The Navigation guide—evidence-based medicine meets environmental health

Systematic review of human evidence for PFOA effects on fetal growth

Paula I. Johnson, Patrice Sutton, Dylan S. Atchley, Erica Koustas, Juleen Lam, Saunak Sen, Karen A. Robinson, Daniel A. Axelrad, Tracey J. Woodruff

Research output: Contribution to journalReview article

123 Citations (Scopus)

Abstract

Background: The Navigation Guide methodology was developed to meet the need for a robust method of systematic and transparent research synthesis in environmental health science. We conducted a case study systematic review to support proof of concept of the method.

Methods: We applied the first 3 steps of the Navigation Guide methodology to human epidemiological data: 1) specify the study question, 2) select the evidence, and 3) rate the quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using prespecified criteria. We evaluated each study for risk of bias and conducted meta-analyses on a subset of studies. We rated quality and strength of the entire body of human evidence.

Objective: We applied the Navigation Guide systematic review methodology to determine whether developmental exposure to perfluorooctanoic acid (PFOA) affects fetal growth in humans.

Results: We identified 18 human studies that met our inclusion criteria, and 9 of these were combined through meta-analysis. Through meta-analysis, we estimated that a 1‑ng/mL increase in serum or plasma PFOA was associated with a –18.9 g (95% CI: –29.8, –7.9) difference in birth weight. We concluded that the risk of bias across studies was low, and we assigned a “moderate” quality rating to the overall body of human evidence.

Conclusion: On the basis of this first application of the Navigation Guide systematic review methodology, we concluded that there is “sufficient” human evidence that developmental exposure to PFOA reduces fetal growth.

Original languageEnglish (US)
Pages (from-to)1028-1039
Number of pages12
JournalEnvironmental Health Perspectives
Volume122
Issue number10
DOIs
StatePublished - Oct 1 2014

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perfluorooctanoic acid
Environmental Health
Fetal Development
Medicine
Meta-Analysis
Human Body
Birth Weight
Serum
Research

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

The Navigation guide—evidence-based medicine meets environmental health : Systematic review of human evidence for PFOA effects on fetal growth. / Johnson, Paula I.; Sutton, Patrice; Atchley, Dylan S.; Koustas, Erica; Lam, Juleen; Sen, Saunak; Robinson, Karen A.; Axelrad, Daniel A.; Woodruff, Tracey J.

In: Environmental Health Perspectives, Vol. 122, No. 10, 01.10.2014, p. 1028-1039.

Research output: Contribution to journalReview article

Johnson, Paula I. ; Sutton, Patrice ; Atchley, Dylan S. ; Koustas, Erica ; Lam, Juleen ; Sen, Saunak ; Robinson, Karen A. ; Axelrad, Daniel A. ; Woodruff, Tracey J. / The Navigation guide—evidence-based medicine meets environmental health : Systematic review of human evidence for PFOA effects on fetal growth. In: Environmental Health Perspectives. 2014 ; Vol. 122, No. 10. pp. 1028-1039.
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