Perfluorooctanoic acid and low birth weight: Estimates of US attributable burden and economic costs from 2003 through 2014

Background and objective: In utero exposure to perfluorooctanoic acid (PFOA) has been associated with decreases in birth weight. We aimed to estimate the proportion of PFOA-attributable low birth weight (LBW) births and associated costs in the US from 2003 to 2014, a period during which there were industry-initiated and regulatory activities aimed at reducing exposure. Methods: Serum PFOA levels among women 18–49 years were obtained from the National Health and Nutrition Examination Survey (NHANES) for 2003–2014; birth weight distributions were obtained from the Vital Statistics Natality Birth Data. The exposure-response relationship identified in a previous meta-analysis (18.9 g decrease in birth weight per 1 ng/mL of PFOA) was applied to quantify PFOA-attributable LBW (reference level of 3.1 ng/mL for our base case, 1 and 3.9 ng/mL for sensitivity analyses). Hospitalization costs and lost economic productivity were also estimated. Results: Serum PFOA levels remained approximately constant from 2003–2004 (median: 3.3 ng/mL) to 2007–2008 (3.5 ng/mL), and declined from 2009–2010 (2.8 ng/mL) to 2013–2014 (1.6 ng/mL). In 2003–2004, an estimated 12,764 LBW cases (4% of total for those years) were potentially preventable if PFOA exposure were reduced to the base case reference level (10,203 cases in 2009–2010 and 1,491 in 2013–2014). The total cost of PFOA-attributable LBW for 2003 through 2014 was estimated at $13.7 billion, with $2.97 billion in 2003–2004, $2.4 billion in 2009–2010 and $347 million in 2013–2014. Conclusions: Serum PFOA levels began to decline in women of childbearing age in 2009–2010. Declines were of a magnitude expected to meaningfully reduce the estimated incidence of PFOA-attributable LBW and associated costs.