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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Background

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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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