The DOI matches its Crossref record; 120 of the 121 references it cites were found in a registry or an index.
The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth
Open accessAbstract
Abstract Background: In contrast to current methods of expert-based narrative review, the Navigation Guide is a systematic and transparent method for synthesizing environmental health research from multiple evidence streams. The Navigation Guide was developed to effectively and efficiently translate the available scientific evidence into timely prevention-oriented action. Objectives: We applied the Navigation Guide systematic review method to answer the question “Does fetal developmental exposure to perfluorooctanoic acid (PFOA) or its salts affect fetal growth in animals ?” and to rate the strength of the experimental animal evidence. Methods: We conducted a comprehensive search of the literature, applied prespecified criteria to the search results to identify relevant studies, extracted data from studies, obtained additional information from study authors, conducted meta-analyses, and rated the overall quality and strength of the evidence. Results: Twenty-one studies met the inclusion criteria. From the meta-analysis of eight mouse gavage data sets, we estimated that exposure of pregnant mice to increasing concentrations of PFOA was associated with a change in mean pup birth weight of –0.023 g (95% CI: –0.029, –0.016) per 1-unit increase in dose (milligrams per kilogram body weight per day). The evidence, consisting of 15 mammalian and 6 nonmammalian studies, was rated as “moderate” and “low” quality, respectively. Conclusion: Based on this first application of the Navigation Guide methodology, we found sufficient evidence that fetal developmental exposure to PFOA reduces fetal growth in animals. Citation: Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. 2014. The Navigation Guide—evidence-based medicine meets environmental health: systematic review of nonhuman evidence for PFOA effects on fetal growth. Environ Health Perspect 122:1015–1027; http://dx.doi.org/10.1289/ehp.1307177
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In utero exposure to per- and polyfluoroalkyl substances (PFAS), which are recognized developmental toxicants, potentially leads to decreased anthropometric measures in infants at birth.”
From Associations between in utero exposure of per- and polyfluoroalkyl substances (PFAS) mixture and anthropometry measures at birth (2025) · cites this paper as Koustas et al., 2014
Experimental — accuracy not yet measuredIn the citing paper
“such methods have only recently been developed and utilized in environmental health sciences [23–30].”
From A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder (2016) · cites this paper as [24]
In the citing paper
“This observation is consistent with our previous systematic reviews, [24, 27, 28, 30]”
From A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder (2016) · cites this paper as [24]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020
Conducting Meta-Analyses in R with the metafor Package
Viechtbauer, W. (2010) · Journal of Statistical Software · doi:10.18637/jss.v036.i03 · Cited by 20,464
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010 · Cited by 17,796
(2014) · Medical Entomology and Zoology · Cited by 17,633
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709
(2008) · Cited by 3,790
Flagged first, then by citations
1 of the 121 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Higgins JPT, Deeks JJ, eds. 2011. Chapter 7: Selecting studies and collecting data. In: Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 (Higgins JPT, Green S, eds).Available: http://www.cochrane-handbook.org [accessed 7 February 2013].
Cited by
Sorted by citations
Items 301–349 of 349
Michel, S., Atmakuri, A., & Ehrenstein, O. S. V. (2024) · Environmental Health · doi:10.1186/s12940-024-01069-z · Cited by 10
Systematic Reviews: Perhaps “The Answer to Policy Makers’ Prayers”?
Fox, D. M., & Bero, L. A. (2014) · Environmental Health Perspectives · doi:10.1289/ehp.1408599 · Cited by 9
Birth cohorts in Asia: The importance, advantages, and disadvantages of different-sized cohorts
Kishi, R., Araki, A., Minatoya, M., Itoh, S., Goudarzi, H., & Miyashita, C. (2017) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2017.08.268 · Cited by 9
Environmental Exposures and Adverse Pregnancy-Related Outcomes
Minatoya, M., Hanaoka, T., & Kishi, R. (2019) · Current topics in environmental health and preventive medicine · doi:10.1007/978-981-15-0520-1_2 · Cited by 11
Zhao, N., Zhang, X., Li, Y., Zhang, H., Yang, E., Ding, L., & Liu, Y. (2025) · Environmental Pollution · doi:10.1016/j.envpol.2025.126093 · Cited by 8
Cao, W., Horzmann, K. A., Schemera, B., Petrofski, M., Kendall, T., Spooner, J., Rynders, P. E., VandeBerg, J. L., & Wang, X. (2023) · Frontiers in Genetics · doi:10.3389/fgene.2023.1073461 · Cited by 8
