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Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review

  • Authors:
    • Maria Lyrou
    • Grigorios Karampas
    • Dimitra Metallinou
    • Chrysoula Rozalia Athanasiadou
    • Kleanthi Gourounti
    • Vaidas Jotautis
    • Vasiliki Epameinondas Georgakopoulou
    • Demetrios A. Spandidos
    • Antigoni Sarantaki
  • View Affiliations / Copyright

    Affiliations: Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece, Second Department of Obstetrics and Gynecology, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece, Faculty of Medicine, Kauno Kolegija Higher Education Institution, 50468 Kaunas, Lithuania, Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
    Copyright: © Lyrou et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 51
    |
    Published online on: June 24, 2025
       https://doi.org/10.3892/mi.2025.250
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Abstract

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants with potential immunotoxic effects. The present systematic review evaluated the association between prenatal PFAS exposure and the incidence of respiratory infections in infants and children. For this purpose, a comprehensive literature search was conducted across the PubMed, Scopus and Cochrane Library databases following the referred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines. Studies assessing prenatal PFAS exposure and childhood respiratory infections were included. A total of six studies meeting the eligibility criteria were analyzed. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid were the most frequently detected PFAS in maternal blood. While no significant associations were found in infancy, a greater prenatal exposure to perfluorohexane sulfonate and PFOS was linked to increased respiratory infections, particularly pneumonia and respiratory syncytial virus infections, in early childhood. Conversely, perfluorononanoic acid and perfluorodecanoic acid were associated with a reduced risk of lower respiratory tract infections and wheezing in children aged 4 to 7 years. The biological mechanisms likely involve PFAS‑induced immune dysregulation, including altered cytokine responses and impaired vaccine effectiveness. The present systematic review highlights the complex role of prenatal PFAS exposure in modulating childhood respiratory health. Given the widespread presence of PFAS in the environment, regulatory policies should focus on minimizing exposure, particularly during pregnancy. Further research is required to clarify causal mechanisms and assess long‑term respiratory outcomes in children.
View Figures

Figure 1

Flowchart for the study selection
process.

Figure 2

Pathway of prenatal PFAS exposure and
its impact on childhood respiratory infections. PFAS,
perfluoroalkyl and polyfluoroalkyl substances; PFOS,
perfluorooctane sulfonate; PFOA, perfluorooctanoic acid; PFHxS,
perfluorohexane sulfonate; PFNA, perfluorononanoic acid; PFDA,
perfluorodecanoic acid.

Figure 3

Impact of prenatal PFAS exposure on
immune function and infection risk in childhood. PFAS,
perfluoroalkyl and polyfluoroalkyl substances; Th1 cells, T helper
1 cells (involved in cellular immunity); Th2 cells, T helper 2
cells (associated with allergic responses); Th17 cells, T helper 17
cells (linked to inflammation and autoimmunity); NK cells, natural
killer cells (involved in immune surveillance and viral defense).
Parts of this image derived from the free medical site http://smart.servier.com/ (accessed on February 25,
2025) by Servier, licenced under a Creative Commons Attribution 4.0
Unported Licence.
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Copy and paste a formatted citation
Spandidos Publications style
Lyrou M, Karampas G, Metallinou D, Athanasiadou CR, Gourounti K, Jotautis V, Georgakopoulou VE, Spandidos DA and Sarantaki A: Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review. Med Int 5: 51, 2025.
APA
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C.R., Gourounti, K., Jotautis, V. ... Sarantaki, A. (2025). Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review. Medicine International, 5, 51. https://doi.org/10.3892/mi.2025.250
MLA
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C. R., Gourounti, K., Jotautis, V., Georgakopoulou, V. E., Spandidos, D. A., Sarantaki, A."Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review". Medicine International 5.5 (2025): 51.
Chicago
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C. R., Gourounti, K., Jotautis, V., Georgakopoulou, V. E., Spandidos, D. A., Sarantaki, A."Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review". Medicine International 5, no. 5 (2025): 51. https://doi.org/10.3892/mi.2025.250
Copy and paste a formatted citation
x
Spandidos Publications style
Lyrou M, Karampas G, Metallinou D, Athanasiadou CR, Gourounti K, Jotautis V, Georgakopoulou VE, Spandidos DA and Sarantaki A: Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review. Med Int 5: 51, 2025.
APA
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C.R., Gourounti, K., Jotautis, V. ... Sarantaki, A. (2025). Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review. Medicine International, 5, 51. https://doi.org/10.3892/mi.2025.250
MLA
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C. R., Gourounti, K., Jotautis, V., Georgakopoulou, V. E., Spandidos, D. A., Sarantaki, A."Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review". Medicine International 5.5 (2025): 51.
Chicago
Lyrou, M., Karampas, G., Metallinou, D., Athanasiadou, C. R., Gourounti, K., Jotautis, V., Georgakopoulou, V. E., Spandidos, D. A., Sarantaki, A."Association between prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and the incidence of infant and childhood respiratory infections: A systematic review". Medicine International 5, no. 5 (2025): 51. https://doi.org/10.3892/mi.2025.250
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