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Review Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1307177

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

Erica Koustas,1 Juleen Lam,1 Patrice Sutton,2 Paula I. Johnson,2 Dylan S. Atchley,2 Saunak Sen,3 Karen A. Robinson,4 Daniel A. Axelrad,5 and Tracey J. Woodruff
Author Affiliations close
1Oak Ridge Institute for Science and Education (ORISE) Post-doctoral Fellow with the U.S. Environmental Protection Agency, Office of Policy, National Center for Environmental Economics, Washington, DC, USA; 2University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, California, USA; 3University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, USA; 4Johns Hopkins University, Departments of Medicine, Epidemiology and Health Policy & Management, Baltimore, Maryland, USA; 5U.S. Environmental Protection Agency, Office of Policy, National Center for Environmental Economics, Washington, DC, USA
About This Article open

This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

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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Abstract

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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