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Almeida-Toledano L, Navarro-Tapia E, Sebastiani G, Ferrero-Martínez S, Ferrer-Aguilar P, García-Algar Ó, Andreu-Fernández V, Gómez-Roig MD. Effect of prenatal phthalate exposure on fetal development and maternal/neonatal health consequences: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 950:175080. [PMID: 39079634 DOI: 10.1016/j.scitotenv.2024.175080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
The ubiquitous presence of phthalate compounds in cosmetics, personal care products and plastics commonly used in toys, food packaging or household products, results in human exposure with adverse effects on reproductive health and fetal development. Following the PRISMA methodology, this systematic review analyzes the effect of prenatal phthalate exposure on major pregnancy complications, such as gestational diabetes, pregnancy-induced hypertension, fetal growth restriction and preterm birth, and its role in fetal neurodevelopment. This review includes >100 articles published in the last 10 years, showing an association between maternal exposure to phthalates and the risk of developing pregnancy complications. Phthalates are negatively associated with motor skills and memory, and also increase the risk of delayed language acquisition, autism spectrum disorder traits, and behavioral deficits, such as attention deficit hyperactivity disorder in children prenatally exposed to phthalates. Di (2-ethylhexyl) phthalate and its metabolites (mono(2-ethylhexyl) phthalate, mono(3-carboxypropyl) phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, mono(2-ethyl-5-oxohexyl) phthalate) are the main compounds associated with the above-mentioned pregnancy complications and fetal neurodevelopmental disorders. In addition, this review discusses the molecular mechanisms responsible for various pregnancy complications and neurodevelopmental disorders, and the critical window of exposure, in order to clarify these aspects. Globally, the most common molecular mechanisms involved in the effects of phthalates are endocrine disruption, oxidative stress induction, intrauterine inflammation, and DNA methylation disorders. In general, the critical window of exposure varies depending on the pathophysiology of the complication being studied, although the first trimester is considered an important period because some of the most vulnerable processes (embryogenesis and placentation) begin early in pregnancy. Future research should aim to understand the specific mechanism of the disruptive effect of each component and to establish the toxic dose of phthalates, as well as to elucidate the most critical period of pregnancy for exposure and the long-term consequences for human health.
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Affiliation(s)
- Laura Almeida-Toledano
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain.
| | - Elisabet Navarro-Tapia
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain.
| | - Giorgia Sebastiani
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain.
| | - Sílvia Ferrero-Martínez
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain.
| | - Patricia Ferrer-Aguilar
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain.
| | - Óscar García-Algar
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain; Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain.
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Biosanitary Research Institute, Valencian International University (VIU), 46002, Valencia, Spain.
| | - María Dolores Gómez-Roig
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain.
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Yesildemir O, Celik MN. Association between pre- and postnatal exposure to endocrine-disrupting chemicals and birth and neurodevelopmental outcomes: an extensive review. Clin Exp Pediatr 2024; 67:328-346. [PMID: 37986566 PMCID: PMC11222910 DOI: 10.3345/cep.2023.00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 11/22/2023] Open
Abstract
Endocrine-disrupting chemicals (EDCs) are natural or synthetic chemicals that mimic, block, or interfere with the hormones in the body. The most common and well- studied EDCs are bisphenol A, phthalates, and persistent organic pollutants including polychlorinated biphenyls, polybrominated diphenyl ethers, per- and polyfluoroalkyl substances, other brominated flame retardants, organochlorine pesticides, dioxins, and furans. Starting in embryonic life, humans are constantly exposed to EDCs through air, diet, skin, and water. Fetuses and newborns undergo crucial developmental processes that allow adaptation to the environment throughout life. As developing organisms, they are extremely sensitive to low doses of EDCs. Many EDCs can cross the placental barrier and reach the developing fetal organs. In addition, newborns can be exposed to EDCs through breastfeeding or formula feeding. Pre- and postnatal exposure to EDCs may increase the risk of childhood diseases by disrupting the hormone-mediated processes critical for growth and development during gestation and infancy. This review discusses evidence of the relationship between pre- and postnatal exposure to several EDCs, childbirth, and neurodevelopmental outcomes. Available evidence suggests that pre- and postnatal exposure to certain EDCs causes fetal growth restriction, preterm birth, low birth weight, and neurodevelopmental problems through various mechanisms of action. Given the adverse effects of EDCs on child development, further studies are required to clarify the overall associations.
