Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia 30341, USA.
Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee 37830, USA.
Toxicol Sci. 2023 Jul 28;194(2):121-137. doi: 10.1093/toxsci/kfad053.
Per- and polyfluoroalkyl substances (PFAS) are a class of man-made chemicals that are persistent in the environment. They can be transferred across the placenta to fetuses and through human milk to infants. The American Academy of Pediatrics advises that the benefits of breastfeeding infants almost always outweigh the potential risks of harm from environmental chemicals. However, there are few chemical-specific summaries of the potential harms of exposure to PFAS during the neonatal period through breastfeeding. This systematic review explores whether exposure to PFAS through breastfeeding is associated with adverse health outcomes among infants and children using evidence from human and animal studies. Systematic searches identified 4297 unique records from 7 databases. The review included 37 total articles, including 9 animal studies and 1 human study measuring the direct contribution of exposure of the infant or pup through milk for any health outcome. Animal studies provided evidence of associations between exposure to PFOA through breastfeeding and reduced early life body weight gain, mammary gland development, and thyroid hormone levels. They also provided limited evidence of associations between PFOS exposure through breastfeeding with reduced early life body weight gain and cellular changes in the hippocampus. The direct relevance of any of these outcomes to human health is uncertain, and it is possible that many adverse health effects of exposure through breastfeeding have not yet been studied. This review documents the current state of science and highlights the need for future research to guide clinicians making recommendations on infant feeding.
全氟和多氟烷基物质（PFAS）是一类人造化学物质，在环境中具有持久性。它们可以通过胎盘转移到胎儿体内，并通过人乳传递给婴儿。美国儿科学会建议，母乳喂养婴儿的好处几乎总是大于因环境化学物质而造成伤害的潜在风险。然而，关于通过母乳喂养在新生儿期接触 PFAS 可能造成的危害，仅有少数针对具体化学物质的综合评估。本系统评价使用来自人类和动物研究的证据，探讨了通过母乳喂养接触 PFAS 是否与婴儿和儿童的不良健康结果有关。系统检索从 7 个数据库中确定了 4297 条独特记录。该综述共纳入 37 篇文章，包括 9 项动物研究和 1 项人类研究，这些研究均测量了通过乳汁接触婴儿或幼崽的 PFAS 对任何健康结果的直接影响。动物研究提供了证据表明，通过母乳喂养接触 PFOA 与早期生命体重增加减少、乳腺发育不良和甲状腺激素水平降低有关。它们还提供了有限的证据表明，通过母乳喂养接触 PFOS 与早期生命体重增加减少和海马体细胞变化之间存在关联。这些结果中任何一项与人类健康的直接相关性都不确定，而且通过母乳喂养接触可能还有许多不良健康影响尚未得到研究。本综述记录了当前的科学状况，并强调需要开展未来研究，为临床医生就婴儿喂养提出建议提供指导。
