found consistent evidence across studies indicating PFAS-induced alterations in lipid and amino acid metabolites, which may be involved in energy and cell membrane disruption.

Perfluoroalkyl and polyfluoroalkyl substances and hypertensive disorders of pregnancy: A systematic review and meta-analysis

Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women. Several environmental toxins, particularly those that affect the normal function of the placenta and the endothelium, are emerging as potential risk factors for HDP. Among them, per- and polyfluoroalkyl substances (PFAS), widely used in a variety of commercial products, have been related to a variety of adverse health effects including HDP. This study was conducted by searching three databases for observational studies reporting associations between PFAS and HDP, all of which were published before December 2022. We used random-effects meta-analysis to calculate pooled risk estimates, and assessing each combination of exposure and outcome for quality and level of evidence. In total, 15 studies were included in the systematic review and meta-analysis. The results from meta-analyses showed that risk of PE was increased with exposure to PFOA (perfluorooctanoic acid) (RR = 1.39, 95% CI = 1.05, 1.85; N = 6 studies; exposure = 1 ln-unit increment; low certainty), PFOS (perfluorooctane sulfonate) (RR = 1.51, 95% CI = 1.23, 1.86; N = 6 studies; exposure = 1 ln-unit increment; moderate certainty), and PFHxS (perfluorohexane sulfonate) (RR = 1.39, 95% CI = 1.10, 1.76; N = 6 studies; exposure = 1 ln-unit increment; low certainty). PFOS was also associated with an increased risk of HDP (RR = 1.39, 95% CI = 1.10, 1.76; exposure = 1 ln-unit increment; low certainty). Exposure to legacy PFAS (PFOA, PFOS, PFHxS) is associated with an increased risk of PE, and PFOS is further associated with HDP. In view of the limitations of meta-analysis and quality of evidence, these findings should be interpreted with caution. Further research is required that assesses exposure to multiple PFAS in diverse and well-powered cohorts.

Research Progress on Neurodevelopmental Toxicity in Offspring after Indirect Exposure to PFASs in Early Life

Per- and polyfluoroalkyl substances (PFASs) are widespread environmental pollutants. There is increasing evidence that PFASs have various adverse health effects, including renal toxicity, metabolic dysfunction, endocrine disruption, and developmental toxicity. PFASs have been found to accumulate in the placenta, and some PFASs can cross the placental barrier and subsequently accumulate in the fetus via the maternal-fetal circulation. An increasing number of studies have shown that early life exposure to PFASs can affect fetal neurodevelopment. This paper reviews the characteristics of indirect exposure to PFASs in early life, the effects on neurodevelopment in offspring, and the possible mechanisms of toxic effects.

Cross-Species Transcriptomics Analysis Highlights Conserved Molecular Responses to Per- and Polyfluoroalkyl Substances

In recent decades, per- and polyfluoroalkyl substances (PFASs) have garnered widespread public attention due to their persistence in the environment and detrimental effects on the health of living organisms, spurring the generation of several transcriptome-centered investigations to understand the biological basis of their mechanism. In this study, we collected 2144 publicly available samples from seven distinct animal species to examine the molecular responses to PFAS exposure and to determine if there are conserved responses. Our comparative transcriptional analysis revealed that exposure to PFAS is conserved across different tissues, molecules and species. We identified and reported several genes exhibiting consistent and evolutionarily conserved transcriptional response to PFASs, such as ESR1, HADHA and ID1, as well as several pathways including lipid metabolism, immune response and hormone pathways. This study provides the first evidence that distinct PFAS molecules induce comparable transcriptional changes and affect the same metabolic processes across inter-species borders. Our findings have significant implications for understanding the impact of PFAS exposure on living organisms and the environment. We believe that this study offers a novel perspective on the molecular responses to PFAS exposure and provides a foundation for future research into developing strategies for mitigating the detrimental effects of these substances in the ecosystem.

Newborn metabolomic signatures of maternal per- and polyfluoroalkyl substance exposure and reduced length of gestation

Marginalized populations experience disproportionate rates of preterm birth and early term birth. Exposure to per- and polyfluoroalkyl substances (PFAS) has been reported to reduce length of gestation, but the underlying mechanisms are unknown. In the present study, we characterized the molecular signatures of prenatal PFAS exposure and gestational age at birth outcomes in the newborn dried blood spot metabolome among 267 African American dyads in Atlanta, Georgia between 2016 and 2020. Pregnant people with higher serum perfluorooctanoic acid and perfluorohexane sulfonic acid concentrations had increased odds of an early birth. After false discovery rate correction, the effect of prenatal PFAS exposure on reduced length of gestation was associated with 8 metabolomic pathways and 52 metabolites in newborn dried blood spots, which suggested perturbed tissue neogenesis, neuroendocrine function, and redox homeostasis. These mechanisms explain how prenatal PFAS exposure gives rise to the leading cause of infant death in the United States.

Maternal Serum, Cord and Human Milk Levels of Per- and Polyfluoroalkyl Substances (PFAS), Association with Predictors and Effect on Newborn Anthropometry

BACKGROUND

The understanding of per- and polyfluoroalkyl substances (PFAS) health effects is rapidly advancing among critical populations. Therefore, the objective of this study was to assess PFAS serum levels among Lebanese pregnant women, cord serum and human milk levels, their determinants, and effects on newborn anthropometry.

METHODS

We measured concentrations of six PFAS (PFHpA, PFOA, PFHxS, PFOS, PFNA and PFDA) using liquid chromatography MS/MS for 419 participants, of which 269 had sociodemographic, anthropometric, environmental and dietary information.

RESULTS

The percentage of detection for PFHpA, PFOA, PFHxS and PFOS was 36.3-37.7%. PFOA and PFOS levels (95th percentile) were higher than HBM-I and HBM-II values. While PFAS were not detected in cord serum, five compounds were detected in human milk. Multivariate regression showed that fish/shellfish consumption, vicinity to illegal incineration and higher educational level were associated with an almost twice higher risk of elevated PFHpA, PFOA, PFHxS and PFOS serum levels. Higher PFAS levels in human milk were observed with higher eggs and dairy products consumption, in addition to tap water (preliminary findings). Higher PFHpA was significantly associated with lower newborn weight-for-length Z-score at birth.

CONCLUSIONS

Findings establish the need for further studies, and urgent action to reduce exposure among subgroups with higher PFAS levels.

