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.
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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