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Affiliation(s)
- Ozge Yesildemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Mensure Nur Celik
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
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Oh J, Schweitzer JB, Buckley JP, Upadhyaya S, Kannan K, Herbstman JB, Ghassabian A, Schmidt RJ, Hertz-Picciotto I, Bennett DH. Early childhood exposures to phthalates in association with attention-deficit/hyperactivity disorder behaviors in middle childhood and adolescence in the ReCHARGE study. Int J Hyg Environ Health 2024; 259:114377. [PMID: 38692176 DOI: 10.1016/j.ijheh.2024.114377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Early-life exposure to phthalates alters behaviors in animals. However, epidemiological evidence on childhood phthalate exposure and attention-deficit/hyperactivity disorder (ADHD) behaviors is limited. METHODS This study included 243 children from the ReCHARGE (Revisiting Childhood Autism Risks from Genetics and Environment) study, who were previously classified as having autism spectrum disorder (ASD), developmental delay, other early concerns, and typical development in the CHARGE case-control study. Twenty phthalate metabolites were measured in spot urine samples collected from children aged 2-5 years. Parents reported on children's ADHD symptoms at ages 8-18 years using Conners-3 Parent Rating Scale. Covariate-adjusted negative binomial generalized linear models were used to investigate associations between individual phthalate metabolite concentrations and raw scores. Weighted quantile sum (WQS) regression with repeated holdout validation was used to examine mixture effects of phthalate metabolites on behavioral scores. Effect modification by child sex was evaluated. RESULTS Among 12 phthalate metabolites detected in >75% of the samples, higher mono-2-heptyl phthalate (MHPP) was associated with higher scores on Inattentive (β per doubling = 0.05, 95% confidence interval [CI]: 0.02, 0.08) and Hyperactive/Impulsive scales (β = 0.04, 95% CI: 0.00, 0.07), especially among children with ASD. Higher mono-carboxy isooctyl phthalate (MCiOP) was associated with higher Hyperactivity/Impulsivity scores (β = 0.07, 95% CI: -0.01, 0.15), especially among typically developing children. The associations of the molar sum of high molecular weight (HMW) phthalate metabolites and a phthalate metabolite mixture with Hyperactivity/Impulsivity scores were modified by sex, showing more pronounced adverse associations among females. CONCLUSION Exposure to phthalates during early childhood may impact ADHD behaviors in middle childhood and adolescence, particularly among females. Although our findings may not be broadly generalizable due to the diverse diagnostic profiles within our study population, our robust findings on sex-specific associations warrant further investigations.
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Affiliation(s)
- Jiwon Oh
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California at Davis, Sacramento, CA, USA; UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sudhi Upadhyaya
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akhgar Ghassabian
- Department of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA; UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA; UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Deborah H Bennett
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
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Oh J, Kim K, Kannan K, Parsons PJ, Mlodnicka A, Schmidt RJ, Schweitzer JB, Hertz-Picciotto I, Bennett DH. Early childhood exposure to environmental phenols and parabens, phthalates, organophosphate pesticides, and trace elements in association with attention deficit hyperactivity disorder (ADHD) symptoms in the CHARGE study. Environ Health 2024; 23:27. [PMID: 38486233 PMCID: PMC10938747 DOI: 10.1186/s12940-024-01065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND A growing body of literature investigated childhood exposure to environmental chemicals in association with attention-deficit/hyperactivity disorder (ADHD) symptoms, but limited studies considered urinary mixtures of multiple chemical classes. This study examined associations of concurrent exposure to non-persistent chemicals with ADHD symptoms in children diagnosed with autism spectrum disorder (ASD), developmental delay (DD), and typical development (TD). METHODS A total of 549 children aged 2-5 years from the Childhood Autism Risks from Genetics and Environment (CHARGE) case-control study were administered the Aberrant Behavior Checklist (ABC). This study focused on the ADHD/noncompliance subscale and its two subdomains (hyperactivity/impulsivity, inattention). Sixty-two chemicals from four classes (phenols/parabens, phthalates, organophosphate pesticides, trace elements) were quantified in child urine samples, and 43 chemicals detected in > 70% samples were used to investigate their associations with ADHD symptoms. Negative binomial regression was used for single-chemical analysis, and weighted quantile sum regression with repeated holdout validation was applied for mixture analysis for each chemical class and all chemicals. The mixture analyses were further stratified by diagnostic group. RESULTS A phthalate metabolite mixture was associated with higher ADHD/noncompliance scores (median count ratio [CR] = 1.10; 2.5th, 97.5th percentile: 1.00, 1.21), especially hyperactivity/impulsivity (median CR = 1.09; 2.5th, 97.5th percentile: 1.00, 1.25). The possible contributors to these mixture effects were di-2-ethylhexyl phthalate (DEHP) metabolites and mono-2-heptyl phthalate (MHPP). These associations were likely driven by children with ASD as these were observed among children with ASD, but not among TD or those with DD. Additionally, among children with ASD, a mixture of all chemicals was associated with ADHD/noncompliance and hyperactivity/impulsivity, and possible contributors were 3,4-dihydroxy benzoic acid, DEHP metabolites, MHPP, mono-n-butyl phthalate, and cadmium. CONCLUSIONS Early childhood exposure to a phthalate mixture was associated with ADHD symptoms, particularly among children with ASD. While the diverse diagnostic profiles limited generalizability, our findings suggest a potential link between phthalate exposure and the comorbidity of ASD and ADHD.
