Academic journal article Environmental Health Perspectives

Relationship of Perfluorooctanoic Acid Exposure to Pregnancy Outcome Based on Birth Records in the Mid-Ohio Valley

Academic journal article Environmental Health Perspectives

Relationship of Perfluorooctanoic Acid Exposure to Pregnancy Outcome Based on Birth Records in the Mid-Ohio Valley

Article excerpt

BACKGROUND: Perfluorooctanoic acid (PFOA) is a potential cause of adverse pregnancy outcomes, but previous studies have been limited by low exposures and small study size.

OBJECTIVES: Using birth certificate information, we examined the relation between estimated PFOA exposure and birth outcomes in an area of West Virginia and Ohio whose drinking water was contaminated by a chemical plant.

METHODS: Births in the study area from 1990 through 2004 were examined to generate case groups of stillbirth (n = 106), pregnancy-induced hypertension (n = 224), preterm birth (n = 3,613), term low birth weight (n = 918), term small-for-gestational-age (SGA) (n = 353), and a continuous measure of birth weight among a sample of term births (n = 4,534). A 10% sample of term births [greater than or equal to] 2,500 g were selected as a source of controls (n = 3,616). Historical estimates of serum PFOA were derived from a previously developed fate and transport model. In a second study, we examined 4,547 area births linked to a survey with residential history data.

RESULTS: In the analysis based only on birth records, we found no consistent evidence of an association between estimated PFOA exposure and stillbirth, pregnancy-induced hypertension, preterm birth, or indices of fetal growth. In the analysis of birth records linked to the survey, PFOA was unrelated to pregnancy-induced hypertension or preterm birth but showed some suggestion of an association with early preterm birth. Measures of growth restriction showed weak and inconsistent associations with PFOA.

CONCLUSIONS: Based on the analysis using the health survey, these results provide little support for an effect of PFOA exposure on most pregnancy outcomes, except for early preterm birth and possibly fetal growth restriction.

KEY WORDS: fetal growth restriction, perfluorooctanoic add, pregnancy, pregnancy-induced hypertension, preterm birth, stillbirth. Environ Health Perspect 120:1201-1207 (2012). http://dx.doi.org/10.1289/ehp.1104752 [Online 26 March 2012]

Adverse effects of perfluorooctanoic acid (PFOA) and related perfluoroalkyl acids on pregnancy and development have been suggested based on toxicology (Lau et al. 2007) and a small but growing epidemiologic literature (Steenland et al. 2010). The strongest support from laboratory studies suggests the potential for reductions in fetal growth (Lau et al. 2007). Epidemiologic findings on measures of reduced growth are mixed (Apelberg et al. 2007; Fei et al. 2007; Hamm et al. 2010; Nolan et al. 2009; Washino et al. 2009), but generally consistent with a small decrement in birth weight associated with higher levels of serum PFOA. Duration of gestation has not been related to PFOA in these same studies (Apelberg et al. 2007; Fei et al. 2007; Hamm et al. 2010). More extreme, clinically consequential end points of fetal growth restriction and preterm birth have been examined less extensively and often with limited statistical power; none of the human studies support an association (Fei et al. 2007; Hamm et al. 2010; Nolan et al. 2009). Given ubiquitous exposure, suggestive toxicologic data, and limited epidemiologic research, continued examination of the potential association between PFOA and pregnancy outcomes is warranted.

A large population in Ohio and West Virginia has been exposed to PFOA predominantly through industrial contamination of drinking-water supplies (Frisbee et al. 2009). Within this population, PFOA exposure varies considerably across time and place because of different levels of PFOA contamination in the drinking water, depending on the year and the water district, enabling accurate estimation of serum levels by linking residential histories and historical drinking-water concentrations. The resulting range of PFOA levels are well above background exposure (Steenland et al. 2009), which may allow for a more informative assessment of the impact of PFOA exposure on birth outcomes. …

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