Invited Perspective: PFAS and Pubertal Timing in Girls-A Maturing Literature
By Emily S Barrett and Zorimar Rivera-Núñez
Environ Health Perspect
September 26, 2023
DOI: 10.1289/EHP12658
In a downward global trend in timing of maturation, today’s children are reaching pubertal milestones earlier than prior generations.1,2 The average age at onset of breast development (thelarche), for example, has dropped by 3 months per decade since the 1970s,2 likely owing to higher energy intake and more sedentary lifestyles.3,4 How do environmental pollutants, particularly those that disrupt the gonadal and adrenal hormone axes that regulate puberty, fit in? Although it may be convenient to speculate that the increasing production of synthetic endocrine-disrupting chemicals (EDCs) around the world has fueled the secular trend in pubertal timing, the reality is, of course, more complicated.5
Per- and polyfluoroalkyl substances (PFAS), a class of forever chemicals, are of particular concern in this context given their reproductive and developmental toxicity, their widespread use in industrial applications and consumer products, and their resistance to environmental and biological degradation.6 Data from the National Health and Nutrition Examination Survey indicate nearly 100% of Americans have measurable blood levels of PFAS, with exposure typically occurring through contaminated water and food, as well as via consumer products.7,8 To date, results of epidemiological studies examining the impact of PFAS on pubertal outcomes have been inconsistent, likely owing to methodological differences and challenges.9–12
Among those challenges is the variable timing of pubertal milestones, leading to mistiming of exposure and outcome assessment in some participants.9,12 The widespread reliance on self- or parent-reported assessment of pubertal development, rather than gold-standard Tanner staging by a trained professional, can additionally introduce outcome misclassification and obscure true associations.13,14 Finally, there remains controversy regarding the role of body size as a potential mediator in the association between PFAS and pubertal development; adjustment for body mass index (BMI) as a potential confounder may result in overadjustment bias.
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