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

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

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Johnson, Paula I., Sutton, Patrice, Atchley, Dylan S., Koustas, Erica, Lam, Juleen, Sen, Saunak, Robinson, Karen A., Axelrad, Daniel A., Woodruff, Tracey J.·2014·Environmental Health Perspectives

DOI 10.1289/ehp.1307893PMC PMC4181929

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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

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Udesky, J. O., Dodson, R. E., Perovich, L. J., & Rudel, R. (2019) · Environmental Health · doi:10.1186/s12940-019-0537-8 · Cited by 21
Ableitung von HBM-I-Werten für Perfluoroktansäure (PFOA) und Perfluoroktansulfonsäure (PFOS) – Stellungnahme der Kommission „Humanbiomonitoring“ des Umweltbundesamts
Umweltbundesamt (2018) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-018-2709-z · Cited by 20
“So werden Assoziationen zwischen PFOA-Exposition und verrin-gertem Geburtsgewicht in den zitierten Metaanalysen sowohl für die tierexperi-mentellen als auch die humanepidemiolo-gischen Studien berichtet [103–105].”
Long-term trends in dietary intake of perfluoroalkyl carboxylic acids in relation to their serum concentration in two regions in Japan from 1979 to 2011
Fujii, Y., Harada, K. H., Haraguchi, K., & Koizumi, A. (2017) · Chemosphere · doi:10.1016/j.chemosphere.2017.02.073 · Cited by 23
Draft for internal testing Scientific Committee guidance on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments
More, S. J., Bambidis, V., Benford, D., Bragard, C., Hernández, A. F., Bennekou, S. H., Koutsoumanis, K., Machera, K. A., Naegeli, H., Nielsen, S. S., et al. (2020) · EFSA Journal · doi:10.2903/j.efsa.2020.6221 · Cited by 26
Health effects of living near an incinerator: A systematic review of epidemiological studies, with focus on last generation plants.
Negri, E., Bravi, F., Catalani, S., Guercio, V., Metruccio, F., Moretto, A., la Vecchia, C., & Apostoli, P. (2020) · Environmental Research · doi:10.1016/j.envres.2020.109305 · Cited by 20
Perfluoroalkyl Substances in the Environment
Kempisty, D. M., Xing, Y., & Racz, L. (2018) · CRC Press eBooks · doi:10.1201/9780429487125 · Cited by 20
Systematic Reviews for Occupational Safety and Health Questions
Hempel, S., Xenakis, L., & Danz, M. (2016) · RAND Corporation eBooks · doi:10.7249/rr1463 · Cited by 20
“Published examples (Johnson et al., 2014; Koustas et al., 2014; and Lam et al., 2014) report evidence ratings that”
MethodInfluential
Persistent organic pollutants exposure in newborn dried blood spots and infant weight status: A case-control study of low-income Hispanic mother-infant pairs
Gross, R. S., Ghassabian, A., Vandyousefi, S., Messito, M. J., Gao, C., Kannan, K., & Trasande, L. (2020) · Environmental Pollution · doi:10.1016/j.envpol.2020.115427 · Cited by 21
“Despite postulations that these prenatal chemical exposures are linked to child obesity, a prior meta-analysis (Johnson et al., 2014) and several more recent studies have identified associations with maternal PFAS levels and lower birth weight (Bach et al.”
Result
A systematic review of experimental animal studies on microbial bioaerosols: Dose-response data for the derivation of exposure limits.
Zamfir, M., Gerstner, D., Walser, S., Bünger, J., Eikmann, T., Heinze, S., Kolk, A., Nowak, D., Raulf, M., Sagunski, H., et al. (2019) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2018.11.004 · Cited by 19
The effect of air pollution on morbidity and mortality among children aged under five in sub-Saharan Africa: Systematic review and meta-analysis
Lake, E. A., Karras, J., Marks, G. B., & Cowie, C. T. (2025) · PLoS ONE · doi:10.1371/journal.pone.0320048 · Cited by 23
“In a study in Ibadan Nigeria [51,81], indoor cooking with wood and charcoal significantly increased ARIs and pneumonia in children under five.”