Roth, N., Sandström, J., & Wilks, M. F. (2020) · Environment International · doi:10.1016/j.envint.2020.105768 · Cited by 8
Caban-Martinez, A. J., Solle, N. S., Feliciano, P. L., Griffin, K., Santiago, K. M., Lee, D. J., Daunert, S., Deo, S. K., Fent, K. W., Calkins, M. M., et al. (2019) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001566 · Cited by 7
Tetzlaff, C. N. R., Ramhøj, L., Lardenois, A., Axelstad, M., Evrard, B., Chalmel, F., Taxvig, C., & Svingen, T. (2020) · Toxicology Letters · doi:10.1016/j.toxlet.2020.12.018 · Cited by 9
Chemical Contamination of Red Meat
Smith, D. J., & Kim, M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-08-100674-0.00018-7 · Cited by 7
Chartres, N., Aung, M. T., Norris, S. L., Cooper, C., Bero, L. A., Chou, R., Payne-Sturges, D., Wagner, W. E., Reyes, J. W., Askie, L. M., et al. (2025) · Environmental Science & Technology · doi:10.1021/acs.est.4c08063 · Cited by 6
Self-citationPinto, R., Ardoino, L., Giardullo, P., Villani, P., & Marino, C. (2022) · Systematic Reviews · doi:10.1186/s13643-022-01898-4 · Cited by 6
Li, D., Song, P., Liu, L., & Wang, X. (2018) · Europe PMC (PubMed Central) · Cited by 6
Wang, Y.-Y., Xu, H., & Li, R.-Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-07386-8 · Cited by 6
Zhou, J.-X., Liu, X.-B., Zheng, Z.-Y., Li, Q., Hu, Y., Hu, K., Liu, X., Jia, X., & Qi, W. (2025) · Journal of environmental chemical engineering · doi:10.1016/j.jece.2025.117792 · Cited by 6
Song, X., Ma, Y., Tang, J. Y., Peng, J., Hu, Y., Han, Y., Fu, X., Luo, X., Li, X., Ge, L., et al. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.05.021 · Cited by 5
Li, J., Rugulies, R., Morgan, R. L., Woodruff, T. J., & Siegrist, J. (2020) · Environment International · doi:10.1016/j.envint.2020.106118 · Cited by 7
Self-citationStarling, A. P. (2023) · Environmental Health Perspectives · doi:10.1289/ehp12971 · Cited by 4
Prenatal Exposure to Endocrine Disrupting Chemicals and Their Effect on Health Later in Life
Engdahl, E., & Rüegg, J. (2020) · Springer eBooks · doi:10.1007/978-3-030-35213-4_4 · Cited by 5
Law, H. D., Randall, D., Armstrong, B. K., D’Este, C. A., Lazarevic, N., Hosking, R., Smurthwaite, K. S., Trevenar, S. M., Lucas, R. M., Clements, A., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20196886 · Cited by 4
Endocrine Disruption of Developmental Pathways and Children’s Health
Silver, M. K., & Meeker, J. D. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801139-3.00013-2 · Cited by 4
Wu, X., Braun, J. M., Papandonatos, G. D., Tong, J., Gan, H., Tao, S., Geng, M., Liang, C., Chen, A., Yolton, K. A., et al. (2025) · Environment International · doi:10.1016/j.envint.2025.109990 · Cited by 3
Nachman, K. E., Lam, J., Schinasi, L. H., Smith, T. C., Feingold, B. J., & Casey, J. A. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0575-7 · Cited by 3
Self-citationRathjens, J., Becker, E., Kolbe, A., Ickstadt, K., & Hölzer, J. (2020) · Stochastic Environmental Research and Risk Assessment · doi:10.1007/s00477-020-01932-8 · Cited by 2
O’Shaughnessy, K. L., Oshiro, W. M., Jackson, T. W., Starnes, H. M., Sasser, A. L., & McMichael, B. D. (2023) · Advances in neurotoxicology · doi:10.1016/bs.ant.2023.09.002 · Cited by 2
Bui, T. T., Aasa, J., Abass, K. M., Ågerstrand, M., Beronius, A., Castro, M., Escrivá, L., Galizia, A., Gliga, A. R., Karlsson, O., et al. (2023) · Environmental Science Processes & Impacts · doi:10.1039/d3em00353a · Cited by 2
A Systematic Review of the Efficacy of Compression Wraps as an Anxiolytic in Domesticated Dogs
Mathis, S., Schoolfield, S., Gross, M., Gruen, M. E., & Dorman, D. C. (2024) · Animals · doi:10.3390/ani14233445 · Cited by 2
Macon, M. B., Ren, H., & Fenton, S. (2014) · Toxicological Sciences · doi:10.1093/toxsci/kfu253 · Cited by 2
RetractedSuter, G., & Cormier, S. (2016) · Environmental Toxicology and Chemistry · doi:10.1002/etc.3356 · Cited by 1
Shen, L., Raj, S., Oulhote, Y., Valvi, D., Ng, S., Loy, S. L., Chan, S., Benmarhnia, T., & Huang, J. Y. (2026) · Environmental Health · doi:10.1186/s12940-025-01257-5 · Cited by 1
Bommarito, P. A., Taylor, K. W., Rooney, A. A., Addo, K., Auerbach, S. S., Blain, R. B., Ferguson, K. K., Gaston, S. A., Hall, S., Jackson, C. L., et al. (2026) · Environment International · doi:10.1016/j.envint.2026.110147 · Cited by 1
Blake, B. E., Chappell, V. A., Miller, C. N., Nguyen, H., Phan, T. P., Phadke, D. P., Balik-Meisner, M. R., Tripodi, I. J., Mav, D., Shah, R., et al. (2026) · Environment & Health · doi:10.1021/envhealth.5c00350 · Cited by 1
Rooney, A. A., Boyles, A., & Walker, V. (2015) · Molecular and integrative toxicology · doi:10.1007/978-3-319-15518-0_16 · Cited by 1
Endocrine-Disrupting Chemical Exposure and Later-Onset Diseases
Wu, D., & Du, G.-Z. (2020) · Early-life Environmental Exposure and Disease · doi:10.1007/978-981-15-3797-4_11 · Cited by 1
Fetal and Infant Origins of Obesity
Oken, E., & Ozanne, S. E. (2022) · Wiley eBooks · doi:10.1002/9781119695257.ch3 · Cited by 1
The challenge of reporting scientific excellence.