Association of Early Pregnancy Perfluoroalkyl and Polyfluoroalkyl Substance Exposure With Birth Outcomes

Importance

Prenatal perfluoroalkyl and polyfluoroalkyl substances (PFAS) have been linked to adverse birth outcomes. Previous research showed that higher folate concentrations are associated with lower blood PFAS concentrations in adolescents and adults. Further studies are needed to explore whether prenatal folate status mitigates PFAS-related adverse birth outcomes.

Objective

To examine whether prenatal folate status modifies the negative associations between pregnancy PFAS concentrations, birth weight, and gestational age previously observed in a US cohort.

Design, Setting, and Participants

In a prospective design, a prebirth cohort of mothers or pregnant women was recruited between April 1999 and November 2002, in Project Viva, a study conducted in eastern Massachusetts. Statistical analyses were performed from May 24 and October 25, 2022.

Exposure

Plasma concentrations of 6 PFAS compounds were measured in early pregnancy (median gestational week, 9.6). Folate status was assessed through a food frequency questionnaire and measured in plasma samples collected in early pregnancy.

Main Outcomes and Measures

Birth weight and gestational age, abstracted from delivery records; birth weight z score, standardized by gestational age and infant sex; low birth weight, defined as birth weight less than 2500 g; and preterm birth, defined as birth at less than 37 completed gestational weeks.

Results

The cohort included a total of 1400 mother-singleton pairs. The mean (SD) age of the mothers was 32.21 (4.89) years. Most of the mothers were White (73.2%) and had a college degree or higher (69.1%). Early pregnancy plasma perfluorooctanoic acid concentration was associated with lower birth weight and birth weight z score only among mothers whose dietary folate intake (birth weight: β, -89.13 g; 95% CI, -166.84 to -11.42 g; birth weight z score: -0.13; 95% CI, -0.26 to -0.003) or plasma folate concentration (birth weight: -87.03 g; 95% CI, -180.11 to 6.05 g; birth weight z score: -0.14; 95% CI, -0.30 to 0.02) were below the 25th percentile (dietary: 660 μg/d, plasma: 14 ng/mL). No associations were found among mothers in the higher folate level groups, although the tests for heterogeneity did not reject the null. Associations between plasma perfluorooctane sulfonic acid and perfluorononanoate (PFNA) concentrations and lower birth weight, and between PFNA and earlier gestational age were noted only among mothers whose prenatal dietary folate intake or plasma folate concentration was in the lowest quartile range. No associations were found among mothers in higher folate status quartile groups.

Conclusions and Relevance

In this large, US prebirth cohort, early pregnancy exposure to select PFAS compounds was associated with adverse birth outcomes only among mothers below the 25th percentile of prenatal dietary or plasma folate levels.

A review of cardiovascular effects and underlying mechanisms of legacy and emerging per- and polyfluoroalkyl substances (PFAS)

Cardiovascular disease (CVD) poses the leading threats to human health and life, and their occurrence and severity are associated with exposure to environmental pollutants. Per- and polyfluoroalkyl substances (PFAS), a group of widely used industrial chemicals, are characterized by persistence, long-distance migration, bioaccumulation, and toxicity. Some PFAS, particularly perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and perfluorohexanesulfonic acid (PFHxS), have been banned, leaving only legacy exposure to the environment and human body, while a number of novel PFAS alternatives have emerged and raised concerns, such as polyfluoroalkyl ether sulfonic and carboxylic acid (PFESA and PFECA) and sodium p-perfluorous nonenoxybenzene sulfonate (OBS). Overall, this review systematically elucidated the adverse cardiovascular (CV) effects of legacy and emerging PFAS, emphasized the dose/concentration-dependent, time-dependent, carbon chain length-dependent, sex-specific, and coexposure effects, and discussed the underlying mechanisms and possible prevention and treatment. Extensive epidemiological and laboratory evidence suggests that accumulated serum levels of legacy PFAS possibly contribute to an increased risk of CVD and its subclinical course, such as cardiac toxicity, vascular disorder, hypertension, and dyslipidemia. The underlying biological mechanisms may include oxidative stress, signaling pathway disturbance, lipid metabolism disturbance, and so on. Various emerging alternatives to PFAS also play increasingly prominent toxic roles in CV outcomes that are milder, similar to, or more severe than legacy PFAS. Future research is recommended to conduct more in-depth CV toxicity assessments of legacy and emerging PFAS and explore more effective surveillance, prevention, and treatment strategies, accordingly.

Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress.

OBJECTIVES

We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships.

METHODS

We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS.

RESULTS

We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of β = - 0.15 [95% confidence interval (CI): - 0.27 , - 0.03 ], β = - 0.14 (95% CI: - 0.28 , - 0.002 ), β = - 0.22 (95% CI: - 0.23 , - 0.10 ), β = - 0.06 (95% CI: - 0.18 , 0.06), and β = - 0.25 (95% CI: - 0.37 , - 0.14 ), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: OR PFNA = 0.56 (95% CI: 0.38, 0.83), OR PFDA = 0.52 (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [- 0.28 ; 95% highest posterior density (HPD): - 0.44 , - 0.14 ] and decreased odds of large-for-gestational-age (OR = 0.49 ; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress.

DISCUSSION

Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723.

The role of PFAS in unsettling ocean carbon sequestration

Poly- and perfluoroalkyl substances (PFAS) and global climate change have attracted worldwide attention. PFAS have been found all across the planet, from the polar regions to the global ocean. Global oceans have emerged as a substantial sink for the carbon in the environment due to their remarkable capacity to absorb atmospheric carbon. Oceans absorb around 24% of the world's CO₂ emissions. Thus, the ocean plays a prominent role in the earth's carbon cycle. However, the widespread application of PFAS in a wide range of products and the inefficient management of PFAS-containing wastes made them ubiquitous pollutants, which are increasingly getting as a pollutant of emerging concern. Marine PFAS pollutants can produce harmful effects on gas exchange and the ocean's carbon cycle. Thus, it leads to an increase in greenhouse gas emissions, which eventually adversely affects global warming and climate change. Consequently, threats of marine PFAS to oceans carbon sequestration are discussed in this paper. Marine PFAS pollutants adversely affect the following sectors: (1) The growth and photosynthesis of phytoplankton, (2) development and reproduction of zooplankton by causing toxicity in zooplankton, (3) marine biological pomp, and (4) carbon stock of oceans. In this way, marine PFAS can pose a threat to ocean carbon sequestration. It is expected that this study can develop knowledge about the potential impact of PFAS on ocean carbon sequestration. However, the need for further research to investigate the hidden dimensions of this issue, including the potential scope and scale of this impact, should not be overlooked.