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Affiliation(s)
- Jiwon Oh
- Department of Public Health Sciences, University of California at Davis (UC Davis), Davis, CA, USA.
| | - Kyoungmi Kim
- Department of Public Health Sciences, University of California at Davis (UC Davis), Davis, CA, USA
- UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, NY, USA
| | - Patrick J Parsons
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, NY, USA
| | - Agnieszka Mlodnicka
- UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at Davis (UC Davis), Sacramento, CA, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, University of California at Davis (UC Davis), Davis, CA, USA
- UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Julie B Schweitzer
- UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at Davis (UC Davis), Sacramento, CA, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California at Davis (UC Davis), Davis, CA, USA
- UC Davis MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, Sacramento, CA, USA
| | - Deborah H Bennett
- Department of Public Health Sciences, University of California at Davis (UC Davis), Davis, CA, USA
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Ko MY, Park H, Chon S, Lee B, Cha S, Hyun S, Ka M. Prenatal Di-methoxyethyl phthalate exposure impairs cortical neurogenesis and synaptic activity in the mice. Brain Pathol 2024; 34:e13221. [PMID: 37903655 PMCID: PMC10901619 DOI: 10.1111/bpa.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
Di-methoxyethyl phthalate (DMEP) is a well-known environmentally prevalent endocrine disruptor and may be associated with neurodevelopmental disorders including attention deficit/hyperactivity disorder and intellectual disability. However, the regulatory mechanisms leading to these neurodevelopmental disorders are still poorly understood. Here, we demonstrate that prenatal DMEP exposure causes abnormal brain morphology and function in the mice. DMEP (50 mg/kg) was chronically administered to pregnant mice orally once a day starting on embryonic day 0 (E0) to breast-feeding cessation for the fetus. We found that prenatal DMEP exposure significantly reduced the number of neurons in the parietal cortex by impairing neurogenesis and gliogenesis during the developing cortex. Moreover, we found that prenatal DMEP exposure impaired dendritic spine architectures and synaptic activity in the parietal cortex. Finally, prenatal DMEP exposure in mice induces hyperactivity and reduces anxiety behaviors. Altogether, our study demonstrates that prenatal DMEP exposure leads to abnormal behaviors via impairment of neurogenesis and synaptic activity.
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Affiliation(s)
- Moon Yi Ko
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
| | - Heejin Park
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
- Collage of Veterinary of MedicineJeonbuk National UniversityJeonjuRepublic of Korea
| | - Sun‐Hwa Chon
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
| | - Byoung‐Seok Lee
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
| | - Sin‐Woo Cha
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
| | - Sung‐Ae Hyun
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
| | - Minhan Ka
- Department of Advanced Toxicology ResearchKorea Institute of ToxicologyDaejeonRepublic of Korea
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Sears CG, Liu Y, Lanphear BP, Buckley JP, Meyer J, Xu Y, Chen A, Yolton K, Braun JM. Evaluating Mixtures of Urinary Phthalate Metabolites and Serum Per-/Polyfluoroalkyl Substances in Relation to Adolescent Hair Cortisol: The HOME Study. Am J Epidemiol 2024; 193:454-468. [PMID: 37846096 DOI: 10.1093/aje/kwad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
Results of toxicological studies indicate that phthalates and per-/polyfluoroalkyl substances (PFAS), 2 classes of endocrine-disrupting chemicals, may alter the functioning of the hypothalamic-pituitary-adrenocortical (HPA) axis. We evaluated the associations of urinary phthalate metabolites and serum PFAS during gestation and childhood with adolescent hair cortisol concentrations (pg/mg hair) at age 12 years, an integrative marker of HPA axis activity (n = 205 mother-child pairs; Cincinnati, Ohio; enrolled 2003-2006). We used quantile-based g-computation to estimate associations between mixtures of urinary phthalate metabolites or serum PFAS and hair cortisol. We also examined whether associations of individual phthalate metabolites or PFAS with cortisol varied by the timing of exposure. We found that a 1-quartile increase in all childhood phthalate metabolites was associated with 35% higher adolescent hair cortisol (phthalate mixture ψ = 0.13; 95% confidence interval: 0.03, 0.22); these associations were driven by monoethyl phthalate, monoisobutyl phthalate, and monobenzyl phthalate. We did not find evidence that phthalate metabolites during gestation or serum PFAS mixtures were related to adolescent hair cortisol concentrations. We found suggestive evidence that higher childhood concentrations of individual PFAS were related to higher and lower adolescent hair cortisol concentrations. Our results suggest that phthalate exposure during childhood may contribute to higher levels of chronic HPA axis activity.
