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6387285 
Journal Article 
Maternal plasma perfluoroalkyl substances and miscarriage: a nested case-control study in the Danish National Birth Cohort 
Liew, Z; Luo, J; Nohr, EA; Bech, BH; Bossi, R; Arah, OA; Olsen, J 
2020 
Yes 
Environmental Health Perspectives
ISSN: 0091-6765
EISSN: 1552-9924 
Public Health Services, US Dept of Health and Human Services 
128 
47007 
English 
is supplemented by 10226081 Supplemental material:
is related to other volume(s) 11375431 [Correspondence with Zeyan Liew regarding chemicals identified in Liew et al. 2020 and Liew et al. 2018]
BACKGROUNDPer- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants and endocrine disruptors. High doses of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) exposure can cause pregnancy loss and infant deaths in animals, but the associations between PFAS exposures and risk of miscarriage in humans are not well studied.METHODSUsing a case-control study nested within the Danish National Birth Cohort (DNBC, 1996-2002), we compared 220 pregnancies ending in miscarriage during weeks 12-22 of gestation, with 218 pregnancies resulting in live births. Levels of seven types of PFAS [PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctanesulfonic acid (PFOSA)] were measured in maternal plasma collected in early gestation (mean gestational week 8). We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage and each PFAS as a continuous variable or in quartiles, controlling for maternal age, parity, socio-occupational status, smoking and alcohol intake, gestational week of blood sampling, and maternal history of miscarriage. Stratification by parity and PFAS mixture analyses using weighted quantile sum (WQS) regression were also conducted.RESULTSWe observed a monotonic increase in odds for miscarriage associated with increasing PFOA and PFHpS levels. The ORs comparing the highest PFOA or PFHpS quartile to the lowest were 2.2 (95% CI: 1.2, 3.9) and 1.8 (95% CI: 1.0, 3.2). The ORs were also elevated for the second or third quartile of PFHxS or PFOS, but no consistent exposure-outcome pattern emerged. An interquartile range (IQR) increment in the WQS index of seven PFAS was associated with 64% higher odds for miscarriage (95% CI: 1.15, 2.34). The associations were stronger in parous women, while findings were inconsistent among nulliparous women.CONCLUSIONMaternal exposures to higher levels of PFOA, PFHpS, and PFAS mixtures were associated with the risk of miscarriage and particularly among parous women. Larger replication studies among nulliparous women are needed to allay concerns about confounding by reproductive history. https://doi.org/10.1289/EHP6202. 
Index Medicus 
• PFAS 150
     Literature Search Update December 2021
          PubMed
          WOS
     Missing 2021 searches
     Literature Search Update December 2020
          PubMed
          WOS
     Literature Search August 2019
          PubMed
          Web of Science
          Other sources
               Reference list review of included studies
     Screened Studies
          Included
               Include (TIAB)
               Include (Full Text)
     Perfluoroheptanesulfonic acid
     Perfluorohexanesulfonic acid
• PFAS Universe
     Data Source
          Web of Science
          Pubmed
          Screened Studies
               Excluded
                    Exclude (TIAB)
          Other sources
               Reference list review of included studies
     Perfluorodecanoate
     Perfluorodecanoic acid
     Perfluoroheptane
     Perfluoroheptanesulfonate
     Perfluoroheptanesulfonic acid
     Perfluorohexane
     Perfluorohexanesulfonate
     Perfluorohexanesulfonic acid
     Perfluorononanoic acid
     Perfluorooctanesulfonamide
     Perfluorooctanesulfonate
     Perfluorooctanesulfonic acid
     Perfluorooctanoate
     Sodium perfluorohexanesulfonate
     Perfluorooctanoic acid
• PFDA
     Literature Search
          Pubmed
          WOS
          Other
               Published PFAS SEMs
     Literature Search Update 5/2020
          PubMed
     Literature Search Update 4/2021
          PubMed
          WoS
     Scopus: April 2021
     June 2022 Pelch Database
     Literature Searches (through April 2023 update and post-public comment/peer review)
          Title & Abstract Screening
               Full Text Screening
                    Studies Meeting PECO
                         Human health effects studies
• PFHxS
     Database searches
          Pubmed
          WOS
          Scopus
          Pelch PFAS SEM
     Inclusion
          TiAb
          Full Text
               Human Study
• PFNA
     Literature Search
          Pubmed
          WOS
     LitSearch: May 2019 - May 2020
          PubMed
     LitSearch: May 2020 - April 2021
          WoS
     Title and Abstract Screening
          Full Text Screening
               Studies Meeting PECO
                    Human health effects studies
     June 2022 Pelch Database
OW - HHRAB
• PFOA (335-67-1) and PFOS (1763-23-1)
     LitSearch: Feb 2019 - May 2020
          PubMed
     Literature Search Update (Apr 2019 - Sep 2020)
          PubMed
          WOS
     LitSearch Update (Sept 2020 - Feb 2022)
          WOS
• PFOA and PFOS OW MCLG Approaches
     Cited in White Papers