Serum Concentrations of Selected Poly- and Perfluoroalkyl Substances (PFASs) in Pregnant Women and Associations with Birth Outcomes. A Cross-Sectional Study from Southern Malawi

Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with adverse pregnancy outcomes. The aim of the present study was to examine the determinants of different serum PFAS concentrations in late pregnancy and their relationship with birth outcomes in southern Malawi. The sample included 605 pregnant women with a mean age of 24.8 years and their offspring from three districts in the southern region of Malawi. Six PFAS were measured in serum from third-trimester women. The serum PFAS concentrations were assessed with head circumference, birth length, birth weight, gestational age and ponderal index. Participants living in urban areas had significantly higher serum levels of PFOA, PFNA and SumPFOS, while SumPFHxS concentrations were higher in women from rural settings. High PFOA, PFNA and SumPFHxS concentrations were generally inversely associated with head circumference. Birth length was negatively associated with PFOA and PFNA while SumPFHxS was negatively associated with birth weight. SumPFOS was inversely associated with gestational age. Urban area of residence was the strongest predictor for high PFAS concentrations in the maternal serum and was generally associated with adverse birth outcomes. The results highlight the need to investigate SumPFHxS further as it follows a pattern that is different to similar compounds and cohorts.

Human serum poly- and perfluoroalkyl substance concentrations and their associations with gestational diabetes mellitus

Poly- and perfluoroalkyl substances (PFAS), which have been found in high concentrations in maternal serum, have the potential to impair glucose metabolism in pregnant women. However, the effects of PFAS exposure on the risk of gestational diabetes mellitus (GDM) remain inconsistent. In the current investigation, a case-control study involving 135 patients with GDM and 69 controls was conducted in Hangzhou, China. We determined the concentrations of 17 PFAS in maternal serum from each participant and elucidated the associations between those concentrations and the risk of GDM. Among the 17 PFAS, perfluorooctanesulfonate (median 7.53 and 7.44 ng/mL) was the predominant PFAS in both cases and controls, followed by perfluorooctanoic acid (PFOA; median 5.22 and 5.03 ng/mL) and 6:2 chlorinated perfluoroalkyl ether sulfonate (6:2 Cl-PFESA; median 2.58 and 2.42 ng/mL). Conditional logistic regression analysis showed that the maternal serum continuous levels of PFOA, perfluorononanoic acid (PFNA), perfluorohexanesulfonate (PFHxS), and 6:2 Cl-PFESA were significantly associated with the GDM risk, with adjusted odds ratios (ORs) of 1.84 (95% confidence interval (CI): 1.26, 3.51), 1.47 (1.17, 3.29), 1.33 (1.72, 3.48), and 1.34 (1.17, 2.53), respectively. In the adjusted model, the ORs of GDM for increasing tertiles of PFOA, PFNA, PFHxS, and 6:2 Cl-PFESA significantly increased. The adjusted ORs (95% CI) were 3.38 (2.16, 6.89), 2.61 (1.26, 5.40), 3.46 (1.64, 6.30), and 3.50 (1.62, 6.91) at the highest concentrations of PFOA, PFNA, PFHxS, and 6:2 Cl-PFESA, respectively. These results suggest that higher PFAS exposure, reflected in serum PFAS concentrations, was associated with GDM incidence in pregnant women.

A sensitive and robust method for the simultaneous determination of thirty-three legacy and emerging per- and polyfluoroalkyl substances in human plasma and serum

Legacy and emerging per- and polyfluoroalkyl substances (PFAS) have attracted growing attention due to their potential adverse effects on humans. We developed a method to simultaneously determine thirty-three PFAS (legacy PFAS, precursors, and alternatives) in human plasma and serum using solid phase extraction coupled to ultra-performance liquid chromatography-tandem mass spectrometry (SPE-UPLC-MS/MS). The method yielded good linearity (>0.995) and excellent limits of detection (LODs) (0.0005~0.012 ng mL^-1 in plasma and 0.002~0.016 ng mL^-1 in serum). The relative recoveries ranged from 80.1 to 116%, with intra- and inter-day precision less than 14.3%. The robustness of this method has been tested continuously for 10 months (coefficients of variation <14.9%). Our method was successfully applied to the PFAS analysis of 42 real human plasma and serum samples collected from women. The proposed method is attractive for the biomonitoring of multi-class PFAS in human health risk assessment and epidemiological studies.

Association of single and multiple prefluoroalkyl substances exposure with preterm birth: Results from a Chinese birth cohort study

BACKGROUND

Perfluoroalkyl substances (PFASs) are persistent organic pollutants that may lead the adverse birth outcomes, including preterm birth (PTB). However, previous studies have reported inconsistent results on the association between PFASs and PTB, and lack of the epidemiological evidence regarding the effect of PFASs mixture on PTB. This study aimed to explore association of individual and multiple exposure to PFASs with PTB.

METHODS

The study subjects were consisted of 1341 pregnant women from Guangxi Zhuang Birth Cohort in Guangxi, China, from June 2015 to April 2019. Nine PFASs concentrations in the maternal serum were examined by ultrahigh liquid performance chromatography-tandem mass spectrometry, and the gestational weeks were obtained from medical records. We applied binary logistics regression model to explore correlation between individual PFAS and PTB and inspected the combined effect of PFASs mixture on PTB by applying Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) regression models.

RESULTS

In adjusted logistics regression model, perfluorooctane sulfonate (PFOS), perfluoroheptanoic acid (PFHpA), perfluorobutanesulfonic acid (PFBS), ∑perfluorinated sulfonic acids (PFSA), and ∑PFASs were positively associated with the risk of PTB. In contrast, perfluoroundecanoic acid (PFUnA), perfluorohexane sulfonate (PFHxS), and perfluorooctanoic acid (PFOA) were negatively associated with the risk of PTB. These associations of n PFOS and PFHpA with PTB were found to be more pronounced in male infants. Restricted cubic splines (RCSs) showed an inverse U-shaped relationship between PFBS and PTB. Analysis from BKMR model showed a positive association between PFASs mixture and PTB, and no evidence of interactions among the nine PFASs were detected. Additionally, PFHpA, PFOS, and PFBS were identified as the main contributors for the effect of PFASs mixture on increasing the risk of PTB by BKMR and WQS models.

CONCLUSION

Prenatal exposure to higher levels of PFASs mixture was associated with higher risk of PTB.

