Lyrou Maria, Karampas Grigorios, Metallinou Dimitra, Athanasiadou Chrysoula Rozalia, Gourounti Kleanthi, Jotautis Vaidas, Georgakopoulou Vasiliki Epameinondas, Spandidos Demetrios A, Sarantaki Antigoni
Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece.
Second Department of Obstetrics and Gynecology, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Med Int (Lond). 2025 Jun 24;5(5):51. doi: 10.3892/mi.2025.250. eCollection 2025 Sep-Oct.
Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants with potential immunotoxic effects. The present systematic review evaluated the association between prenatal PFAS exposure and the incidence of respiratory infections in infants and children. For this purpose, a comprehensive literature search was conducted across the PubMed, Scopus and Cochrane Library databases following the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies assessing prenatal PFAS exposure and childhood respiratory infections were included. A total of six studies meeting the eligibility criteria were analyzed. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid were the most frequently detected PFAS in maternal blood. While no significant associations were found in infancy, a greater prenatal exposure to perfluorohexane sulfonate and PFOS was linked to increased respiratory infections, particularly pneumonia and respiratory syncytial virus infections, in early childhood. Conversely, perfluorononanoic acid and perfluorodecanoic acid were associated with a reduced risk of lower respiratory tract infections and wheezing in children aged 4 to 7 years. The biological mechanisms likely involve PFAS-induced immune dysregulation, including altered cytokine responses and impaired vaccine effectiveness. The present systematic review highlights the complex role of prenatal PFAS exposure in modulating childhood respiratory health. Given the widespread presence of PFAS in the environment, regulatory policies should focus on minimizing exposure, particularly during pregnancy. Further research is required to clarify causal mechanisms and assess long-term respiratory outcomes in children.
全氟烷基和多氟烷基物质（PFAS）是具有潜在免疫毒性作用的持久性环境污染物。本系统评价评估了产前PFAS暴露与婴幼儿呼吸道感染发病率之间的关联。为此，按照系统评价和荟萃分析报告规范（PRISMA）指南，在PubMed、Scopus和Cochrane图书馆数据库中进行了全面的文献检索。纳入评估产前PFAS暴露与儿童期呼吸道感染的研究。共分析了六项符合纳入标准的研究。全氟辛烷磺酸（PFOS）和全氟辛酸是母血中最常检测到的PFAS。虽然在婴儿期未发现显著关联，但产前较高的全氟己烷磺酸和PFOS暴露与幼儿期呼吸道感染增加有关，尤其是肺炎和呼吸道合胞病毒感染。相反，全氟壬酸和全氟癸酸与4至7岁儿童下呼吸道感染和喘息风险降低有关。其生物学机制可能涉及PFAS诱导的免疫失调，包括细胞因子反应改变和疫苗效力受损。本系统评价突出了产前PFAS暴露在调节儿童呼吸道健康方面的复杂作用。鉴于PFAS在环境中广泛存在，监管政策应侧重于尽量减少暴露，尤其是在孕期。需要进一步研究以阐明因果机制并评估儿童的长期呼吸道结局。
