Environmental Exposure to Per- and Polyfluorylalkyl Substances (PFASs) and Reproductive Outcomes in the General Population: A Systematic Review of Epidemiological Studies
Open accessAbstract
This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review synthesized effects of background levels of per- and polyfluorylalkyl substance (PFAS) levels on reproductive health outcomes in the general public: fertility, preterm birth, miscarriage, ovarian health, menstruation, menopause, sperm health, and in utero fetal growth. The inclusion criteria included original research (or primary) studies, human subjects, and investigation of outcomes of interest following non-occupational exposures. It drew from four databases (Web of Science, PubMed, Embase and Health and Environmental Research Online (HERO)) using a standardized search string for all studies published between 1 January 2017 and 13 April 2022. Risk of bias was assessed by two independent reviewers. Data were extracted and reviewed by multiple reviewers. Each study was summarized under its outcome in terms of methodology and results and placed in context, with recommendations for future research. Of 1712 records identified, 30 were eligible, with a total of 27,901 participants (33 datasets, as three studies included multiple outcomes). There was no effect of background levels of PFAS on fertility. There were weakly to moderately increased odds of preterm birth with higher perfluorooctane sulfonic acid (PFOS) levels; the same for miscarriage with perfluorooctanoic acid (PFOA) levels. There was limited yet suggestive evidence for a link between PFAS and early menopause and primary ovarian insufficiency; menstrual cycle characteristics were inconsistent. PFAS moderately increased odds of PCOS- and endometriosis-related infertility, respectively. Sperm motility and DNA health were moderately impaired by multiple PFAS. Fetal growth findings were inconsistent. This review may be used to inform forthcoming drinking water standards and policy initiatives regarding PFAS compounds and drinking water. Future reviews would benefit from more recent studies. Larger studies in these areas are warranted. Future studies should plan large cohorts and open access data availability to capture small effects and serve the public. Funding: Great Lakes Water Authority (Detroit, MI), the Erb Family Foundation through Healthy Urban Waters at Wayne State University (Detroit, MI), and Wayne State University CLEAR Superfund Research (NIH P42ES030991).
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PFAS exposure is associated with reproductive harm, including impaired fertility, miscarriage, and developmental issues, with high risk in pregnant women and children.
“| Reproductive | Impaired fertility, miscarriage, developmental issues. | High | Pregnant women, children | Long-term fertility issues | [224] |”
From Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS (2025) · cites this paper as [224]
The Conclusions report weak-to-moderate evidence for miscarriage and some infertility-related outcomes, and the Introduction identifies pregnancy as a sensitive period for mother and fetus. But the review found no effect on all-cause fertility and inconsistent fetal-growth findings. It does not establish an overall “high” risk for pregnant women and children or long-term fertility issues. (LLM, conf=0.88)
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Epigenetic Consequences of In Utero PFAS Exposure: Implications for Development and Long-Term Health
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Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS
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- Authors
- Haimbaugh, A., Meyer, D. N., Connell, M. L., Blount-Pacheco, J., Tolofari, D., Gonzalez, G., Banerjee, D., Norton, J., Miller, C. J., & Baker, T. R.
- Affiliations
- Wayne State University (US)
- University of Florida Health (US)
- Great Lakes Water Authority (US)
- Corresponding author
- Baker, Tracie R.
- ORCID
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2024-12-02
- Volume
- 21
- Issue
- 12
- Pages
- 1615
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC11675763
- OpenAlex
- W4404915882
- Cited by
- 21
- References
- 200
- Citations by year
- 2026: 16 · 2025: 5
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Great Lakes Water Authority (GLWA) (NIH P42ES030991)
- Erb Family Foundation through Healthy Urban Waters at Wayne State University, and Wayne State University CLEAR Superfund Research (NIH P42ES030991)
- NIH Superfund (NIH P42ES030991)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
- Physical Sciences › Materials Science › Polymers and Plastics › Synthesis and properties of polymers
- Keywords
- per- and polyfluoroalkyl substances, PFAS exposure, reproductive outcomes, fertility, preterm birth, miscarriage, perfluorooctanoic acid, PFOS, early menopause, primary ovarian insufficiency, menstrual cycle, polycystic ovary syndrome, endometriosis, sperm motility, sperm DNA damage, fetal growth, drinking water standards, general population
- MeSH terms
- Environmental Exposure, Environmental Pollutants, Female, Fluorocarbons, Humans, Male, Pregnancy, Reproduction
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