Sarcouncil Journal of Medical Sciences

Abstract: Per- and polyfluoroalkyl substances (PFAS) are persistent synthetic chemicals with ubiquitous environmental distribution and measurable concentrations in nearly all populations worldwide. The developing brain represents a particularly vulnerable target for PFAS toxicity due to critical windows of neurodevelopment during prenatal and early postnatal periods. This comprehensive review synthesizes current epidemiological evidence examining associations between early-life PFAS exposure and neurodevelopmental outcomes in children, incorporating findings from major birth cohort studies and cross-sectional investigations. A systematic literature search identified studies examining prenatal and childhood PFAS exposure in relation to cognitive development, behavioral outcomes, and motor function across pediatric populations. The strongest evidence emerges from prospective birth cohort studies demonstrating consistent associations between prenatal PFAS exposure and reduced cognitive function, with effect estimates ranging from 2-5 point reductions in IQ per natural log unit increase in exposure. Behavioral outcomes, particularly attention deficit hyperactivity disorder (ADHD) symptoms, show robust associations with prenatal PFAS exposure across multiple populations, with odds ratios typically ranging from 1.2-1.8. Evidence for autism spectrum disorders and motor development deficits remains more limited but emerging. Critical exposure windows appear to occur during the first and second trimesters of pregnancy, coinciding with fundamental neurodevelopmental processes including neurogenesis, neuronal migration, and early synaptogenesis. Current regulatory frameworks vary internationally but increasingly recognize the need for protective action, given the persistent nature of PFAS compounds and the vulnerability of developing children.