Pediatric effects of forever chemicals may last for a long time

Abstract Perfluorinated alkylate substances (PFASs) have been in use for about 75 years. Because of their persistence, concentrations in the environment have increased, and absorbed PFAS will remain in the human body, some compounds for many years. The fetus and the newborn infant are particularly vulnerable to PFAS toxicity due to the intense development of organs and body functions. In addition, PFASs pass the placenta so that a pregnant woman shares her accumulated PFAS burden with the progeny. In addition, PFASs are excreted in the milk, so that the resulting serum-PFAS concentration in the infant may greatly exceed that of the mother. Multi-organ effects have been reported, some related to endocrine disruption. Immunotoxicity can occur at very low exposure levels, with elevated risks of infectious disease and possibly also cancer development. Unfortunately, little research was carried out during the first 50 years of industrial use, and some study reports were hidden. Independent research has been carried out only recently. Due to incomplete evidence, governmental regulations have been delayed and remain insufficient, in part because of objections from industrial interests. Impact The perfluorinated alkylate substances (PFASs) are persistent and accumulate in the environment and in the human body. The greatest risk of PFAS toxicity occurs at early age, as PFASs are transferred through the placenta and human milk. This means that early-life exposures may trigger development of diseases and other adverse outcomes that may seriously burden adult health. Research has been delayed due to secrecy. While pediatric studies in this field are underway, prudent decisions to protect public health should be made despite possible concerns regarding incomplete evidence. Practical complications, and current guidelines and interventions are by far insufficient. Current evidence on PFASs shows that these industrial chemicals are persistent and that highly elevated exposures occur already at early age. The maternal body burden of PFAS is shared with the fetus, and substantial amounts are transferred in human milk, thus impacting the unique nutritional advantage of breast-feeding. Recent evidence suggests that early PFAS exposure can affect public health, also during adult age, and that some adverse effects may be transferred to the next generation.