Pregnant with PFAS: The threat of ‘forever chemicals’ in cord blood

The developing fetus faces a threat from the harmful “forever chemicals” known as PFAS in their umbilical cord, a new Environmental Working Group science review finds.

EWG scientists have identified dozens of studies published in the past five years that report the presence of PFAS, or perfluoroalkyl and polyfluoroalkyl substances, in cord blood. The presence of these chemicals is also a threat to pregnant people, serving as first contacts with PFAS before they can pass from the uterus to the developing fetus by way of the umbilical cord.

EWG scientists reviewed 40 studies examining the presence and health effects of PFAS in cord blood. All 40 reported the detection of a wide range of PFAS in the blood. Sixteen studies found associations between PFAS exposure in cord blood and changes in vital body molecules called cord blood lipids, as well as harm to fetal and childhood development.

At least 14 studies found an association between PFAS in cord blood, detection of PFAS later in childhood, or increased risk of health impacts in adulthood, or a combination of all three.

The studies were conducted in the U.S.,1-5 and 11 other countries 6-40 including Brazil, China and Japan, and published in peer-reviewed journals between 2018 and mid-2022 (Table 1).

Our review builds on past work by EWG, Commonweal and Rachel’s Network from 2005 and 2009 that revealed PFAS in umbilical cord samples from 20 U.S.-born babies.

Table 1: PFAS detections in umbilical cord blood in U.S. and non-U.S. research

Perfluoroalkyl and polyfluoroalkyl substances

U.S. studies

Studies outside of the U.S.

Perfluorooctanesulfonate (PFOS)

Perfluorooctanoic acid (PFOA)

6:2 chlorinated polyfluorinated ether sulfonate (6:2 CI-PFESA)


8:2 chlorinated polyfluorinated ether sulfonate (8:2 CI-PFESA)


4:2 chlorinated polyfluorinated ether sulfonate (4:2 CI-PFESA)


Perfluorooctanesulfonamide (PFOSA)


Perfluorohexansulfonate (PFHxS)

Perfluoroheptanesulfonic acid (PFHpS)


Perfluorobutanoic acid (PFBA)


Perfluorohexanoic acid (PFHxA)

Perfluoroheptanoic acid (PFHpA)

Perfluorononanoic acid (PFNA)

Perfluorodecanoic acid (PFDA)

Perfluroundecanoic acid (PFUnDA)

Perfluorododecanoic acid (PFDoDA)

Perfluorotridecanoic acid (PFTrDA)


Perfluorotetradecanoic acid (PFTeDA)


Perfluorobutane sulfonic acid (PFBS)


Perfluorodecane sulfonate (PFDS)

Perfluoroundecanoic acid (PFUA)


Perfluorooctane sulfonamide (FOSA)

N-Methyl perfluorooctane sulfonamido acetic acid (NMeFOSAA)

N-ethyl perfluorooctane sulfonamido acetic acid (EtFOSAA)

Perfluoropentanoic acid (PFPA)


Perfluorodecanoic acid (PFDeA)


Perfluoropentanoic acid (PFPeA)


Perfluoropentanesulfonic acid (PFPeS)


6:2 Fluorotelomer sulfonic acid (6:2 FTSA)


8:2 Fluorotelomer sulfonic acid (8:2 FTSA)


Perfluorinated sulfonamidoacetic acids (FOSAA)


6:2 Fluorotelomer phosphate diester (6:2 diPAP)


8:2 Fluorotelomer phosphate diester (8:2 diPAP)


6:2 Fluorotelomer phosphate monoester (6:2 monoPAP)


Methyl perfluoroundecanoate


2-perfluorooctyl ethanoic acid


Source: EWG review of 40 journal articles

Humans can be exposed to PFAS through contaminated food and water, and inhalation of dust and fumes from consumer products. The developing fetus can be exposed through the umbilical cord and placenta, and babies through breastfeeding.4142

