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Review Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1307893

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

Paula I. Johnson,1 Patrice Sutton,1 Dylan S. Atchley,1 Erica Koustas,2 Juleen Lam,2 Saunak Sen,3 Karen A. Robinson,4 Daniel A. Axelrad,5 and Tracey J. Woodruff
Author Affiliations close
1University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, California, USA; 2ORISE Post-doctoral Fellowship, U.S. Environmental Protection Agency, Office of Policy, National Center for Environmental Economics, Washington, DC, 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
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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: Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Human Evidence for PFOA Effects on Fetal Growth. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307893.

Received: 15 November 2013
Accepted: 23 June 2014
Advance Publication: 25 June 2014

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Abstract

Background: The Navigation Guide methodology was developed to meet the need for a robust method of systematic and transparent research synthesis in environmental health science. We conducted a case study systematic review to support proof-of-concept of the method.

Objective: Apply the Navigation Guide systematic review methodology to answer the question: Does developmental exposure to perfluorooctanoic acid (PFOA) affect fetal growth in humans?

Methods: We applied the first 3 steps of the Navigation Guide methodology to human epidemiological data: 1) Specify a study question, 2) Select the evidence, and 3) Rate quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using pre-specified criteria. We evaluated each study for risk of bias and conducted meta-analyses on a subset of studies. We rated quality and strength of the entire body of human evidence.

Results: We identified 18 human studies that met our inclusion criteria, of which 9 were combined through meta-analysis. Through meta-analysis, we estimated that a 1- ng/mL increase in serum or plasma PFOA was associated with a -18.9 g (95% CI: -29.8, -7.9) difference in birth weight. We concluded that the risk of bias across studies was low, and assigned a “moderate” quality rating to the overall body of human evidence.

Conclusion: Based on this first application of the Navigation Guide systematic review methodology, we concluded that there is “sufficient” human evidence that developmental exposure to PFOA reduces fetal growth.


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