Public health evaluation of PFAS exposures and breastfeeding: a systematic literature review

Area of Science:

• Environmental Health
• Toxicology
• Pediatrics

Background:

• Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants. Neonatal exposure can occur via maternal transfer across the placenta and through human milk. The American Academy of Pediatrics generally supports breastfeeding, but chemical-specific risks require evaluation.
• Limited data exists on the specific health impacts of PFAS exposure in infants through breastfeeding, necessitating a comprehensive review of available evidence.

Approach:

• A systematic review was conducted to explore associations between PFAS exposure via breastfeeding and adverse health outcomes in infants and children.
• Searches across 7 databases yielded 4297 unique records; 37 articles, including 9 animal and 1 human study, were included for analysis.
• Studies examined direct infant/pup exposure through milk and associated health outcomes.

Key Points:

• Animal studies indicated associations between perfluorooctanoic acid (PFOA) exposure via breastfeeding and reduced early-life body weight gain, impaired mammary gland development, and altered thyroid hormone levels.
• Limited evidence from animal studies suggested associations between perfluorooctanesulfonic acid (PFOS) exposure via breastfeeding and reduced early-life body weight gain and hippocampal cellular changes.
• The direct human health relevance of these animal study findings remains uncertain, and many potential adverse effects may be understudied.

Conclusions:

• This review synthesizes current scientific understanding of PFAS exposure risks through breastfeeding.
• Significant knowledge gaps exist regarding the long-term health consequences for infants exposed to PFAS via human milk.
• Further research is crucial to inform clinical recommendations on infant feeding practices in the context of environmental chemical exposures.