Scientific Committee guidance on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments
More, S. J., Bampidis, V., Benford, D., Bragard, C., Hernández, A. F., Bennekou, S. H., Koutsoumanis, K. P., Lambré, C., Machera, K. A., Mennes, W. C., et al. (2024) · EFSA Journal · doi:10.2903/j.efsa.2024.8866 · Cited by 13
Prenatal exposures to per- and polyfluoroalkyl substances and epigenetic aging in umbilical cord blood: The Healthy Start study
Niemiec, S., Kechris, K. J., Pattee, J. W., Yang, I. V., Adgate, J. L., Calafat, A. M., Dabelea, D., & Starling, A. P. (2023) · Environmental Research · doi:10.1016/j.envres.2023.116215 · Cited by 22
Prenatal exposure and transplacental transfer of perfluoroalkyl substance isomers in participants from the upper and lower reaches of the Yangtze River
Liu, Y., Liu, K., Zheng, P., Yin, S., Jin, H., Bai, X., Li, Y., Zheng, J., Dai, Y., Zhao, M., et al. (2020) · Environmental Pollution · doi:10.1016/j.envpol.2020.116202 · Cited by 21
The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations
Patwary, M. M., Bardhan, M., Browning, M. H. E. M., Astell‐Burt, T., van den Bosch, M. A., Dong, J., Dzhambov, A. M., Dadvand, P., Fasolino, T. K., Markevych, I., et al. (2023) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2023.169635 · Cited by 24
“Downgrades considered the risk of bias, indirectness, inconsistency, imprecision, and publication bias (Johnson et al. , 2014).”
Background
Prenatal Perfluorooctanoic Acid (PFOA) Exposure Is Associated With Lower Infant Birthweight Within the MADRES Pregnancy Cohort
Peterson, A. K., Eckel, S. P., Habre, R., Yang, T., Faham, D., Farzan, S. F., Grubbs, B. H., Kannan, K., Robinson, M., Lerner, D. L., et al. (2022) · Frontiers in Epidemiology · doi:10.3389/fepid.2022.934715 · Cited by 23
Environmental contaminants and child’s growth
Kadawathagedara, M., de Lauzon‐Guillain, B., & Botton, J. (2018) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174418000995 · Cited by 30
Using systematic review in occupational safety and health
Howard, J., Piacentino, J. D., MacMahon, K. L., & Schulte, P. A. (2017) · American Journal of Industrial Medicine · doi:10.1002/ajim.22771 · Cited by 19
Transplacental transfer of perfluorinated and poly-fluorinated substances in maternal-cord serum and association with birth weight: A birth cohort study, China
Xu, L., Li, Y., Chen, L., Wang, S., Ding, X., Zhu, P., & Jiao, J. (2024) · Environmental Pollution · doi:10.1016/j.envpol.2024.124943 · Cited by 16
Green and blue space exposure and non-communicable disease related hospitalizations: A systematic review
Luque-García, L., Muxika-Legorburu, J., Mendia-Berasategui, O., Lertxundi, A., García‐Baquero, G., & Ibarluzea, J. M. (2023) · Environmental Research · doi:10.1016/j.envres.2023.118059 · Cited by 18
Adult Organophosphate and Carbamate Insecticide Exposure and Sperm Concentration: A Systematic Review and Meta-Analysis of the Epidemiological Evidence
Ellis, L. B., Molina, K., Robbins, C., Freisthler, M. S., Sgargi, D., Mandrioli, D., & Perry, M. J. (2023) · Environmental Health Perspectives · doi:10.1289/ehp12678 · Cited by 20
“The Navigation Guide strength of evidence de ﬁ nitions 38,39,43 (Table S11) are based on categories used by the International Agency for Research on Cancer, 96 the U.S. Preventive Services Task Force, 97 and U.S. Environmental Protection Agency 98,99 and re ﬂ ect the level of certainty in the…”
BackgroundMethodInfluential
Infant formula and baby food as a source of perfluoroalkyl substances for infants
Mikołajczyk, S., Warenik-Bany, M., & Pajurek, M. (2022) · Environmental Pollution · doi:10.1016/j.envpol.2022.120810 · Cited by 16
The Psychological Impact of Per- and Poly-Fluoroalkyl Substances (PFAS) Pollution in the Veneto Region, Italy: A Qualitative Study with Parents
Menegatto, M., Lezzi, S., Musolino, M., & Zamperini, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192214761 · Cited by 21
“In fact, as evidenced by research [36,52], PFAS accumulated in the mother’s body can be transmitted to the unborn child through the placenta and during lactation.”
