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