Exposure to PFOA and PFOS and fetal growth: a critical merging of toxicological and epidemiological data

Eva Negri, Francesca Metruccio, Valentina Guercio, Luca Tosti, Emilio Benfenati, Rossella Bonzi, Carlo La Vecchia, Angelo Moretto

Research output: Contribution to journalReview articlepeer-review


Toxicological and epidemiological evidence on the association between perfluorooctanoic acid (PFOA) or perfluorooctane sulfonic acid (PFOS) and birth/fetal weight was assessed. An extensive search for toxicological information in rats and mice, and a systematic search for epidemiological evidence were conducted. The linear regression coefficient (LRC) of birth weight (BrthW) on PFOA/PFOS was considered, and separate random effects meta-analyses for untransformed (i.e. not mathematically transformed) and log-transformed values were performed. Toxicological evidence: PFOA: 12 studies (21 datasets) in mice showed statistically significant lower birth/fetal weights from 5 mg/kg body weight per day. PFOS: most of the 13 studies (19 datasets) showed lower birth/fetal weights following in utero exposure. Epidemiological evidence: Sixteen articles were considered. The pooled LRC for a 1 ng/mL increase in untransformed PFOA (12 studies) in maternal plasma/serum was −12.8 g (95% CI −23.2; 2.4), and −27.1 g (95% CI −50.6; −3.6) for an increase of 1 loge ng/mL PFOA (nine studies). The pooled LRC for untransformed PFOS (eight studies) was −0.92 g (95%CI −3.4; 1.6), and for an increase of 1 loge ng/mL was −46.1(95% CI −80.3; −11.9). No consistent pattern emerged for study location or timing of blood sampling. Conclusions: Epidemiological and toxicological evidence suggests that PFOA and PFOS elicit a decrease in BrthW both in humans and rodents. However, the effective animal extrapolated serum concentrations are 102–103 times higher than those in humans. Thus, there is no quantitative toxicological evidence to support the epidemiological association, thus reducing the biological plausibility of a causal relationship.

Original languageEnglish
Pages (from-to)482-508
Number of pages27
JournalCritical Reviews in Toxicology
Issue number6
Publication statusPublished - Jul 3 2017


  • Birth weight
  • epidemiology
  • evidence
  • fetal growth
  • integration
  • meta-analysis
  • perfluoroalkyls
  • PFOA
  • PFOS
  • reproduction
  • systematic review
  • toxicology

ASJC Scopus subject areas

  • Toxicology


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