Perfluoroalkyl Mixture Exposure in Relation to Fetal Growth: Potential Roles of Maternal Characteristics and Associations with Birth Outcomes

Perfluoroalkyl substances (PFASs) exposure is suggested to interfere with fetal growth. However, limited investigations considered the roles of parity and delivery on PFASs distributions and the joint effects of PFASs mixture on birth outcomes. In this study, 506 birth cohorts were investigated in Hangzhou, China with 14 PFASs measured in maternal serum. Mothers with higher maternal ages who underwent cesarean section were associated with elevated PFASs burden, while parity showed a significant but diverse influence. A logarithmic unit increment in perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorononane sulfonate (PFNS) was significantly associated with a reduced birth weight of 0.153 kg (95% confidence interval (CI): -0.274, -0.031, p = 0.014), 0.217 kg (95% CI: -0.385, -0.049, p = 0.012), and 0.137 kg (95% CI: -0.270, -0.003, p = 0.044), respectively. Higher perfluoroheptanoic acid (PFHpA) and perfluoroheptane sulphonate (PFHpS) were associated with increased Apgar-1 scores. PFOA (Odds ratio (OR): 2.17, 95% CI: 1.27, 3.71, p = 0.004) and PFNS (OR:1.59, 95% CI: 1.01, 2.50, p = 0.043) were also risk factors to preterm birth. In addition, the quantile-based g-computation showed that PFASs mixture exposure was significantly associated with Apgar-1 (OR: 0.324, 95%CI: 0.068, 0.579, p = 0.013) and preterm birth (OR: 0.356, 95% CI: 0.149, 0.845, p = 0.019). In conclusion, PFASs were widely distributed in the maternal serum, which was influenced by maternal characteristics and significantly associated with several birth outcomes. Further investigation should focus on the placenta transfer and toxicities of PFASs.

Health-related toxicity of emerging per- and polyfluoroalkyl substances: Comparison to legacy PFOS and PFOA

Per- and polyfluoroalkyl substances (PFAS) are highly persistent, manufactured chemicals used in various manufacturing processes and found in numerous commercial products. With over 9000 compounds belonging to this chemical class, there is increasing concern regarding human exposure to these compounds due to their persistent, bioaccumulative, and toxic nature. Human exposure to PFAS may occur from a variety of exposure sources, including, air, food, indoor dust, soil, water, from the transfer of PFAS from non-stick wrappers to food, use of cosmetics, and other personal care products. This critical review presents recent research on the health-related impacts of PFAS exposure, highlighting compounds other than Perfluorooctanoic acid (PFOA) and Perfluoroctane sulfonate (PFOS) that cause adverse health effects, updates the current state of knowledge on PFAS toxicity, and, where possible, elucidates cause-and-effect relationships. Recent reviews identified that exposure to PFAS was associated with adverse health impacts on female and male fertility, metabolism in pregnancy, endocrine function including pancreatic dysfunction and risk of developing Type 2 diabetes, lipid metabolism and risk of childhood adiposity, hepatic and renal function, immune function, cardiovascular health (atherosclerosis), bone health including risk for dental cavities, osteoporosis, and vitamin D deficiency, neurological function, and risk of developing breast cancer. However, while cause-and-effect relationships for many of these outcomes were not able to be clearly elucidated, it was identified that 1) the evidence derived from both animal models and humans suggested that PFAS may exert harmful impacts on both animals and humans, however extrapolating data from animal to human studies was complicated due to differences in exposure/elimination kinetics, 2) PFAS precursor kinetics and toxicity mechanism data are still limited despite ongoing exposures, and 3) studies in humans, which provide contrasting results require further investigation of the long-term-exposed population to better evaluate the biological toxicity of chronic exposure to PFAS.

Simultaneous determination of poly- and perfluoroalkyl substances and organophosphorus flame retardants in serum by ultra-performance liquid chromatography/tandem mass spectrometry

RATIONALE

Poly- and perfluoroalkyl substances (PFASs) and organophosphorus flame retardants (OPFRs) are two types of emerging organic pollutants with potential human health hazards. Here, a rapid and sensitive method was developed for the determination of sixteen PFASs and seven OPFRs in human serum by ultra-performance liquid chromatography/tandem mass spectrometry (UPLC/MS/MS).

METHODS

After optimizing the chromatographic and mass spectrometric conditions, respectively, 100 μL of serum sample was liquid-liquid extracted using 8 mL of methyl tert-butyl ether. The 23 targets were quantified within 8 min. All targets were quantified by the isotope-internal standard method in both negative- and positive-ion mode by UPLC/MS/MS.

RESULTS

The method was validated in terms of sensitivity, linearity, precision, and accuracy. The limit of detection ranged between 0.004 and 0.650 ng/mL. Recoveries ranged from70.0% to 118.9% with a relative standard deviation lower than 20%. The developed method was successfully applied to analyze targeted analytes in human serum samples. A total of 13 of 23 analytes were detected in over 50% of samples.

CONCLUSIONS

A sensitive and rapid method was developed to quantify sixteen PFASs and seven OPFRs in serum. Sensitivity, linearity, recovery, and precision were validated and found to be satisfactory. This method can be a valuable tool for evaluation of exposure to both PFASs and OPFRs with high separation efficiency and sensitivity.

The relationship between multiple perfluoroalkyl substances and cardiorespiratory fitness in male adolescents

Exposure to perfluoroalkyl substances (PFASs) is associated with a number of adverse health outcomes. However, the relationship between mixed and individual PFAS exposure and cardiorespiratory fitness (CRF) in adolescents remains unclear. We used cross-sectional data from 491 teenagers (aged 13-19 years) from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) and examined the association between mixed PFAS exposure and CRF via weighted quantile sum (WQS) regression. Maximal oxygen consumption (VO₂max) was used to evaluate CRF. Multivariate linear regression was performed to investigate the relationship between each PFAS and VO₂max as well as the relationship between PFAS exposure and the inflammation parameters and blood lipid content. Mediation analyses were performed to investigate possible explanations of the risk of low CRF due to PFAS exposure. The results showed that for males, mixed PFAS exposure was negatively related to VO₂max (beta =  - 0.80, 95% CI: - 1.53 to - 0.10, P = 0.028) and that of the PFASs, perfluorononanoic acid (PFNA) had the greatest influence on VO₂max. In the individual PFAS analysis, PFNA was negatively related to VO₂max in male adolescents (beta =  - 1.49, 95% CI: - 2.65 to - 0.32, P = 0.013). Additionally, significant relationships among serum PFNA levels and total cholesterol and the white blood cell (WBC) count were found. Mediation analyses revealed that WBC count accounted for 24.18% of the variation between PFNA level and CRF. The present results provide epidemiological evidence that exposure to PFASs, mainly PFNA, is negatively associated with CRF, possibly via alterations in WBC count.

