Breastfeeding Initiation and Duration after High Exposure to PFAS through Contaminated Drinking Water: A Cohort Study from Ronneby, Sweden

By Christel Nielsen, Ying Li, Magdalena Lewandowski, Tony Fletcher, and Kristina Jakobsson
Nordic Council of Ministers
June 28, 2021

Background: The drinking water in parts of Ronneby municipality was heavily contaminated with primarily PFHxS and PFOS for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the supporting epidemiologic literature is conflicting and based on populations with only background levels of exposure. The effects on breastfeeding in populations with a point source of high exposure are unknown.

Objectives: 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 (95% CI: 0.8, 6.7) higher risk 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.

Discussion: 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.

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