New research shows how PFAS could be affecting New Hampshire’s nursing moms, babies

By CLAIRE SULLIVAN

New Hampshire Bulletin

Published: 08-15-2024 5:00 PM

A recent study of New Hampshire mothers led by a Dartmouth researcher found that mothers with higher PFAS levels were at greater risk of stopping exclusive breastfeeding early.

Experts recommend infants be exclusively breastfed for the first six months because of a number of health benefits.

The New Hampshire study, published in May, found the association with shorter breastfeeding durations were “driven largely by PFOA,” or perfluorooctanoate. Those in the highest quarter of PFOA levels had a 28 percent greater risk of stopping exclusive breastfeeding before six months than those in the bottom quarter of PFOA levels.

PFAS — or per- and polyfluoroalkyl substances — are a class of harmful, man-made chemicals commonly used in consumer and industrial products.

Some New Hampshire communities have also suffered acute PFAS exposure from emissions from Saint-Gobain Performance Plastics in Merrimack and Pease Air Force Base on the Seacoast.

PFAS are linked to a number of health problems, including some cancers, but people may not realize the impact it can have in the earliest stages of life.

Breast milk can expose infants to PFAS and other environmental chemicals, according to the Agency for Toxic Substances and Disease Registry.

“I think it often is very surprising to people,” said Megan E. Romano, the Dartmouth researcher who led the study, “to think about this idea that chemicals in our environment might influence lactation.”

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Medical experts recommend exclusive breastfeeding — which, as it sounds, means the baby consumes just breast milk — until 6 months and continuing partial breastfeeding — human milk plus other food — until 2 years old or longer.

The study did not find an association between PFAS and stopping partial breastfeeding before 12 months.

One year of breastfeeding was the recommendation of the American Academy of Pediatrics until it was lengthened to two years in 2022.

Women face a number of pressures — socioeconomic and otherwise — that can make reaching these recommendations difficult. Only about a quarter of U.S. newborns were exclusively breastfeeding at six months, and only about 35.9 percent breastfeed for a year, according to recent data from the Centers for Disease Control and Prevention.

Breastfeeding is linked to a number of benefits for both children and mothers, which is why PFAS potentially playing a role in shortening it is significant.

Breastfed babies tend to have fewer infections in the first year of life, including ear and respiratory tract infections and diarrhea, Romano said. In the longer term, there’s a reduction in risk for Type 1 and Type 2 diabetes and obesity in childhood and possibly into adulthood, she said.

For moms, breastfeeding decreases the risk of ovarian and breast cancers, hypertension, and Type 2 diabetes in the long term, she said.

Romano said these recent findings on PFAS exposure and the duration of breastfeeding were on track with what other studies have shown. Research on the topic has been mostly focused in Europe, but there have been a handful of American studies in the last year or two, she said. There’s been a consistency in results across geographical locations and sociodemographics.

“That does kind of lead us to believe that there’s something real that is going on under that association,” she said, “even though we don’t fully understand the biological mechanism yet.”

Animal studies could offer some hints, Romano said. Scientists think PFAS may impair the development of mammary glands or interfere with the process by which breasts get ready to produce milk, called lactogenesis. It may also suppress endocrine signaling and influence the placental hormones that get lactation started, she said.

PFAS can also cause harm during pregnancy.

“One thing that we do see pretty consistently is that PFAS exposure in pregnancy is linked to pregnancy induced hypertension for the pregnant person,” Romano said. Hypertension, which is high blood pressure, can affect heart health over time.

PFAS can also cause small reductions in birth weight, Romano said, which can have “longer term implications for child cardiometabolic health.”

Exposure before birth can have long-lasting effects on a person.

“It does seem like the prenatal exposure is very important,” Romano said. “That that can really kind of set people on a trajectory for their longer-term health.”

In early life, exposure to PFAS may also reduce responses to vaccines, Denmark studies have shown, Romano said.

Romano is hoping to study the link between PFAS and breastfeeding using a more nationally representative sample. She and other researchers have also been working to close the gap between the research and clinical practice, including developing educational materials for clinicians with the state Department of Health and Human Services.

“Environmental health is not an area that is included in great detail in the medical school curriculum,” she said. “And so it is often something new that people encounter in practice.”

Romano added a caveat to her research: “It is not my intention to offer sort of prescriptive advice about whether or not people should breastfeed. That’s a very personal decision.”

“My impetus in doing this work,” she said, “is really that I don’t want these environmental risk factors to be something that gets in the way of people breastfeeding for as long as they would like to.”