Growing health concerns from perfluoroalkyl substances: public health perspectives and clinical implications.
Growing health concerns from perfluoroalkyl substances: public health perspectives and clinical implications.
复制标题
全氟烷基物质日益增长的健康问题：公共卫生观点和临床影响。
DOI：
10.1038/s41390-020-0836-3
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发表时间：
2020
影响因子：
3.6
通讯作者：
Anderko,Laura
中科院分区：
文献类型：
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作者：
Anderko,Laura
当母体血液穿过胎盘到达脐带血时，发育中的胎儿可能会暴露于全氟烷基物质（PFAS）。妊娠期母体血清PFAS浓度与脐带血浓度密切相关。1 Wikstrom等人进行的纵向妊娠队列研究为更好地了解母体PFAS水平与出生结局之间的关系提供了关键证据。产前母体血液中PFAS（特别是PFOS、PFOA、PFNA、PFDA和PFUnDA）水平的升高与出生体重较低、出生胎龄体重较低和出生胎龄较小有关。这些关联在女孩中更为明显，具有统计学意义。这些发现是强有力的，特别是考虑到最近美国的一项研究在全国代表性的3至11岁儿童样本中检测到所有儿童血清中的PFAS。在美国和其他工业化国家，大多数人的血液中都有可测量的PFAS。PFOA和PFOS是最突出的。日常消费品和饮用水中PFAS暴露的广泛性，加上这些出生结果（如低出生体重）对健康的长期影响，应该引起全世界的关注。有证据表明，与正常体重的婴儿相比，低出生体重的婴儿可能面临更多未来健康问题的风险，如智力和神经发育障碍，肥胖和心血管疾病。3-7广泛接触和健康影响的可能性要求采取公共卫生办法，以长期保护儿童的健康。迫切需要减少和消除接触，以改善儿童一生的健康。自1999年以来，国家健康和营养检查调查（NHANES）测量了美国人群的血液PFAS。根据前三个周期年收集的数据，一般人群血液中的全氟辛酸和全氟辛烷磺酸水平普遍下降。这似乎是由于2006年PFAS行业的八家主要公司达成协议，自愿在2015年之前逐步淘汰这两种PFAS。然而，作为PFAS重要来源的饮用水目前在美国没有受到监管。美国环境保护署（EPA）还没有发布一个可执行的标准，称为最大污染物水平（MCL）。2016年，美国环保署制定了终身健康咨询水平（HAL），将PFOS和PFOA的总浓度设定为万亿分之70（ppt）。有害健康限量在法律上是不可强制执行的，也不是为了确定一个确定的健康影响水平，而是提供一个终生的保护幅度。8，9面对不确定性和缺乏联邦监管，一些州开始建立自己的指导方针。例如，纽约成为第一个将全氟辛酸最大容许浓度定为万亿分之十（ppt）、全氟辛烷磺酸最大容许浓度定为万亿分之十（ppt）的州，明尼苏达州将全氟辛烷磺酸最大容许浓度定为15 ppt，远低于美国环保署规定的70 ppt标准。10，11州饮用水管理员协会提供了有关州的信息，并提出或制定了标准。12除了缺乏饮用水法规外，PFAS还没有确定的临床参考水平。这为寻求管理暴露于PFAS的母亲及其子女的病例的提供者提供了不确定性。由于对暴露于高于背景水平的人的长期医疗管理没有共识，减少（和预防）暴露是...
Developing fetuses can be exposed to perfluoroalkyl substances (PFAS) when maternal blood crosses the placenta and reaches the umbilical cord blood. Maternal serum PFAS concentrations during pregnancy are strongly correlated with cord serum concentrations. 1 The longitudinal pregnancy cohort study conducted by Wikstrom et al. provides critical evidence in the effort to better understand the association between maternal levels of PFAS and birth outcomes. Increased prenatal maternal blood levels of PFAS (specifically, PFOS, PFOA, PFNA, PFDA and PFUnDA) were associated with lower birth weight, lower birth weight for gestational age, and being born small for gestational age. These associations were more pronounced and statistically significant in girls. These findings are powerful, especially considering a recent US study detected PFAS in the serum of all children in a nationally representative sample of 3-to 11-year-olds. 2 Most people in the United States and in other industrialized countries have measurable amounts of PFAS in their blood. PFOA and PFOS are the most prominent. The widespread nature of PFAS exposures from everyday consumer products and drinking water, coupled with the potential for long-term health impacts from these birth outcomes such as low birth weight, should elevate concerns worldwide. Evidence has shown that compared to normal weight infants, low-birth-weight infants may be at more risk for many future health problems such as intellectual and neurodevelopmental disabilities, obesity, and cardiovascular disease. 3–7 The potential for widespread exposure and health impacts commands public health approaches to protect the health of children in the long term. There is a critical need to reduce and eliminate exposures to improve the health of children over a lifetime. Since 1999, the National Health and Nutrition Examination Survey (NHANES) has measured blood PFAS in the US population. Based on data collected from previous NHANES 3 cycle years, levels of PFOA and PFOS are generally decreasing in the blood of the general population. This appears to be a result of the 2006 agreement by eight major companies in the PFAS industry to phase out—voluntarily—these two PFAS by 2015. However, drinking water, an important source of PFAS, is currently not regulated in the US. The US Environmental Protection Agency (EPA) has not yet issued an enforceable standard called a Maximum Contaminant Level (MCL). In 2016 the EPA established a lifetime Health Advisory Level (HAL), which is set at 70 parts per trillion (ppt) for the combined concentrations of PFOS and PFOA. HALs are not legally enforceable and are not designed to be a definitive health-effect level but rather provide a margin of protection over a lifetime. 8, 9 In the face of uncertainty and lack of federal regulation, some states are beginning to establish their own guidelines. For example, New York became the first state to adopt an MCL of 10 parts per trillion (ppt) for PFOA and 10 ppt for PFOS, and in Minnesota a new PFOS value of 15 ppt was established, which is well below the 70 ppt standard set by the EPA. 10, 11 The Association of State Drinking Water Administrators provides information on states with proposed or established standards. 12In addition to an absence of a drinking water regulation, there are no established clinical reference levels for PFAS. This provides uncertainty by providers looking to manage cases of mothers exposed to PFAS and their children. Since there is no consensus related to long-term medical management for those exposed to levels higher than background, reducing (and preventing) exposure is the …