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Breastfeeding initiation and duration after high exposure to perfluoroalkyl substances through contaminated drinking water : A cohort study from Ronneby, Sweden

Nielsen, Christel LU orcid ; Li, Ying ; Lewandowski, Magdalena LU ; Fletcher, Tony and Jakobsson, Kristina LU (2022) In Environmental Research 207.
Abstract

Background: The drinking water in parts of Ronneby was heavily contaminated with perfluoroalkyl substances (PFAS) for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the effects in populations with a point source of high exposure are unknown. Objectives: To investigate associations between high PFAS exposure and 1) initiation and 2) duration of breastfeeding. Methods: We retrieved data on infant feeding practices for 2374 children born between 1999 and 2009 from Child Health Care centers in Ronneby and a reference municipality. Residential address before delivery was used as a proxy for exposure, and confounders were obtained from charts and registers. We used modified Poisson regressions... (More)

Background: The drinking water in parts of Ronneby was heavily contaminated with perfluoroalkyl substances (PFAS) for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the effects in populations with a point source of high exposure are unknown. Objectives: To investigate associations between high PFAS exposure and 1) initiation and 2) duration of breastfeeding. Methods: We retrieved data on infant feeding practices for 2374 children born between 1999 and 2009 from Child Health Care centers in Ronneby and a reference municipality. Residential address before delivery was used as a proxy for exposure, and confounders were obtained from charts and registers. We used modified Poisson regressions to estimate the relative risks (RR) of not initiating breastfeeding, not breastfeeding exclusively after 3 months, and not breastfeeding at all at 6 months. We also estimated hazard ratios (HR) of cessation of exclusive breastfeeding before 6 months and any breastfeeding before 12 months. Results: Mothers who had received contaminated water seemed to have a higher risk of not initiating breastfeeding (RR = 2.4; 95% CI: 0.8, 6.7). 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 6 months. The results were confirmed by the Cox regressions, which further showed that the HR for cessation of any breastfeeding was time dependent and higher in early lactation, thereafter decreasing as lactation progressed. We observed no overall associations in multiparous mothers. Discussion: Exposure to high levels of PFAS seemed to be associated with increased risks of not initiating breastfeeding and shorter breastfeeding duration in primiparous mothers. The findings imply that the ability of first-time mothers to establish breastfeeding is a sensitive outcome after high exposure to PFAS.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
AFFF-Foam, Breastfeeding, Contaminated drinking water, Maternal exposure, Perfluoroalkyl substances
in
Environmental Research
volume
207
article number
112206
publisher
Elsevier
external identifiers
  • scopus:85117397617
  • pmid:34653413
ISSN
0013-9351
DOI
10.1016/j.envres.2021.112206
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors
id
e1b17eb4-bbf4-4f90-a07a-abbcaa2ccf46
date added to LUP
2021-12-20 11:50:02
date last changed
2024-06-15 22:59:45
@article{e1b17eb4-bbf4-4f90-a07a-abbcaa2ccf46,
  abstract     = {{<p>Background: The drinking water in parts of Ronneby was heavily contaminated with perfluoroalkyl substances (PFAS) for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the effects in populations with a point source of high exposure are unknown. Objectives: To investigate associations between high PFAS exposure and 1) initiation and 2) duration of breastfeeding. Methods: We retrieved data on infant feeding practices for 2374 children born between 1999 and 2009 from Child Health Care centers in Ronneby and a reference municipality. Residential address before delivery was used as a proxy for exposure, and confounders were obtained from charts and registers. We used modified Poisson regressions to estimate the relative risks (RR) of not initiating breastfeeding, not breastfeeding exclusively after 3 months, and not breastfeeding at all at 6 months. We also estimated hazard ratios (HR) of cessation of exclusive breastfeeding before 6 months and any breastfeeding before 12 months. Results: Mothers who had received contaminated water seemed to have a higher risk of not initiating breastfeeding (RR = 2.4; 95% CI: 0.8, 6.7). 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 6 months. The results were confirmed by the Cox regressions, which further showed that the HR for cessation of any breastfeeding was time dependent and higher in early lactation, thereafter decreasing as lactation progressed. We observed no overall associations in multiparous mothers. Discussion: Exposure to high levels of PFAS seemed to be associated with increased risks of not initiating breastfeeding and shorter breastfeeding duration in primiparous mothers. The findings imply that the ability of first-time mothers to establish breastfeeding is a sensitive outcome after high exposure to PFAS.</p>}},
  author       = {{Nielsen, Christel and Li, Ying and Lewandowski, Magdalena and Fletcher, Tony and Jakobsson, Kristina}},
  issn         = {{0013-9351}},
  keywords     = {{AFFF-Foam; Breastfeeding; Contaminated drinking water; Maternal exposure; Perfluoroalkyl substances}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Environmental Research}},
  title        = {{Breastfeeding initiation and duration after high exposure to perfluoroalkyl substances through contaminated drinking water : A cohort study from Ronneby, Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.envres.2021.112206}},
  doi          = {{10.1016/j.envres.2021.112206}},
  volume       = {{207}},
  year         = {{2022}},
}