Background
The Relationship Between Perfluoroalkyl Substances Concentrations and Thyroid Function in Early Childhood: A Prospective Cohort Study
Kim, H. Y., Kim, K., Shin, C. H., Lim, Y.-H., Kim, J. I., Kim, B.-N., Hong, Y., & Lee, Y. A. (2020) · Thyroid · doi:10.1089/thy.2019.0436 · Cited by 21
“S2), both PFAS concentrations (exposure) (19,20) and thyroid function (outcome) can affect BMI (21), and BMI can be considered as a collider rather than a confounder; adjustment for BMI could therefore bias the models (22).”
Perfluorooctanoate and changes in anthropometric parameters with age in young girls in the Greater Cincinnati and San Francisco Bay Area
Pinney, S. M., Windham, G. C., Xie, C., Herrick, R., Calafat, A. M., McWhorter, K. L., Fassler, C. S., Hiatt, R. A., Kushi, L. H., & Biro, F. M. (2019) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2019.07.002 · Cited by 28
Endocrine Disruptors and Autism Spectrum Disorder in Pregnancy: A Review and Evaluation of the Quality of the Epidemiological Evidence
Marí-Bauset, S., Donat‐Vargas, C., González, A. L., Marí-Sanchis, A., Peraita‐Costa, I., Llopis-Morales, J., & Morales‐Suárez‐Varela, M. (2018) · Children · doi:10.3390/children5120157 · Cited by 17
Human Evidence of Perfluorooctanoic Acid (PFOA) Exposure on Hepatic Disease: A Systematic Review and Meta-Analysis
Choi, J., Kim, J., & Lee, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811318 · Cited by 20
PFOA and PFOS breakdown in experimental sand, laboratory-grade water, investigation-derived groundwater and wastewater effluent samples at 50 kGy electron beam dose
Kowald, C., Brorman, E., Shankar, S., Klemashevich, C. L., Staack, D., & Pillai, S. D. (2020) · Radiation Physics and Chemistry · doi:10.1016/j.radphyschem.2020.109323 · Cited by 22
Contrasting prenatal nutrition and environmental exposures in association with birth weight and cognitive function in children at 7 years
Gennings, C., Wolk, A., Håkansson, N., Lindh, C. H., & Bornehag, C.-G. (2020) · BMJ Nutrition, Prevention & Health · doi:10.1136/bmjnph-2020-000099 · Cited by 15
Maternal serum concentrations of perfluoroalkyl substances during pregnancy and gestational weight gain: The Avon Longitudinal Study of Parents and Children
Marks, K. J., Jeddy, Z., Flanders, W. D., Northstone, K., Fraser, A., Calafat, A. M., Kato, K., & Hartman, T. J. (2019) · Reproductive Toxicology · doi:10.1016/j.reprotox.2019.08.003 · Cited by 19
Variability and epistemic uncertainty in water ingestion rates and pharmacokinetic parameters, and impact on the association between perfluorooctanoate and preeclampsia in the C8 Health Project Population
Avanasi, R., Shin, H.-M., Vieira, V., & Bartell, S. (2016) · Environmental Research · doi:10.1016/j.envres.2016.01.011 · Cited by 15
“…the validity of this study has been questioned by one group of researchers who excluded it from a meta-analysis of PFOA exposure and fetal growth due to the retrospectively modeled exposure assignments with limited validation by measured biomarkers (Johnson and Sutton, 2014; Koustas et al., 2014).”
Elucidating the Molecular Basis of Adverse Health Effects from Exposure to Anthropogenic Polyfluorinated Compounds Using Toxicoproteomic Approaches
Hansmeier, N., Chao, T., Herbstman, J. B., Goldman, L. R., Witter, F. R., & Halden, R. U. (2014) · Journal of Proteome Research · doi:10.1021/pr500990w · Cited by 17
Placentation Disruption by Perfluorooctanoic Acid and Perfluorooctanesulfonate in Human Trophoblast Organoids.
