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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