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

Although previous meta-analyses have shown that prenatal PFASs exposure is associated with reduction in birth weight, effects of prenatal PFASs exposure on birth outcomes have not been fully explored. We conducted a meta-analysis of 23 eligible studies searched from Embase, PubMed, and Web of Science before March 21, 2021 to analyze the association between prenatal PFASs exposure and birth outcomes, including premature birth (PTB), low birth weight (LBW), small for gestational age (SGA) and miscarriage. Odds ratio (OR) and corresponding confidence intervals were extracted for analysis. According to the heterogeneity of the included studies, fixed-effects (I² ≤ 50%) and random-effects (I² > 50%) models were applied respectively. The significant associations between PFOS and PTB (pooled OR = 1.54, 95% CI: 1.20-1.98), PFOA and miscarriage (pooled OR = 1.40, 95% CI: 1.15-1.70), and PFOS and LBW (pooled OR = 1.52, 95% CI: 1.19-1.94) were obtained. There were differences between included studies with different study regions, sampling time, and samples type used for PFASs assessment. These findings may provide insight in risk assessment and decision-making in producing products that contain PFASs.

Maternal exposure to endocrine disrupting chemicals (EDCs) and preterm birth: A systematic review, meta-analysis, and meta-regression analysis

Preterm birth is the second most common cause of death in children under 5 years of age. The etiology of preterm birth has not yet been elucidated. Although maternal exposure to endocrine disrupting chemicals (EDCs) may increase the risk for preterm birth, associations have not been confirmed. We performed a meta-analysis to elucidate the relationships between maternal exposure to EDCs and preterm birth. A systematic search of PubMed, Ovid-EMBASE, and the Cochrane Library (CENTRAL) for relevant published studies providing quantitative data on the association between maternal EDC exposure and preterm birth in humans was conducted in July 2021. To calculate the overall estimates, we pooled the adjusted regression coefficients with 95% confidence intervals (CIs) from each study by the inverse variance method. A total of 59 studies were included. The pooled results indicated that maternal exposure to metals (OR, 1.23; 95% CI, 1.17 to 1.29) and phthalates (OR, 1.31; 95% CI, 1.21 to 1.42) was related to an increased risk for preterm birth. Specifically, maternal exposure to lead, cadmium, chromium, copper and manganese appeared to be correlated with an elevated risk for preterm birth. Additionally, maternal exposure to monoethyl phthalate (MEP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), monobenzyl phthalate (MBzP), and di (2-ethylhexyl) phthalate (DEHP) was also associated with preterm birth. In conclusion, maternal exposure to metals and phthalates may increase the risk for preterm birth based on current evidence.

Developmental toxicant exposures and sex-specific effects on epigenetic programming and cardiovascular health across generations

Despite substantial strides in diagnosis and treatment, cardiovascular diseases (CVDs) continue to represent the leading cause of death in the USA and around the world, resulting in significant morbidity and loss of productive years of life. It is increasingly evident that environmental exposures during early development can influence CVD risk across the life course. CVDs exhibit marked sexual dimorphism, but how sex interacts with environmental exposures to affect cardiovascular health is a critical and understudied area of environmental health. Emerging evidence suggests that developmental exposures may have multi- and transgenerational effects on cardiovascular health, with potential sex differences; however, further research in this important area is urgently needed. Lead (Pb), phthalate plasticizers, and perfluoroalkyl substances (PFAS) are ubiquitous environmental contaminants with numerous adverse human health effects. Notably, recent evidence suggests that developmental exposure to each of these toxicants has sex-specific effects on cardiovascular outcomes, but the underlying mechanisms, and their effects on future generations, require further investigation. This review article will highlight the role for the developmental environment in influencing cardiovascular health across generations, with a particular emphasis on sex differences and epigenetic mechanisms. In particular, we will focus on the current evidence for adverse multi and transgenerational effects of developmental exposures to Pb, phthalates, and PFAS and highlight areas where further research is needed.

Determination of 56 per- and polyfluoroalkyl substances in top predators and their prey from Northern Europe by LC-MS/MS

Per- and polyfluoroalkyl substances (PFAS) are a group of emerging substances that have proved to be persistent and highly bioaccumulative. They are broadly used in various applications and are known for their long-distance migration and toxicity. In this study, 65 recent specimens of a terrestrial apex predator (Common buzzard), freshwater and marine apex predators (Eurasian otter, harbour porpoise, grey seal, harbour seal) and their potential prey (bream, roach, herring, eelpout) from northern Europe (United Kingdom, Germany, the Netherlands and Sweden) were analyzed for the presence of legacy and emerging PFAS, employing a highly sensitive liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) method. 56 compounds from 14 classes were measured; 13 perfluoroalkyl carboxylic acids (PFCAs), 7 perfluoroalkyl sulphonic acids (PFSAs), 3 perfluorooctane sulfonamides (FOSAs), 4 perfluoroalkylphosphonic acids (PFAPAs), 3 perfluoroalkylphosphinic acids (PFPi's), 5 telomer alcohols (FTOHs), 2 mono-substituted polyfluorinated phosphate esters (PAPs), 2 di-substituted polyfluorinated phosphate esters (diPAPs), 6 saturated fluorotelomer acids (FTAS), 3 unsaturated fluorotelomer acids (FTUAs), 2 N-Alkyl perfluorooctane sulfonamidoethanols (FOSEs), 3 fluorotelomer sulphonic acids (FTSAs), 2 perfluoroether carboxylic acids (PFECAs) and 1 chlorinated perfluoroether sulphonic acid (Cl-PFESA). All samples were lyophilized before analysis, in order to enhance extraction efficiency, improve the precision and achieve lower detection limits. The analytes were extracted from the dry matrices through generic methods of extraction, using an accelerated solvent extraction (ASE), followed by clean-up through solid phase extraction (SPE). Method detection limits and method quantification limits ranged from 0.02 to 1.25 ng/g wet weight (ww) and from 0.05 to 3.79 ng/g (ww), respectively. Recovery ranged from 40 to 137%. Method precision ranged from 3 to 20 %RSD. The sum of PFAS concentration in apex predators livers ranged from 0.2 to 20.2 μg/g (ww), whereas in the fish species muscle tissues it ranged from 16 to 325 ng/g (ww). All analyzed specimens were primarily contaminated with PFOS, while the three PFPi's included in this study exhibited frequency of appearance (FoA) 100 %. C9 to C13 PFCAs were found at high concentrations in apex predator livers, while the overall PFAS levels in fish fillets also exceeded ecotoxicological thresholds. The findings of our study show a clear association between the PFAS concentrations in apex predators and the geographical origin of the specimens, with samples that were collected in urban and agricultural zones being highly contaminated compared to samples from pristine or semi-pristine areas. The high variety of PFAS and the different PFAS composition in the apex predators and their prey (AP&P) samples is alarming and strengthens the importance of PFAS monitoring across the food chain.