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Leader J, Mínguez-Alarcón L, Williams PL, Ford JB, Dadd R, Chagnon O, Bellinger DC, Oken E, Calafat AM, Hauser R, Braun JM. Paternal and maternal preconception and maternal pregnancy urinary phthalate metabolite and BPA concentrations in relation to child behavior. ENVIRONMENT INTERNATIONAL 2024; 183:108337. [PMID: 38088019 PMCID: PMC10868726 DOI: 10.1016/j.envint.2023.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Epidemiologic studies on health effects of parental preconception exposures are limited despite emerging evidence from toxicological studies suggesting that such exposures, including to environmental chemicals, may affect offspring health. OBJECTIVE We investigated whether maternal and paternal preconception and maternal pregnancy urinary phthalate metabolite and bisphenol A (BPA) concentrations were associated with child behavior. METHODS We analyzed data from the Preconception Environmental exposure And Childhood health Effects (PEACE) Study, an ongoing prospective cohort study of children aged 6-11 years whose parent(s) previously enrolled in the prospective preconception Environment and Reproductive Health (EARTH) study. Using linear mixed models, we estimated covariate-adjusted associations of 11 urinary phthalate metabolite and BPA concentrations collected prior to conception and during pregnancy with Behavioral Assessment System for Children-3 (BASC-3) T-scores (higher scores indicate more problem behaviors). RESULTS This analysis included 134 mothers, 87 fathers and 157 children (24 sets of twins); parents were predominantly non-Hispanic white (mothers and fathers86%). Higher maternal preconception or pregnancy monobenzyl phthalate (MBzP) concentrations were related to higher mean externalizing problems T-scores in their children (β = 1.3 per 1-loge unit increase; 95 % CI: -0.2, 2.4 and β = 2.1, 95 % CI: 0.7, 3.6, respectively). Higher maternal preconception monocarboxyoctyl phthalate (MCOP) was suggested to be related to lower mean externalizing problems T-scores (β = -0.9; 95 % CI: -1.8, 0.0). Higher paternal preconception MCOP was suggestively associated with lower internalizing problems (β = -0.9; 95 %CI:-1.9, 0.1) and lower Behavioral Symptoms Index (BSI) T-scores (β = -1.3; 95 % CI: -2.1, -0.4). CONCLUSION In this cohort, higher maternal preconception and pregnancy MBzP were associated with worse parent-reported child behavior, while higher maternal and paternal preconception MCOP concentrations were related to lower BASC-3 scores.
