Polyfluoroalkyl substances (PFAs, also known as forever chemicals) have made headway lately as a new study in Seattle showed 100 percent of collected breast milk samples contained pre- and current-PFAs, alarming researchers to the potential amount of PFAs exposure in newborns. PFAs contamination is very common and also hard to avoid, as they’re found in everyday consumer products, from stain-resistant formulas to nonstick cookware like teflon to even groundwater, which can eventually impact localized drinking water.
According to the Environmental Protection Agency (EPA), there is evidence that exposure to PFAs can lead to adverse human health effects. The good news is certain PFAs chemicals are no longer manufactured in the United States as a result of phase out programs resulting in eight major chemical manufacturers agreeing to eliminate the use of perfluorooctanoic acid (PFOA) and PFOA-related chemicals in their products and as emissions from their facilities. However, while PFOA and PFOS are no longer manufactured domestically, they are still produced internationally and can be imported into the United States.
To better understand how this impacts public health, specifically that of mom and baby, we connected with Jenelle Ferry, M.D., neonatologist at Pediatrix Medical Group of Tampa, Florida for a timely Q&A.
Do PFAs (forever chemicals) stay in human breast milk and get transferred to breastfed newborns?
PFAs are man-made chemicals engineered to be extremely resistant to degradation, and therefore can accumulate and persist in animal and human tissues for years. They can be found in the blood of almost all men, women and children worldwide, and concentrations have wide geographic ranges. A human body’s exposure begins as a fetus, as these molecules can cross the placenta. They can also be found in breast milk and therefore transferred to newborns.
What health effects do these chemicals have on a baby?
It is difficult to show if these substances can directly cause any human health problems. Any real or potential effects seem to be after many years of exposure and build up over time. Studies in humans have not consistently shown association with neurodevelopment, ADHD, cancer, thyroid, kidney or metabolic disease. There is a potential association with high cholesterol. There does seem to be a link between high levels of PFAs and slightly lower fetal growth rate due to exposure through the placenta. It is unclear if exposure in infancy (via breast milk) and later childhood (via food and water) also affects growth, with potential for increased adiposity later in life. Significant effects of any type of environmental toxins to nursing infants have only been seen in cases where mom had a sufficiently large enough exposure to be ill/toxic herself.
Are forever chemicals a medical concern to breastfeeding mothers?
There was a change in manufacturing processing in early the 2000’s, which resulted in shorter chain PFAs chemicals now being produced. These are also constantly changing, and methods for detecting them have a hard time keeping up. Less is known about long term exposure to newer PFAs; few studies have suggested they are less persistent. On a positive note, with the exception of some concentrated contamination sites, most studies of PFAs in humans have reported concentrations well below any predicted effect.
Can mothers get tested to see if their milk registers at a high level?
If you have concerns about high levels of PFAs in your environment, you should talk to your doctor. Testing for PFAs is expensive and not routine but has been conducted in areas with suspected higher concentrations, especially via water contamination. Testing is usually performed on blood. Surveillance studies have shown a wide range of levels in breast milk, and there are no published records of reference ranges. This makes testing levels in breast milk very difficult to interpret. Knowing PFAs are present can leave a mother with insufficient information to make an informed decision.
Should a mother reconsider breastfeeding because of forever chemicals?
In almost all cases the answer is please continue breastfeeding. The benefits of breastfeeding far outweigh potential, and likely small, negative effects of PFAs. Breastfeeding conveys benefits for the infant (decreased obesity, ear and respiratory infections, sudden infant death syndrome) as well as the mother (decreased risk of high blood pressure, Type 2 diabetes and breast and ovarian cancers). The Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics (AAP) strongly recommend the continuation of breastfeeding. The AAP states “even though a number of environmental pollutants readily pass to the infant through human milk, the advantages of breastfeeding continue to greatly outweigh the potential risks in nearly every circumstance.”
How can a mother limit exposure to new PFAs and minimize the risk of passing them on to a child?
PFAs can be found in soil, water and air. The main source of transmission to humans is via water sources and diet. Mothers can check with their local health department to see if the levels in their water supply are known and at an advisory level. Water system levels are very low in most areas but have been found to be much higher in some. You can check with your local or state health and environmental quality departments for fish advisories. PFAs are used in some food packaging containers, such as takeout containers and pizza boxes. There is insufficient data to make any single recommendation for limiting exposure. It is important for a woman to maintain a healthy, balanced diet and weight, which will benefit the quality of her breast milk in many ways. This may help decrease PFAs, as there have been observations of higher PFA levels with increasing obesity, and a balanced diet with limited takeout may decrease toxicity exposure from food packaging materials. Finally, granular activated carbon water filtration systems may decrease toxic chemicals in water levels, though this can be costly and is not entirely proven.
Anything else you would like to add?
As a mother, trying to navigate the many dangers to your child—real, potential, big and small—can certainly be overwhelming. The reality in regard to PFAs is there is so much we just don’t know from an environmental health standpoint. The most important thing a mother can do for her newborn is provide good nutrition for a healthy immune system and the best future health foundation. This includes breastfeeding whenever possible.