PFAS are persistent and ubiquitous environmental contaminants used to make many commercial and industrial products because of their water- and oil-repelling properties. They’re found in products like nonstick cookware, clothing, food packaging, carpets and firefighting foam.43

Exposure to these forever chemicals is associated with health harms including adverse changes in blood lipid profiles, and metabolic diseases like diabetes and obesity.4445 PFAS have also been linked to increases in liver enzymes, behavioral and neurological outcomes, cancer, immune suppression, thyroid disorders, kidney disease, cardiovascular diseases, and harms to the developmental, and reproductive systems, such as reduced birth weight and length, and reduced abdominal circumference. 4647

Tests from the Centers for Disease Control and Prevention have found nearly all Americans have PFOA or PFOS – two of the most widespread and well-known PFAS – in their blood.

Scientific literature shows PFAS are detected in several human biological fluids or tissues, including serum, brain, liver, lung, bone, kidney, and breast milk, as well as umbilical cord blood. In the U.S., the production and use of PFOS and PFOA has declined, and national trends suggest a decline in the blood concentration of PFAS.48

What can people do to protect themselves from PFAS chemicals?

Risks of PFAS exposure for children

Kids are more vulnerable to PFAS exposure. They are harmed in the long-term because of their growing body and exposure to the chemicals.

Research shows high levels of PFAS in children, which have been associated with reduced vaccine antibody response. That data in part informed the Environmental Protection Agency’s recent decision to dramatically tighten its lifetime health advisories for PFOA and PFOS.

Unless more steps are taken to tackle the problem of PFAS pollution, children will remain at risk. Some health problems caused by PFAS in umbilical cord blood include higher total cholesterol and triglycerides in babies and changes in their bodies’ bile acids,122923 which show a higher risk of cardiovascular problems later in life.495051

PFAS in cord blood is also associated with disruptions among newborns in relation to their thyroid function1315 microbial cells in the colon10 and growth.16,  2040

Because PFAS persist in human bodies, effects on cognitive,333 lung21 and reproductive functions,27 as well as changes in weight,2534 can continue through childhood and adulthood. Researchers have found prenatal exposure to PFAS led to adults developing an altered glucose balance.32

PFAS can also lead to childhood respiratory tract infection21and a type of eczema,38 due to the chemicals’ immune-suppressing capability.24

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What governments are doing, and what they need to do

The U.S. government should be  responsible for protecting the general population, especially the developing fetus, from toxic chemicals such as PFAS.

PFOA and PFOS have largely been phased out of the U.S., but both they and other PFAS persist in the environment, not just in the body. Evidence reveals PFAS replacement chemicals like PFBS and GenX also persist and pose health risks similar to those of PFOA and PFOS.52

In June, the EPA not only tightened its non-enforceable health advisories for PFOA and PFOS but also announced new lifetime health advisories for PFBS and GenX in drinking water.

The agency in August then announced another effort to tackle the problem of PFAS pollution, proposing to designate PFOA and PFOS as hazardous substances under the Superfund law.

In 2020, the European Union’s Food Safety Authority released a drinking water directive that includes a health protective limit for all PFAS, and a stronger threshold for PFAS in food.

These steps recognize the toxic impacts of PFAS exposure, but much more is needed to reduce exposure among the general population, especially children and the developing fetus.

There are no federal regulations for PFAS in many consumer products, even with substantial scientific evidence linking PFAS exposure to adverse health impacts. The EPA, Food and Drug Administration and other federal regulators should prioritize public health, especially for vulnerable populations like pregnant people and babies.

Simple steps to reduce PFAS exposure for all Americans include:

  • Banning unnecessary uses of PFAS in consumer products.
  • Limiting government purchases of products that use PFAS unnecessarily.
  • Identifying PFAS-contaminated sites, setting and enforcing science-based cleanup standards.
  • Understanding the scope of PFAS contamination through monitoring.
  • Setting and enforcing science-based exposure limits in drinking water and food.
  • Limiting industrial discharges of PFAS into the air and water.

