Review Advance Publication
The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth
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Citation: Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307177.
Received: 4 June 2013
Accepted: 23 April 2014
Advance Publication: 25 June 2014
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Background: In contrast to current methods of “expert-based narrative review”, the Navigation Guide is a systematic and transparent method for synthesizing environmental health research from multiple evidence streams. The Navigation Guide was developed to effectively and efficiently translate the available scientific evidence into timely prevention-oriented action.
Objectives: Apply the Navigation Guide systematic review method to answer the question: “Does fetal developmental exposure to perfluorooctanoic acid (PFOA) or its salts affect fetal growth in animals,” and rate the strength of the experimental animal evidence.
Methods: We conducted a comprehensive search of the literature, applied pre-specified criteria to the search results to identify relevant studies, extracted data from studies, obtained additional information from study authors, conducted meta-analyses, and rated the overall quality and the strength of the evidence.
Results: Twenty-one studies met the inclusion criteria. From the meta-analysis of eight mouse gavage datasets, we estimated that exposure of pregnant mice to increasing concentrations of PFOA was associated with a decrease in mean pup birth weight of -0.023g (95% CI: -0.029, -0.016) per 1-unit increase in dose (mg/kg BW/day). The evidence, consisting of 15 mammalian and 6 non-mammalian studies, was rated as ‘moderate’ and ‘low’ quality, respectively.
Conclusion: Based on this first application of the Navigation Guide methodology, we found ‘sufficient’ evidence that fetal developmental exposure to PFOA reduces fetal growth in animals.
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CEHN September 2014 Article of the Month“Prenatal Polybrominated Diphenyl Ether Exposures and Neurodevelopment in U.S. Children through 5 Years of Age: The HOME Study” (Environ Health Perspect; DOI:10.1289/ehp.1307562) has been selected by the Children’s Environmental Health Network (CEHN) as its September 2014 Article of the Month. These CEHN summaries discuss the potential policy implications of current children’s environmental health research.
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