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Affiliation(s)
- Jordana Leader
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
| | - Paige L Williams
- Departments of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramace Dadd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olivia Chagnon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David C Bellinger
- Research Director Emeritus, Cardiac Neurodevelopment Program, Boston Children's Hospital, Boston, MA, USA; Professor of Neurology and Psychology, Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russ Hauser
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Vilcins D, Lee WR, Pham C, Tanner S, Knibbs LD, Burgner D, Blake TL, Mansell T, Ponsonby AL, Sly PD. Association of maternal air pollution exposure and infant lung function is modified by genetic propensity to oxidative stress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.13.23296994. [PMID: 37873073 PMCID: PMC10592989 DOI: 10.1101/2023.10.13.23296994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Introduction The association between air pollution and poor respiratory health outcomes is well established, however less is known about the biological mechanisms, especially in early life. Children are particularly at risk from air pollution, especially during the prenatal period as their organs and systems are still undergoing crucial development. Therefore, our study aims to investigate if maternal exposure to air pollution during pregnancy is associated with oxidative stress (OS) and inflammation in pregnancy or infant lung function at 4 weeks of age, and the extent to which the association is modified by an infant's genetic risk of OS. Methods The Barwon Infant Study (BIS) is a longitudinal study of Australian children from the region of Geelong, Victoria. A total of 314 infants had available lung function and maternal OS markers. Exposure to annual air pollutants (NO 2 and PM 2.5 ) were estimated using validated, satellite-based, land-use regression models. Infant lung function was measured by multiple-breath washout, and the ratio of peak tidal expiratory flow over expiratory time was calculated at 4 weeks of age. An inflammation biomarker, glycoprotein acetyls (GlycA), was measured in maternal (36 weeks) and cord blood, and oxidative stress (OS) biomarkers, 8-hydroxyguanine (8-OHGua) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured in maternal urine at 28 weeks. A genetic pathway score for OS (gPFS ox ) was calculated for each infant participant in the BIS cohort, and high risk defined as score >8. Linear regression was used to explore the association of maternal air pollution exposure with infant lung function, and potential modification by OS genotype was tested through use of interaction terms and other methods. Results There was no evidence of a relationship between maternal exposure to air pollution and infant lung function in the whole population. We did not find an association between air pollution and GlycA or OS during pregnancy. We found evidence of an association between NO 2 and lower in functional residual capacity (FRC) for children with a high genetic risk of OS (β=-5.3 mls, 95% CI (-9.3, -1.3), p=0.01). We also found that when NO 2 was considered in tertiles, the highest tertile of NO 2 was associated with increase in lung clearance index (LCI) (β=0.46 turnovers, (95% CI 0.10, 0.82), p=0.01) in children with a genetic propensity to OS. Conclusion Our study found that high prenatal levels of exposure to ambient NO 2 levels is associated with lower FRC and higher LCI in infants with a genetic propensity to oxidative stress. There was no relationship between maternal exposure to air pollution with maternal and cord blood inflammation or OS biomarkers.
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Munk Andreasen S, Frederiksen H, Bilenberg N, Andersson AM, Juul A, Kyhl HB, Kold Jensen T. Maternal concentrations of phthalates and Attention-Deficit Hyperactivity Disorder (ADHD-) related symptoms in children aged 2 to 4 years from Odense child cohort. ENVIRONMENT INTERNATIONAL 2023; 180:108244. [PMID: 37797478 DOI: 10.1016/j.envint.2023.108244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/11/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Phthalates are endocrine disrupting chemicals used in everyday consumer products. Several epidemiological studies have examined the association between prenatal phthalate concentration and Attention-Deficit Hyperactivity Disorder (ADHD) in offspring, but the findings have been inconclusive. OBJECTIVES To investigate the association between maternal urinary concentrations of phthalate metabolites during pregnancy and ADHD related symptoms in children at 2 to 4 years in a large prospective cohort. METHODS In the Odense Child Cohort from Denmark were women recruited in early pregnancy from 2010 to 2012. Phthalate concentrations were measured in urine samples collected in 3rd trimester and separated into low and high weight phthalates. Parents filled in the Child Behavior Checklist for ages 1.5 to 5 years (CBCL/1½-5), including a 6-item ADHD symptom scale at children aged 2 to 4 years. Data were analysed by use of adjusted negative binomial regression. RESULTS A total of 658 mother-child pairs were included. Urinary phthalate metabolite concentrations were generally low compared to previous cohorts. A doubling in maternal concentration of the low-weighted phthalate metabolite MCPP was significantly associated with lower ADHD symptoms score in children (IRR: 0.95 (95 % CI 0.91-0.98)), strongest in girls (IRR: 0.92 (0.87-0.98)). Sex differences were observed. High maternal phthalate metabolite concentrations were associated with lower ADHD symptom score in girls, significant trends across tertile of MCPP and MnBP (p = 0.018, p = 0.038, respectively). In boys, maternal concentrations of high-molecular-weight phthalates (MBzP, ∑DiNP and ∑DEHP) were associated with an almost significantly higher ADHD symptom score (IRR for a doubling in concentration: 1.04 (95 % CI: 0.99-1.10), IRR: 1.05 (95 % CI: 0.97-1.13), IRR: 1.04 (95 % CI: 0.99-1.10), respectively). CONCLUSION Maternal concentration of the low-weighted phthalate metabolite MCPP was significantly associated with a lower ADHD symptom score in children, strongest in girls. Maternal concentrations of high-molecular-weight phthalates were associated with non-significant increase in ADHD symptom score in boys.
