Abstract
BACKGROUND AND AIM: The drinking water in parts of Ronneby municipality was heavily contaminated with perfluoroalkyl substances (PFAS) for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the supporting epidemiologic literature is conflicting and based solely on populations with background levels of exposure. The effects on breastfeeding in populations with a point source of exposure are unknown. The aim was to investigate the potential associations between high PFAS exposure and 1) initiation and 2) duration of breastfeeding in a population-based cohort. METHODS: We retrieved data on infant feeding practices for 2,374 children born between 1999 and 2009 from Child Health Care centers in Ronneby and Karlshamn, a nearby municipality with background levels of exposure. Maternal residential address before delivery was used as a proxy for exposure, and confounder data were obtained from charts and national registers. We used modified Poisson regressions to estimate the risk of not initiating breastfeeding and, among initiators, the risks of not breastfeeding exclusively after 3 months and not breastfeeding at all at 6 months. RESULTS:Mothers who had received the contaminated water at their residential address had a 2.4 times higher risk (95% CI: 0.8, 6.7) of not initiating breastfeeding. Among initiators, primiparous mothers from the exposed area were at a 1.2 times increased risk (95% CI: 0.9, 1.6) of not exclusively breastfeeding at 3 months and a 1.6 times increased risk (95% CI: 1.2, 2.1) of not breastfeeding at all at 6 months. Multiparous women seemed less vulnerable to these effects, although we observed slightly increased risk estimates towards the end of the study period. CONCLUSIONS:Exposure to high levels of PFAS was associated with increased risks of not initiating breastfeeding as well as with shorter breastfeeding duration. Initiation among primiparous mothers was the most critical outcome, and targeted intervention might be warranted. KEYWORDS: PFAS, Long-term exposure, Reproductive Outcomes, Environmental Epidemiology
Highlights
Perfluoroalkyl substances (PFAS) are endocrine-active environ mental contaminants with biological half-lives of several years (Li et al, 2018; Seals et al, 2011; Olsen et al, 2007)
13% of the population at the time participated in this biomonitoring, which showed serum concentrations of perfluorohexane sulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), and perfluorooctanoic acid (PFOA) 135, 35, and 5 times higher, respectively, in Ronneby relative to a nearby municipality (Karlshamn) with uncontaminated drinking water (Xu et al, 2021)
As we suspected a priori that PFAS levels in the drinking water were higher in the late period (>2005), we explored effect modification by time period through introduction of an interaction term in the analyses of not breastfeeding exclusively at 3 months and not breastfeeding at all at 6 months
Summary
Perfluoroalkyl substances (PFAS) are endocrine-active environ mental contaminants with biological half-lives of several years (Li et al, 2018; Seals et al, 2011; Olsen et al, 2007). They have been used in a wide range of consumer products and industrial applications over time, including surface coating of textiles and paper, fire-fighting foam, and electroplating. Discussion: Exposure to high levels of PFAS seemed to be associated with increased risks of not initiating breastfeeding and shorter breastfeeding duration in primiparous mothers.
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