Using Live Imaging and FUCCI Embryonic Stem Cells to Rank DevTox Risks: Adverse Growth Effects of PFOA Compared With DEP Are 26 Times Faster, 1,000 Times More Sensitive, and 13 Times Greater in Magnitude

Fluorescent ubiquitination-based cell cycle indicator (FUCCI) embryonic stem cells (ESCs), which fluoresce green during the S-G2-M phases, generate an S-shaped curve for the accumulation of cells during normal stemness (NS) culture with leukemia-inhibitory factor (LIF). Since it was hypothesized that a culture of ESCs was heterogeneous in the cell cycle, it was expected that increased S-G2-M-phases of the cell cycle would make an S-shaped curve parallel to the accumulation curve. Unexpectedly, it was observed that the fraction of FUCCI ESCs in green decreases over time to a nadir at ∼24 h after previous feeding and then rapidly enters S-G2-M-phases after medium change. G1 delay by infrequent medium change is a mild stress, as it does not affect growth significantly when frequency is increased to 12 h. Perfluoro-octanoic acid (PFOA) and diethyl phthalate (DEP) were used as examples of members of the per- and polyfluoroalkyl substances (PFAS) and phthalate families of chemicals, respectively. Two adverse outcomes were used to compare dose- and time-dependent effects of PFOA and DEP. The first was cell accumulation assay by time-lapse confluence measurements, largely at Tfinal/T74 h. The second was by quantifying dominant toxicant stress shown by the suppression of mild stress that creates a green fed/unfed peak. In terms of speed, PFOA is 26 times faster than DEP for producing a time-dependent LOAEL dose at 100 uM (that is, 2 h for PFOA and 52 h for DEP). PFOA has 1000-fold more sensitive LOAEL doses than DEP for suppressing ESC accumulation (confluence) at day 3 and day 2. There were two means to compare the magnitude of the growth suppression of PFOA and DEP. For the suppression of the accumulation of cells measured by confluence at Tfinal/T74h, there was a 13-fold suppression at the highest dose of PFOA > the highest dose of DEP. For the suppression of entry into the cell cycle after the G1 phase by stress on day 1 and 2, there is 10-fold more suppression by PFOA than DEP. The data presented here suggest that FUCCI ESCs can assay the suppression of accumulated growth or predict the suppression of future growth by the suppression of fed/unfed green fluorescence peaks and that PFOA's adverse effects are faster and larger and can occur at more sensitive lower doses than DEP.

Per- and Polyfluoroalkyl Substances (PFAS) in Integrated Crop-Livestock Systems: Environmental Exposure and Human Health Risks

Per- and polyfluoroalkyl substances (PFAS) are highly persistent synthetic organic contaminants that can cause serious human health concerns such as obesity, liver damage, kidney cancer, hypertension, immunotoxicity and other human health issues. Integrated crop–livestock systems combine agricultural crop production with milk and/or meat production and processing. Key sources of PFAS in these systems include firefighting foams near military bases, wastewater sludge and industrial discharge. Per- and polyfluoroalkyl substances regularly move from soils to nearby surface water and/or groundwater because of their high mobility and persistence. Irrigating crops or managing livestock for milk and meat production using adjacent waters can be detrimental to human health. The presence of PFAS in both groundwater and milk have been reported in dairy production states (e.g., Wisconsin and New Mexico) across the United States. Although there is a limit of 70 parts per trillion of PFAS in drinking water by the U.S. EPA, there are not yet regional screening guidelines for conducting risk assessments of livestock watering as well as the soil and plant matrix. This systematic review includes (i) the sources, impacts and challenges of PFAS in integrated crop–livestock systems, (ii) safety measures and protocols for sampling soil, water and plants for determining PFAS concentration in exposed integrated crop–livestock systems and (iii) the assessment, measurement and evaluation of human health risks related to PFAS exposure.

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

BACKGROUND

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes; however, the findings have been inconsistent. We aimed to conduct a systematic review and meta-analysis to provide an overview of these associations.

METHODS

The online databases PubMed, EMBASE and Web of Science were searched comprehensively for eligible studies from inception to February 2021. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random- or fixed-effects models, and dose-response meta-analyses were also conducted when possible.

FINDINGS

A total of 29 studies (32,905 participants) were included. The pooled results demonstrated that perfluorooctane sulfonate (PFOS) exposure during pregnancy was linearly associated with increased preterm birth risk (pooled OR per 1-ng/ml increase: 1.01, 95% CIs: 1.00-1.02, P = 0.009) and perfluorononanoate (PFNA) and perfluorooctanoate (PFOA) exposure showed inverted U-shaped associations with preterm birth risk (P values for the nonlinear trend: 0.025 and 0.030). Positive associations were also observed for exposure to perfluorodecanoate (PFDA) and miscarriage (pooled OR per 1-ng/ml increase: 1.87, 95% CIs: 1.15-3.03) and PFOS and preeclampsia (pooled OR per 1-log increase: 1.27, 95% CIs: 1.06-1.51), whereas exposure to perfluoroundecanoate (PFUnDA) was inversely associated with preeclampsia risk (pooled OR per 1-log increase: 0.81, 95% CIs: 0.71-0.93). Based on individual evidence, detrimental effects were observed between PFDA exposure and small for gestational age and between PFOA and PFOS and intrauterine growth restriction. No significant associations were found between pregnancy PFAS exposure and other adverse pregnancy outcomes (i.e., gestational diabetes mellitus, pregnancy-induced hypertension, low birth weight, and large and small for gestational age).

INTERPRETATION

Our findings indicated that PFOS, PFOA and PFNA exposure during pregnancy might be associated with increased preterm birth risk and that PFAS exposure might be associated with the risk of miscarriage and preeclampsia. Due to the limited evidence obtained for most associations, additional studies are required to confirm these findings.

