Cited by 449Per- and polyfluoroalkyl substances researchMeta-analysis and systematic reviewsHealth, Environment, Cognitive Aging

The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Human Evidence for PFOA Effects on Fetal Growth

Open access
Johnson, Paula I., Sutton, Patrice, Atchley, Dylan S., Koustas, Erica, Lam, Juleen, Sen, Saunak, Robinson, Karen A., Axelrad, Daniel A. +1 more·2014·Environmental Health Perspectives

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. Objective: We applied the Navigation Guide systematic review methodology to determine whether developmental exposure to perfluorooctanoic acid (PFOA) affects fetal growth in humans. 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. 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. Citation: Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. 2014. The Navigation Guide—evidence-based medicine meets environmental health: systematic review of human evidence for PFOA effects on fetal growth. Environ Health Perspect 122:1028–1039; http://dx.doi.org/10.1289/ehp.1307893

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.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1289/ehp.1307893

Cites

111 of 111 references verified0 citation errors · 0 not checkable

Statistics

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.

A few free checks a day · papers already verified open instantly · results are public

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

20 of the 131 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [22]22. Higgins JPT, Deeks JJ. 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://handbook.cochrane.org/chapter_7/7_selecting_studies_and_collecting_data.htm [accessed 29 August 2014]
  2. [55]55. Stein CR Savitz DA Dougan M 2009 Serum levels of perfluorooctanoic acid and perfluorooctane sulfonate and pregnancy outcome. Am J Epidemiol 170 837 846 19692329 10.1093/aje/kwp212 · DOI

Cited by

Sorted by citations

Authors
Johnson, P. I., Sutton, P., Atchley, D. S., Koustas, E., Lam, J., Sen, S., Robinson, K. A., Axelrad, D. A., & Woodruff, T. J.
Affiliations
  • University of California, San Francisco (US)
  • Environmental Protection Agency (US)
  • Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  • Johns Hopkins University (US)
Corresponding author
Johnson, Paula I.
Venue
Environmental Health Perspectives
Published
2014-06-25
Volume
122
Issue
10
Pages
1028-1039
ISSN
  • 0091-6765 (ISSN-L)
  • 1552-9924
OpenAlex
W4243002209
Cited by
449
References
131
Citations by year
2026: 29 · 2025: 31 · 2024: 36 · 2023: 43 · 2022: 32 · 2021: 50 · 2020: 68 · 2019: 34 · 2018: 31 · 2017: 42 · 2016: 25 · 2015: 20 · 2014: 8
FWCI
2.88
Type
journal article
Language
en
Open access
Locations
  • Environmental Health Perspectives (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Energy
  • U.S. Environmental Protection Agency (RD-83543301)
  • New York Community Trust
  • Heinz Endowments
  • Johnson Family Foundation
  • Rose Foundation for Communities and the Environment
  • Kaiser Permanente
  • Office of Research and Development
  • Oak Ridge Institute for Science and Education
  • University of California, San Francisco
  • National Center For Environmental Assessment
  • National Institute of Environmental Health Sciences (ES018135, P01ES022841, ES022841, P20ES018135)
Topics
  • Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
Keywords
perfluorooctanoic acid, fetal growth, birth weight, early life exposure, environmental health, risk of bias, perfluorinated compounds

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