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Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies

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  • Joan Forns, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
  • ,
  • Marc-Andre Verner, Université de Montréal Public Health Research Institute (IRSPUM), Université de Montréal, Montreal, Canada.
  • ,
  • Nina Iszatt, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
  • ,
  • Nikola Nowack, Department of Developmental Psychology, Ruhr-University Bochum, Bochum, Germany.
  • ,
  • Cathrine Carlsen Bach
  • Martine Vrijheid, CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
  • ,
  • Olga Costa, Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)-Universitat Jaume I-Universitat de València, Valencia, Spain.
  • ,
  • Ainara Andiarena, Faculty of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain.
  • ,
  • Eva Sovcikova, Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic.
  • ,
  • Birgit Bjerre Høyer
  • ,
  • Jürgen Wittsiepe, Department of Hygiene, Social and Environmental Medicine, Ruhr University Bochum, Bochum, Germany.
  • ,
  • Maria-Jose Lopez-Espinosa, Department of Nursing and Chiropody, Universitat de València, Valencia, Spain.
  • ,
  • Jesus Ibarluzea, Faculty of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain.
  • ,
  • Irva Hertz-Picciotto, UC Davis Medical Investigations of Neurodevelopmental Disorders Institute, UC Davis, Davis, California, USA.
  • ,
  • Gunnar Toft
  • Hein Stigum, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
  • ,
  • Mònica Guxens, ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: monica.guxens@isglobal.org.
  • ,
  • Zeyan Liew
  • Merete Eggesbø, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.

INTRODUCTION: To date, the evidence for an association between perfluoroalkyl substances (PFAS) exposure and attention deficit and hyperactivity disorder (ADHD) is inconclusive.

OBJECTIVE: We investigated the association between early life exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), and ADHD in a collaborative study including nine European population-based studies, encompassing 4,826 mother-child pairs.

METHODS: Concentrations of PFOS and PFOA were measured in maternal serum/plasma during pregnancy, or in breast milk, with different timing of sample collection in each cohort. We used a validated pharmacokinetic model of pregnancy and lactation to estimate concentrations of PFOS and PFOA in children at birth and at 3, 6, 12, and 24 months of age. We classified ADHD using recommended cutoff points for each instrument used to derive symptoms scores. We used multiple imputation for missing covariates, logistic regression to model the association between PFAS exposure and ADHD in each study, and combined all adjusted study-specific effect estimates using random-effects meta-analysis.

RESULTS: A total of 399 children were classified as having ADHD, with a prevalence ranging from 2.3% to 7.3% in the studies. Early life exposure to PFOS or PFOA was not associated with ADHD during childhood [odds ratios (ORs) ranging from 0.96 (95% CI: 0.87, 1.06) to 1.02 (95% CI: 0.93, 1.11)]. Results from stratified models suggest potential differential effects of PFAS related to child sex and maternal education.

CONCLUSION: We did not identify an increased prevalence of ADHD in association with early life exposure to PFOS and PFOA. However, stratified analyses suggest that there may be an increased prevalence of ADHD in association with PFAS exposure in girls, in children from nulliparous women, and in children from low-educated mothers, all of which warrant further exploration. https://doi.org/10.1289/EHP5444.

OriginalsprogEngelsk
Artikelnummer57002
TidsskriftEnvironmental Health Perspectives
Vol/bind128
Nummer5
Antal sider10
ISSN0091-6765
DOI
StatusUdgivet - maj 2020

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