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

“Environmental Health Perspectives • volume 122 | number 10 | October 2014 1031 across studies (DerSimonian and Laird 1986).”

“Such methods already exist to evaluate clinical evidence (GRADE Working Group 2012; Higgins and Green 2011) and include steps such as developing an a priori protocol, a comprehensive search, and rating the quality of the evidence.”

“Future reviews could be strengthened if more investigators followed standardized reporting criteria such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (von Elm et al. 2008), enabling improved quality assessment.”

“Future reviews could be strengthened if more investigators followed standardized reporting criteria such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (von Elm et al. 2008), enabling improved quality assessment.”

“In assessing quality and strength according to factors and considera tions that had not been pre specified, we conducted further analysis and abided by GRADE’s principle to be conservative in changing the rating of the body of evidence up or down (Balshem et al. 2011).”

“Evaluation factors Summary of criteria Downgrading factors Risk of bias Study limitations include a substantial risk of bias across the body of evidence.”

“…the evidence of an association between PFOA and fetal growth (DeWitt et al. 2009; Hekster et al. 2003; Jensen and Leffers 2008; Kennedy et al. 2004; Kudo and Kawashima 2003; Lau et al. 2004, 2007; Lindstrom et al. 2011; Olsen et al. 2009; Post et al. 2012; Steenland et al. 2010; White et al. 2011).”

“Long-chain PFAS like perfluorooctanoic acid (PFOA) pose significant health risks, including hepatotoxicity, lipid dysregulation, immunosuppression, developmental issues, and cancer (Barry et al., 2013; Consonni et al., 2013; Johnson et al., 2014; Li et al., 2021; Zhang et al., 2023)).”

“…the systematic review using the Navigation guide, a systematic review methodology for evaluating environmental evidence based on methods used in the clinical sciences, including the Cochrane Collaboration and Grading Recommendation Assessment, Development and Evaluation (GRADE) framework [15,16].”

“17,26 Ethics and dissemination This review will bebased onpublished data and does not require ethical approval.”

“…equipment in occupational settings, interlaboratory comparison programs to ensure the quality of the laboratory analysis methods and consideration of spatial and temporal variability for exposures modeled using air concentration data (Johnson et al., 2014; Lam et al., 2021, Mandrioli et al., 2018).”

“PFOA is suspected to have adverse health affects with regard to fetal development, among others (Johnson et al. 2014; Lam et al. 2014).”

“In both the Korsak and Rydzyński (1996) and Douglas et al. (1993) studies, latency to paw lick was still increased relative to control after termination of exposure in the high dose animals (~ 12–37%).”

“We used the Navigation Guide risk of bias tool for human and animal studies which has been previously described [38, 39].”