Li, M., Xu, C.-K., Li, L.-W., Gao, F., Xu, C., Yu, Y., Huang, C., Liu, Y.-N., Shen, X., & Hu, J.-Y. (2025) · Environmental Science and Technology · doi:10.1021/acs.est.5c07230 · Cited by 14
Associations between Exposure to Sodium/Iodide Symporter Inhibitors and Thyroid Function: A Systematic Review and Meta-Analysis
Jang, H., Calder, L., Choi, J. W., Kwon, B., Pearce, E. N., & Shin, H. (2024) · Chemosphere · doi:10.1016/j.chemosphere.2025.144098 · Cited by 16
Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort
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) · Environmental Health · doi:10.1186/s12940-023-01009-3 · Cited by 16
“Systematic reviews evaluating human and animal studies have concluded that maternal serum PFOA is associated with lower birthweight [57–59] with some evidence suggesting that PFAS exposure may lead to lower birthweight via disruption of the placenta [60].”
Background
In utero exposure to perfluoroalkyl and polyfluoroalkyl substances and attention and executive function in the offspring: A study in the Danish National Birth Cohort
Bach, C. C., Liew, Z., Matthiesen, N. B., Henriksen, T. B., Bech, B. H., Nohr, E. A., Bonefeld‐Jørgensen, E. C., & Olsen, J. (2022) · Environmental Research · doi:10.1016/j.envres.2022.113262 · Cited by 17
Prenatal exposure to perfluoroalkyl substances and adipocytokines: the HOME Study
Buck, C. O., Eliot, M., Kelsey, K. T., Calafat, A. M., Chen, A., Ehrlich, S. R., Lanphear, B. P., & Braun, J. M. (2018) · Pediatric Research · doi:10.1038/s41390-018-0170-1 · Cited by 16
“Despite this, epidemiologic and toxicological evidence suggests that gestational perfluoroalkyl substances exposure is associated with impaired fetal growth.(6,7) While we did not find evidence that neonatal adipocytokine concentrations, markers of fetal growth, were associated with perfluoroalkyl substances serum con…”
Background
Review of reviews on exposures to synthetic organic chemicals and children’s neurodevelopment: Methodological and interpretation challenges
LaKind, J. S., Anthony, L. G., & Goodman, M. G. (2017) · Journal of Toxicology and Environmental Health Part B · doi:10.1080/10937404.2017.1370847 · Cited by 15
“Other instruments were developed to guide systematic reviews and meta-analyses of observational research (Stroup et al. 2000) and, more specifically, assessments of the environmental epidemiologic studies (Johnson et al. 2014; LaKind et al. 2014a; Morgan et al. 2016; Youngstrom et al. 2011).”
BackgroundMethod
Exposure of mice to environmentally relevant per- and polyfluoroalkyl substances (PFAS) alters the sperm epigenome
Gillespie, L., Martin, J. H., Anderson, A. L., Bernstein, I. R., Stanger, S. J., Trigg, N. A., Schjenken, J. E., Gannon, A., Parameswaran, S., Smyth, S. P., et al. (2025) · Communications Biology · doi:10.1038/s42003-025-08865-4 · Cited by 14
“…in 4-cell embryos fertilized by these sperm identi ﬁ ed the activation of disease functions relating to several cancers, “ size of body ” , “ disorder of lipid metabolism ” , and “ growth failure ” in the low PFAS group, all of which have been linked to PFAS exposure in humanstudies 18,63,64 .”
Prenatal exposure to air pollution and maternal and fetal thyroid function: a systematic review of the epidemiological evidence
O’Donnell, C., Campbell, E. J., McCormick, S., & Anenberg, S. C. (2024) · Environmental Health · doi:10.1186/s12940-024-01116-9 · Cited by 14
“We compared the results of the strength of evidence rating to definitions specified in the Johnson et al. [31] Navigation Guide for “sufficient evidence of toxicity,” “limited evidence of toxicity,” “inad-equate evidence of toxicity,” or “evidence of lack of toxic-ity” (Table S5).”
MethodResultInfluential
Prenatal Exposure to Poly- and Perfluoroalkyl Substances (2009–2014) and Vaccine Antibody Titers of Measles, Mumps, Rubella, and Varicella in Children Four to Eight Years Old from the Healthy Start Cohort
Zell-Baran, L. M., Dabelea, D., Norris, J. M., Glueck, D. H., Adgate, J. L., Brown, J. M., Harrall, K. K., Calafat, A. M., & Starling, A. P. (2023) · Environmental Health Perspectives · doi:10.1289/ehp12863 · Cited by 13
Prenatal exposure to mixtures of persistent environmental chemicals and fetal growth outcomes in Western Australia.