Turk, M. A., & McDermott, S. (2015) · Disability and Health Journal · doi:10.1016/j.dhjo.2015.02.001
Davis, A., & Kraft, A. (2017) · Environmental Research · doi:10.1016/j.envres.2017.07.017
Reviews in Environmental Health: How Systematic are they?
Sutton, P., Daniels, N., Lam, J., Archibald, H., Davis, K., Tesoro, H., & Woodruff, T. J. (2018) · ISEE Conference Abstracts · doi:10.1289/isesisee.2018.p02.4070
Self-citationRathjens, J., Kolbe, A., Holzer, J., Ickstadt, K., & Klein, N. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2104.14243
Kowald, C. (2021) · OakTrust (Texas A&M University Libraries)
Safe, S. H. (2020) · Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature · doi:10.3410/f.731254143.793579050
Zhang, J., Huang, Z., Xu, J., Wang, T., Sun, D., Jia, Z., & Zhou, L. (2025) · Journal of Applied Polymer Science · doi:10.1002/app.56675
Kinkade, C. W., Rivera‐Núñez, Z., Thurston, S. W., Kannan, K., Miller, R. K., Brunner, J., Wong, E., Groth, S. W., O’Connor, T. G., & Barrett, E. S. (2023) · Figshare · doi:10.6084/m9.figshare.24076931
Pinto, R., Ardoino, L., Giardullo, P., Paola, V., & Marino, C. (2022) · Figshare · doi:10.6084/m9.figshare.19185694
Boesen, S. A. H., Long, M., Wielsøe, M., Mustieles, V., Fernandez, M. F., & Bonefeld‐Jørgensen, E. C. (2020) · Figshare · doi:10.6084/m9.figshare.13088109
Lactation Interrupted: PFAS Impact on Capacity to Breastfeed Ignored
Pelch, K. E., Romano, M. E., Reade, A., Fenton, S. E., & Timmermann, C. A. G. (2026) · Current Environmental Health Reports · doi:10.1007/s40572-026-00546-6
Assessing features of PFAS groundwater occurrence using SHAP-enhanced machine learning
Wang, L., Ma, Y., Rajapakshe, D., Xu, X., Cao, H., & Li, R. (2026) · Environmental Pollution · doi:10.1016/j.envpol.2026.128849
Metadata
- Authors
- Koustas, E., Lam, J., Sutton, P., Johnson, P. I., Atchley, D. S., Sen, S., Robinson, K. A., Axelrad, D. A., & Woodruff, T. J.
- Affiliations
- Environmental Protection Agency (US)
- University of California, San Francisco (US)
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Johns Hopkins University (US)
- Corresponding author
- Koustas, Erica
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2014-06-25
- Volume
- 122
- Issue
- 10
- Pages
- 1015-1027
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC4181920
- OpenAlex
- W1969835924
- Cited by
- 349
- References
- 121
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 14 · 2023: 30 · 2022: 25 · 2021: 41 · 2020: 60 · 2019: 31 · 2018: 30 · 2017: 42 · 2016: 24 · 2015: 22 · 2014: 10
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor, 1283 d)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Environmental Health Sciences (ES018135, P01ES022841, ES022841, P20ES018135)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
- Keywords
- perfluorooctanoic acid, fetal growth, prenatal exposure, animal studies, birth weight, evidence synthesis, perfluorinated compounds, developmental toxicity
- MeSH terms
- Animals, Birth Weight, Caprylates, Environmental Health, Environmental Pollutants, Female, Fluorocarbons, Pregnancy, Evidence-Based Medicine, Fetal Development, Mice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
