Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Environ Res. 2023 Jan 1;216(Pt 3):114718. doi: 10.1016/j.envres.2022.114718. Epub 2022 Nov 2.
The reproductive toxicity of perfluoroalkyl and polyfluoroalkyl substances (PFAS) has been verified in both animal and in vitro experiments, however, the association between PFAS and female fertility remains contradictory in population studies. Therefore, in this systematic review and meta-analysis, we evaluated the effects of PFAS on female fertility based on population evidence.
Electronic searches of the Web of Science, PubMed, The Cochrane Library, and Embase databases were conducted (from inception to March 2022) to collect observational studies related to PFAS and female fertility. Two evaluators independently screened the literature, extracted information and evaluated the risk of bias for the included studies, meta-analysis was performed using R software.
A total of 5468 records were searched and 13 articles fully met the inclusion criteria. Meta-analysis showed that perfluorooctanoic acid (PFOA) exposure was negatively associated with the female fecundability odds ratio (FOR = 0.88, 95% confidence interval (Cl) [0.78; 0.98]) and positively associated with the odds ratio for infertility (OR = 1.33, 95%Cl [1.03; 1.73]). Perfluorooctane sulfonate (PFOS) exposure was negatively associated with the fecundability odds ratio (FOR = 0.94, 95% CI [0.90; 0.98]). Pooled effect values for perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorohexane sulfonate (PFHxS) exposure did not find sufficient evidence for an association with female fertility.
Based on the evidence provided by the current study, increased levels of PFAS exposure are associated with reduced fertility in women, this was characterized by a reduction in fecundability odds ratio and an increase in odds ratio for infertility. This finding could partially explain the decline in female fertility and provide insight into risk assessment when manufacturing products containing PFAS.
已有动物实验和体外实验证实全氟烷基和多氟烷基物质（PFAS）具有生殖毒性，然而，人群研究中 PFAS 与女性生育力之间的关系仍存在矛盾。因此，在本系统评价和荟萃分析中，我们基于人群证据评估了 PFAS 对女性生育力的影响。
从数据库建立到 2022 年 3 月，我们对 Web of Science、PubMed、The Cochrane Library 和 Embase 数据库进行了电子检索，以收集与 PFAS 和女性生育力相关的观察性研究。两名评估员独立筛选文献、提取信息并评估纳入研究的偏倚风险，使用 R 软件进行荟萃分析。
共检索到 5468 条记录，13 篇文章完全符合纳入标准。荟萃分析显示，全氟辛酸（PFOA）暴露与女性受孕能力比值比（FOR=0.88，95%置信区间（CI）[0.78；0.98]）呈负相关，与不孕比值比（OR=1.33，95%CI [1.03；1.73]）呈正相关。全氟辛烷磺酸（PFOS）暴露与受孕能力比值比（FOR=0.94，95%CI [0.90；0.98]）呈负相关。对全氟壬酸（PFNA）、全氟癸酸（PFDA）和全氟己烷磺酸（PFHxS）暴露的汇总效应值没有发现与女性生育力相关的充分证据。
基于本研究提供的证据，PFAS 暴露水平的增加与女性生育力下降有关，这表现为受孕能力比值比降低和不孕比值比增加。这一发现部分解释了女性生育力下降的原因，并为评估含有 PFAS 的产品制造过程中的风险提供了参考。