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11 Naspolini, N.F., P.P. Machado, J.C. Moreira, C.I.R.F. Asmus, and A. Meyer, Maternal consumption of ultra-processed foods and newborn exposure to perfluoroalkyl substances (PFAS). Cadernos de Saúde Pública, 2021. 37. DOI:

12 Sinisalu, L., L.W. Yeung, J. Wang, Y. Pan, J. Dai, and T. Hyötyläinen, Prenatal exposure to poly-/per-fluoroalkyl substances is associated with alteration of lipid profiles in cord-blood. Metabolomics, 2021. 17(12): p. 1-13. DOI:

13 Guo, J., J. Zhang, Z. Wang, L. Zhang, X. Qi, Y. Zhang, X. Chang, C. Wu, and Z. Zhou, Umbilical cord serum perfluoroalkyl substance mixtures in relation to thyroid function of newborns: Findings from Sheyang Mini Birth Cohort Study. Chemosphere, 2021. 273: p. 129664. DOI:

14 Cai, D., Q.-Q. Li, C. Chu, S.-Z. Wang, Y.-T. Tang, A.A. Appleton, R.-L. Qiu, B.-Y. Yang, L.-W. Hu, and G.-H. Dong, High trans-placental transfer of perfluoroalkyl substances alternatives in the matched maternal-cord blood serum: Evidence from a birth cohort study. Science of The Total Environment, 2020. 705: p. 135885. DOI:

15 Aimuzi, R., K. Luo, Q. Chen, H. Wang, L. Feng, F. Ouyang, and J. Zhang, Perfluoroalkyl and polyfluoroalkyl substances and fetal thyroid hormone levels in umbilical cord blood among newborns by prelabor caesarean delivery. Environment international, 2019. 130: p. 104929. DOI:

16 Cao, W., X. Liu, X. Liu, Y. Zhou, X. Zhang, H. Tian, J. Wang, S. Feng, Y. Wu, and P. Bhatti, Perfluoroalkyl substances in umbilical cord serum and gestational and postnatal growth in a Chinese birth cohort. Environment international, 2018. 116: p. 197-205. DOI:

17 Kung, Y.-P., C.-C. Lin, M.-H. Chen, M.-S. Tsai, W.-S. Hsieh, and P.-C. Chen, Intrauterine exposure to per-and polyfluoroalkyl substances may harm children's lung function development. Environmental Research, 2021. 192: p. 110178. DOI:

18 Li, J., J. Yao, W. Xia, J. Dai, H. Liu, Y. Pan, S. Xu, S. Lu, S. Jin, and Y. Li, Association between exposure to per-and polyfluoroalkyl substances and blood glucose in pregnant women. International Journal of Hygiene and Environmental Health, 2020. 230: p. 113596. DOI:

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23 Li, Y., X. Lu, N. Yu, A. Li, T. Zhuang, L. Du, S. Tang, W. Shi, H. Yu, and M. Song, Exposure to legacy and novel perfluoroalkyl substance disturbs the metabolic homeostasis in pregnant women and fetuses: A metabolome-wide association study. Environment International, 2021. 156: p. 106627. DOI:

24 Zeng, X.-W., M.S. Bloom, S.C. Dharmage, C.J. Lodge, D. Chen, S. Li, Y. Guo, M. Roponen, P. Jalava, and M.-R. Hirvonen, Prenatal exposure to perfluoroalkyl substances is associated with lower hand, foot and mouth disease viruses antibody response in infancy: Findings from the Guangzhou Birth Cohort Study. Science of the Total Environment, 2019. 663: p. 60-67. DOI:

25 Chen, Q., X. Zhang, Y. Zhao, W. Lu, J. Wu, S. Zhao, J. Zhang, and L. Huang, Prenatal exposure to perfluorobutanesulfonic acid and childhood adiposity: a prospective birth cohort study in Shanghai, China. Chemosphere, 2019. 226: p. 17-23. DOI:

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