Lazarevic, N., Barnett, A., Sly, P., Callan, A. C., Stasinska, A., Heyworth, J., Hinwood, A., & Knibbs, L. (2020) · International Journal of Hygiene and Environmental Health · doi:10.1289/isee.2020.virtual.p-0316 · Cited by 13
Protocol for a systematic review and meta-analysis of human exposure to pesticide residues in honey and other bees’ products
Sgargi, D., Ádám, B., Budnik, L. T., Dinelli, G., Moldovan, H. R., Perry, M. J., Scheepers, P. T. J., Schlünssen, V., Teixeira, J. P., Mandrioli, D., et al. (2020) · Environmental Research · doi:10.1016/j.envres.2020.109470 · Cited by 22
“…(PRISMA) (Moher et al., 2015; Shamseer et al., 2015; Beller et al., 2013Liberati et al., 2009), the Navigation Guide (Woodruff and Sutton, 2014; Koustas et al., 2014), the Cochrane Collaboration Higgins and Green, 2011( and the WHO/ILO joint methodology for systematic reviews (Mandrioli et…”
Method
WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on stroke
Descatha, A., Sembajwe, G. N., Baer, M., Boccuni, F., Tecco, C. D., Duret, C., Evanoff, B., Gagliardi, D., Ivanov, I. D., Leppink, N., et al. (2018) · Environment International · doi:10.1016/j.envint.2018.06.016 · Cited by 52
The Alarming Effects of Per- and Polyfluoroalkyl Substances (PFAS) on One Health and Interconnections with Food-Producing Animals in Circular and Sustainable Agri-Food Systems
Shurson, G. C. (2025) · Sustainability · doi:10.3390/su17156957 · Cited by 12
Residential exposure to municipal solid waste incinerators and health effects: a systematic review with meta-analysis
Bottini, I., Vecchi, S., Sario, M. D., Bauleo, L., Trentalange, A., Michelozzi, P., & Ancona, C. (2025) · BMC Public Health · doi:10.1186/s12889-025-23150-z · Cited by 18
“Following the guidelines provided by the Navigation Guide, which are based on the sufficiency or insufficiency of information regarding the presence or absence of specific biases, each domain was rated as "high", "probably high", as, "low" or "probably low" risk of bias [27].”
Influential
The associations between maternal and fetal exposure to endocrine-disrupting chemicals and asymmetric fetal growth restriction: a prospective cohort study
Hong, S., Kang, B. S., Kim, O., Won, S., Kim, H. S., Wie, J., Shin, J., Choi, S., Yun, S.-J., Kim, Y. H., et al. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1351786 · Cited by 12
Metals and per- and polyfluoroalkyl substances mixtures and birth outcomes in the New Hampshire Birth Cohort Study: Beyond single-class mixture approaches
Yim, G., McGee, G., Gallagher, L. G., Baker, E., Jackson, B. P., Calafat, A. M., Botelho, J. C., Gilbert‐Diamond, D., Karagas, M. R., Romano, M. E., et al. (2023) · Chemosphere · doi:10.1016/j.chemosphere.2023.138644 · Cited by 13
Associations between temperature and Ross River virus infection: A systematic review and meta-analysis of epidemiological evidence.
Damtew, Y. T., Tong, M., Varghese, B., Hansen, A., Liu, J.-W., Dear, K., Zhang, Y., Morgan, G. G., Driscoll, T. G., Capon, T., et al. (2022) · Acta Tropica · doi:10.1016/j.actatropica.2022.106454 · Cited by 12
Reviews in environmental health: How systematic are they?
Sutton, P., Chartres, N., Rayasam, S. D. G., Daniels, N., Lam, J., Maghrbi, E., & Woodruff, T. J. (2021) · Environment International · doi:10.1016/j.envint.2021.106473 · Cited by 19
Self-citation

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.
ORCID: Johnson, Paula I.
Lam, Juleen
Robinson, Karen A.
Axelrad, Daniel A.
Woodruff, Tracey J.
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2014-06-25
Volume: 122
Issue: 10
Pages: 1028-1039
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp.1307893
PMC: PMC4181929
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: 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)
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

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

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