Associations of Prenatal Exposure to Per- and Polyfluoroalkyl Substances with the Neonatal Birth Size and Hormones in the Growth Hormone/Insulin-Like Growth Factor Axis

Toxicological data suggest a significant developmental toxicity of per- and polyfluoroalkyl substances (PFASs); however, evidence in humans remains inconclusive. Furthermore, the effects of prenatal exposure to PFASs on hormones in the growth hormone (GH)/insulin-like growth factor (IGF) axis of newborns remain largely unclear. We aimed to investigate the associations of prenatal exposure to PFASs with the neonatal birth size, GH, IGF-1, and IGF-binding protein 3 (IGFBP-3). The concentrations of 22 PFASs were measured in the plasma of 224 pregnant women collected within 3 days before delivery (39.3 weeks) in Guangzhou, China, and the anthropometric data were gathered from medical records. Paired cord blood was collected at delivery to determine GH, IGF-1, and IGFBP-3 levels. Multivariable linear regression models revealed the inverse associations of several long-chain PFASs with birth weight and ponderal index as well as the significant associations of perfluorobutanoic acid and perfluorooctanoic acid (PFOA) with IGFBP-3 levels. The Bayesian kernel machine regression confirmed the association of perfluorooctane sulfonate with birth weight and ponderal index and of PFOA with IGFBP-3 and identified an inverse joint effect of exposure to a mixture of multiple PFASs on birth weight. The findings provide the first comprehensive evidence on the individual and joint effects of multiple PFASs on the neonatal birth size and hormones in the GH/IGF axis, which requires further confirmation.

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

Perfluoroalkyl and polyfluoroalkyl substances (PFASs), a class of persistent endocrine-disrupting chemicals, are widely used in consumer products due to their unique amphiphilic properties. Previous epidemiological studies suggest association of maternal PFASs exposure and adverse pregnancy outcomes, while evidences about the association are inconsistent. The aim of this systematic review and meta-analysis is to assess the relationship of maternal PFASs exposure and adverse pregnancy outcomes. Twenty-one relevant studies were identified from three databases before 2020. The quality, heterogeneity and possibility of publication bias of included studies were evaluated by Newcastle-Ottawa Scale, Q-statistic and Begg's test, respectively. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained by means of random-effects meta-analysis models. Meta-analysis results revealed that maternal exposure to perfluorooctane sulfonic acid (PFOS) may have a positive association with preterm birth (OR = 1.20, 95% CI: 1.04, 1.38). The pooled estimates also showed limited evidence of association between maternal perfluorononanoic acid (PFNA) exposure and miscarriage (OR = 1.48, 95% CI: 0.92, 2.38) with obvious heterogeneity (I² = 93.9, p < 0.01). However, no such significant associations were found between the other PFASs and miscarriage, stillbirth and preterm birth. In addition, the subgroup analyses showed that studies on the relationship of maternal PFASs exposure and miscarriage were mainly contributed by developed countries. The meta-analysis results indicated maternal exposure to PFOS can increase the risk of preterm birth. The results of the included studies are inconsistent and the effects of PFASs on human health are complex. Further studies with enough samples are required to verify these findings.

Perfluorodecanoic acid induces meiotic defects and deterioration of mice oocytes in vitro

Perfluorodecanoic acid (PFDA) is a member of the perfluoroalkyl substances, which are toxic to organic functions. Recently, it has been found in follicular fluid, seriously interfering with reproduction. Follicular fluid provides the oocyte with necessary resources during the process of oocytes maturation. However, the effects of PFDA on the oocyte need investigation. Our study evaluated the impacts of PFDA on the meiosis and development potential of mouse oocytes by exposing oocytes to PFDA in vitro at 350, 400, and 450 μM concentrations. The results showed that exposure to PFDA resulted in the first meiotic prophase arrest by obstructing the function of the maturation-promoting factor. It also induced the dysfunction of the spindle assembly checkpoint, expedited the progression of the first meiotic process, and increased the risk of aneuploidy. The oocytes treated with PFDA had a broken cytoskeleton which also contributed to meiotic maturation failure. Besides, PFDA exposure caused mitochondria defections, increased the reactive oxygen species level in oocytes, and consequently induced oocyte apoptosis. Moreover, PFDA produced epigenetic modifications in oocytes and increased the frequency of mature oocytes with declined development potential. In summary, our data indicated that PFDA disturbs the meiotic process and induces oocyte quality deterioration.

Direct injection analysis of per and polyfluoroalkyl substances in surface and drinking water by sample filtration and liquid chromatography-tandem mass spectrometry

We developed and validated a method for direct determination of per- and polyfluoroalkylated substances (PFASs) in environmental water samples without prior sample concentration. Samples are centrifuged and supernatants passed through an Acrodisc Filter (GXF/GHP 0.2  um, 25  mm diameter). After addition of ammonium acetate, samples are analyzed by UPLC-MS/MS using an AB Sciex 6500 plus Q-Trap mass spectrometer operated in negative multiple reaction-monitoring (MRM) mode. The instrument system incorporates a delay column between the pumps and autosampler to mitigate interference from background PFAS. The method monitors eight short-/long-chain PFAS which are identified by monitoring specific precursor product ion pairs and by their retention times and quantified using isotope mass-labeled internal standard based calibration plots. Average spiked recoveries (n = 8) of target analytes ranged from 84 to 110% with 4-9% relative standard deviation (RSD). The mean spiked recoveries (n = 8) of four surrogates were 94-106% with 3-8% RSD. For continuous calibration verification (CCV), average spiked recoveries (n = 8) for target analytes ranged from 88 to 114% with 4-11% RSD and for surrogates ranged from 104-112% with 3-11% RSD. The recoveries (n = 6) of matrix spike (MX), matrix spike duplicate (MXD), and field reagent blank (FRB) met our acceptance criteria. The limit of detection for the target analytes was between 0.007 and 0.04 ng/mL. The method was used to measure PFAS in tap water and surface water.

Perfluorooctanoic acid induces liver and serum dyslipidemia in humanized PPARα mice fed an American diet

Per- and polyfluoroalkyl substances (PFAS) are pervasive in the environment resulting in nearly universal detection in people. Human serum PFAS concentrations are strongly associated with increased serum low-density lipoprotein cholesterol (LDL-C), and growing evidence suggests an association with serum triacylglycerides (TG). Here, we tested the hypothesis that perfluorooctanoic acid (PFOA) dysregulates liver and serum triacylglycerides in human peroxisome proliferator activated receptor α (hPPARα)-expressing mice fed an American diet. Mice were exposed to PFOA (3.5 mg/L) in drinking water for 6 weeks resulting in a serum concentration of 48 ± 9 μg/ml. In male and female hPPARα mice, PFOA increased total liver TG and TG substituted with saturated and monounsaturated fatty acids. Lack of expression of PPARα alone also increased total liver TG, and PFOA treatment had little effect on liver TG in PPARα null mice. In hPPARα mice, PFOA neither significantly increased nor decreased serum TG; however, there was a modest increase in TG associated with very low-density cholesterol particles in both sexes. Intriguingly, in female PPARα null mice, PFOA significantly increased serum TG, with a similar trend in males. PFOA also modified fatty acid and TG homeostasis-related gene expression in liver, in a hPPARα-dependent manner, but not in adipose. The results of our study and others reveal the importance of context (serum concentration and genotype) in determining the effect of PFOA on lipid homeostasis.

