Forever Chemicals (PFAS)

ABSTRACT: Per- and polyfluoroalkyl substances (PFAS) constitute a large class of chemicals with widespread exposure in the United States. They are commonly used in products because they repel water, stain, and grease. Concerns about the health impacts from PFAS exposures continue to grow as science has linked this chemical family with a wide range of health effects. A recent report by the Agency for Toxic Substances and Disease Registry ( ATSDR, 2024 ), along with findings from the National Academies of Sciences, Engineering, and Medicine ( NASEM, 2022 ), found sufficient evidence for the following health effects in children: decreased antibody response, dyslipidemia, and decreases in birthweight. For pregnant patients, health effects include gestational hypertension and preeclampsia. Some of these chemicals can pass through human breastmilk and when tested, are routinely found in umbilical cord blood and fetal organs ( ATSDR, 2021 ). Concerns for human health prompted the U.S. Environmental Protection Agency (EPA) to recently regulate five different PFAS and combinations of them. We offer clinical perspectives based on the most current literature to reduce health effects including methods to reduce exposure, implications of lab testing, and clinical management considerations. This topic is important because of widespread human exposure. PFAS may bioaccumulate in humans; may increase cancer risk; have long half-lives in humans; and may affect the developing fetus and child. PFAS levels exceed EPA's Lifetime Health Advisory (LTHA) in drinking water in most states. An overview of this issue and related health concerns is presented in the context of implications for maternity and pediatric patients.