Maternal serum perfluoroalkyl substances during pregnancy and duration of breastfeeding

Abstract

Background Perfluoroalkyl substances (PFAS) may affect breast development and decrease duration of breastfeeding, thus interfering with the health benefits of breastfeeding. We investigated the association between maternal PFAS exposure and breastfeeding duration. Methods We measured PFAS concentrations in maternal serum collected during pregnancy in 2003–2006. After delivery, women (n=336) completed standardized breastfeeding surveys every 3 months until ending breastfeeding or 36 months postpartum. We estimated relative risks (RRs) for ending any breastfeeding within 3 or 6 months postpartum by Poisson regression, adjusted for relevant confounding factors. Results Women in the 4th quartile of perfluorooctanoic acid (PFOA) serum concentration had 1.77 times the risk of ending any breastfeeding by 3 months (95% confidence interval (CI): 1.23, 2.54; p-trend=0.003) and 1.41 times the risk of ending any breastfeeding by 6 months (95%CI: 1.06, 1.87; p-trend=0.038), compared with women in the first quartile. Women in the 4th quartile of perfluorooctane sulfonic acid serum concentration had a marginally increased risk of discontinuing any breastfeeding by 3 months (RR=1.32; 95%CI: 0.97, 1.79; p-trend=0.065). Conclusions Maternal serum PFOA concentrations were inversely related to duration of any breastfeeding in this cohort, even after controlling for prior breastfeeding. These findings suggest that PFOA exposure may adversely affect breastfeeding duration and highlight the need to consider the potential adverse effects of maternal environmental chemical exposure on breastfeeding.

Maternal Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Breastfeeding Duration in the Norwegian Mother and Child Cohort

“…In Fei et al, the median PFOA level for cases was 5.9 ng/mL (IQR: 4.7, 7.5) (12). In the Romano et al study, the median PFOA concentration was 5.5 ng/mL (IQR: 3.8, 7.7) while the median in the present analysis was 2.7 ng/mL (IQR: 2.0, 3.5) (13). In the Timmermann et al study, PFOA concentrations were comparable to those measured in our study (median: 2.4 ng/mL (IQR: 1.5, 3.6)) but PFOS concentrations were higher (median: 19.5 ng/mL (IQR: 18.7, 28.2) vs. median in our study: 12.9 ng/mL (IQR: 9.9, 16.6)) (14).…”

“…In the Timmermann et al study, PFOA concentrations were comparable to those measured in our study (median: 2.4 ng/mL (IQR: 1.5, 3.6)) but PFOS concentrations were higher (median: 19.5 ng/mL (IQR: 18.7, 28.2) vs. median in our study: 12.9 ng/mL (IQR: 9.9, 16.6)) (14). PFOS levels were higher in the Fei et al and Romano et al studies (median for cases in Fei et al: 37.0 ng/mL (IQR: 28.0, 46.9) and median in Romano et al: 13.9 ng/mL (IQR: 9.6, 18.2)) (12, 13). Concentrations of PFNA, PFDA, and PFHxS in the Timmermann et al study population were higher than those measured in our population as well (PFNA: 0.62 vs. 0.49; PFDA: 0.28 vs. 0.10; PFHxS: 1.45 vs. 0.67) (14).…”

“…Exclusion of information on prior breastfeeding inflated effect estimates approximately 18% for PFOA (HRs: 0.85 vs. 1.00). A similar analysis performed by Romano et al yielded concordant results, in which the absence of breastfeeding information biased estimates (13). Inclusion of parity alone does not fully account for this confounding.…”

Association between prenatal exposure to perfluorinated compounds and symptoms of infections at age 1–4years among 359 children in the Odense Child Cohort

“…Finally, analyses were repeated after additional adjustment for maternal smoking (yes/no), child sex, day-care attendance (yes/no) and exclusive breastfeeding (continuous, number of weeks), even though PFAS exposure recently was found to be associated with decreased duration of breastfeeding and thus may be an intermediary factor (Romano et al 2016;Timmermann et al 2016). …”

Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study

“…Data were collected on breastfeeding, and toxins were evaluated for associations with breastfeeding outcomes. One recent report from this cohort found a shortened duration of breastfeeding at higher levels of serum perfluoroalkyl concentrations in pregnancy (Romano et al 2016), raising the concern that other environmental contaminants may have a similar impact. Therefore, we sought to determine whether an association exists between breastfeeding outcomes and prenatal exposures to tobacco smoke, lead and phthalates, as they represent some of the most common household toxins (Jurewicz et al 2013).…”