Impact of gestational exposure to endocrine disrupting chemicals on pregnancy and birth outcomes

With the advent of industrialization, humans are exposed to a wide range of environmental chemicals, many with endocrine disrupting potential. As successful maintenance of pregnancy and fetal development are under tight hormonal control, the gestational exposure to environmental endocrine disrupting chemicals (EDC) have the potential to adversely affect the maternal milieu and support to the fetus, fetal developmental trajectory and birth outcomes. This chapter summarizes the impact of exposure to EDCs both individually and as mixtures during pregnancy, the immediate and long-term consequences of such exposures on the mother and fetus, the direct and indirect mechanisms through which they elicit their effects, factors that modify their action, and the research directions to focus future investigations.

The National Children's Study Archive Model: A 3-Tier Framework for Dissemination of Data and Specimens for General Use and Secondary Analysis

The National Children's Study (NCS) Archive was created as a repository of samples, data, and information from the NCS Vanguard Study-a longitudinal pregnancy and birth cohort evaluating approaches to study influence of environmental exposures on child health and development-to provide qualified researchers with access to NCS materials for use in secondary research. The National Children's Study Archive (NCSA) model is a 3-tiered access model designed to make the wealth of information and materials gathered during the NCS Vanguard Study available at a user appropriate level. The NCSA model was developed as a 3-tier framework, for users of varying access levels, providing intuitive data exploration and visualization tools, an end-to-end data and sample request management system, and a restricted portal for participant-level data access with a team of experts available to assist users. This platform provides a model to accelerate transformation of information and materials from existing studies into new scientific discoveries. Trial Registration: ClinicalTrials.gov Identifier: NCT00852904 (first posted February 27, 2009).

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

BACKGROUND

Residents of a large area of North-Eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Serum PFAS levels have been consistently associated with elevated serum lipids, but few studies have been conducted among pregnant women, and none has stratified analyses by trimester of gestation. Elevated serum lipid levels during pregnancy can have both immediate and long-lasting effects on pregnant women and the developing fetus. We evaluated the association between perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluoro-hexanesulfonate (PFHxS) levels in relation to lipid profiles in highly-exposed pregnant women.

METHODS

A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) enrolled in the Regional health surveillance program. Non-fasting blood samples were obtained in any trimester of pregnancy and analyzed for PFOA, PFOS and PFHxS, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C). Low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFAS (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester.

RESULTS

The geometric means of PFOA, PFOS and PFHxS were 14.78 ng/mL, 2.67 ng/mL and 1.89 ng/mL, respectively. The plasma levels of TC, HDL-C and LDL-C increased steadily throughout the trimesters. In the 1st trimester, PFOS was positively associated with TC and PFHxS with HDL-C. In the 3rd trimester, instead, an inverse relationship was seen between PFOA and PFHxS and both TC and LDL-C.

CONCLUSIONS

Results suggest the associations between PFAS concentrations and lipid profiles in pregnant women might differ by trimesters of pregnancy. In the first trimester, patterns are similar to those of non-pregnant women, while they differ late in pregnancy. Different independent behavior of PFAS and lipid levels throughout the pregnancy might explain our observations. These findings support the ubiquitous exposure to PFAS and possible influence on lipid metabolisms during pregnancy and suggest a careful evaluation of the timing of PFAS measurement, when examining effects of PFAS during pregnancy on gestational outcomes related to serum lipids amounts.

Endocrine disruption by PFAS: A major concern associated with legacy and replacement substances

Perand poly-fluorinated alkyl substances (PFAS) have been used for decades in a great variety of processes and products by virtue of their exceptional properties, versatility and chemical stability. Nevertheless, it is increasingly recognized that these substances can represent a serious hazard to human health and living organisms due to their persistence, long-range transport potential and tendency to accumulate in biota. For this reason, some efforts have been made across the EU to identify alternative molecules, with a shorter carbon chain and theoretically safer profile, that might replace the previous generation of legacy PFAS. Unfortunately, this strategy has not been entirely successful and serious concerns are still posed by PFAS in different human populations. Among others, an emerging aspect is represented by the adverse effects that both legacy and alternative PFAS can exert on the human endocrine system, with respect to vulnerable target subpopulations. In this review we will briefly summarize PFAS properties, uses and environmental fate, focusing on their effects on human reproductive capacity and fertility, body weight control and obesity as well as thyroid function.

Early-Life Exposure to Per- and Poly-Fluorinated Alkyl Substances and Growth, Adiposity, and Puberty in Children: A Systematic Review

Per- or polyfluoroalkyl substances (PFAS), a family of synthetic polyfluorinated compounds, are widely used in consumer products. Ubiquitous exposures to PFAS, in consideration of their persistence, bioaccumulation potential, and toxicities have led to concerns regarding possible harmful effects during critical periods of development in early-life and long-term consequences on health. The potential effects of PFAS depend on various factors including the type of PFAS and the timing and level of exposure. We performed a systematic review of the epidemiologic literature to assess the effects of early-life PFAS exposure on prenatal and postnatal growth, adiposity, and puberty in children and adolescents. For birth size, most studies indicated that prenatal PFAS exposure, in particular long-chain PFAS, may impair fetal growth, albeit some reports of null associations with maternal PFAS. For growth within 2 years of age, prenatal PFAS exposure showed no associations with height and either null or negative associations with weight. However, postnatal PFAS exposures were inversely related to height and weight at 2 years in a cross-sectional study. For postnatal adiposity, prenatal PFAS may mostly have negative associations with body mass index in the first 2 years of life, but positive relationships with adiposity in childhood and adolescence, although some studies showed null associations. For puberty, the evidence for associations between early-life PFAS exposure and pubertal development or sex hormone levels were limited and inconclusive. From experimental studies, plausible mechanisms through which PFAS may affect early-life growth and puberty include PFAS-induced activation of peroxisome proliferator-activated receptor, alterations of thyroid or steroid hormone synthesis and metabolism, and their weak estrogenic or anti-androgenic properties. Although the published literature suggests possible effects of PFAS exposures on early-life growth, adiposity, and puberty, current human evidence is limited in establishing PFAS-induced effects on early-life physical development. 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.