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Affiliation(s)
- Sarah Munk Andreasen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen, Denmark
| | - Niels Bilenberg
- Department of Child and Adolescent Psychiatry, Odense, Mental Health Services in Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; OPEN Patient data Explorative Network, Odense, Denmark
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; OPEN Patient data Explorative Network, Odense, Denmark.
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Pham C, Thomson S, Chin ST, Vuillermin P, O'Hely M, Burgner D, Tanner S, Saffery R, Mansell T, Bong S, Holmes E, Sly PD, Gray N, Ponsonby AL. Maternal oxidative stress during pregnancy associated with emotional and behavioural problems in early childhood: implications for foetal programming. Mol Psychiatry 2023; 28:3760-3768. [PMID: 37845496 PMCID: PMC10730421 DOI: 10.1038/s41380-023-02284-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
Childhood mental disorders, including emotional and behavioural problems (EBP) are increasingly prevalent. Higher maternal oxidative stress (OS) during pregnancy (matOSpreg) is linked to offspring mental disorders. Environmental factors contribute to matOSpreg. However, the role of matOSpreg in childhood EBP is unclear. We investigated the associations between (i) matOSpreg and offspring EBP; (ii) social and prenatal environmental factors and matOSpreg; and (iii) social and prenatal factors and childhood EBP and evaluated whether matOSpreg mediated these associations. Maternal urinary OS biomarkers, 8-hydroxyguanosine (8-OHGua; an oxidative RNA damage marker) and 8-hydroxy-2'-deoxyguanosine (8-OHdG; an oxidative DNA damage marker), at 36 weeks of pregnancy were quantified by liquid chromatography-mass spectrometry in a population-derived birth cohort, Barwon Infant Study (n = 1074 mother-infant pairs). Social and prenatal environmental factors were collected by mother-reported questionnaires. Offspring total EBP was measured by Child Behavior Checklist Total Problems T-scores at age two (n = 675) and Strengths and Difficulties Questionnaire Total Difficulties score at age four (n = 791). Prospective associations were examined by multivariable regression analyses adjusted for covariates. Mediation effects were evaluated using counterfactual-based mediation analysis. Higher maternal urinary 8-OHGua at 36 weeks (mat8-OHGua36w) was associated with greater offspring total EBP at age four (β = 0.38, 95% CI (0.07, 0.69), P = 0.02) and age two (β = 0.62, 95% CI (-0.06, 1.30), P = 0.07). Weaker evidence of association was detected for 8-OHdG. Five early-life factors were associated with both mat8-OHGua36w and childhood EBP (P-range < 0.001-0.05), including lower maternal education, socioeconomic disadvantage and prenatal tobacco smoking. These risk factor-childhood EBP associations were partly mediated by higher mat8-OHGua36w (P-range = 0.01-0.05). Higher matOSpreg, particularly oxidant RNA damage, is associated with later offspring EBP. Effects of some social and prenatal lifestyle factors on childhood EBP were partly mediated by matOSpreg. Future studies are warranted to further elucidate the role of early-life oxidant damage in childhood EBP.
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Affiliation(s)
- Cindy Pham
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
- Florey Institute, University of Melbourne, Parkville, VIC, 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sarah Thomson
- Florey Institute, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sung-Tong Chin
- Australian National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, VIC, 3220, Australia
| | - Martin O'Hely
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Samuel Tanner
- Florey Institute, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sze Bong
- Australian National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Elaine Holmes
- Australian National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Peter D Sly
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
- Child Health Research Centre, University of Queensland, South Brisbane, QLD, 4101, Australia
| | - Nicola Gray
- Australian National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia.
- Florey Institute, University of Melbourne, Parkville, VIC, 3052, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3052, Australia.
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Hall AM, Keil AP, Choi G, Ramos AM, Richardson DB, Olshan AF, Martin CL, Villanger GD, Reichborn-Kjennerud T, Zeiner P, Øvergaard KR, Sakhi AK, Thomsen C, Aase H, Engel SM. Prenatal organophosphate ester exposure and executive function in Norwegian preschoolers. Environ Epidemiol 2023; 7:e251. [PMID: 37304339 PMCID: PMC10256412 DOI: 10.1097/ee9.0000000000000251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Organophosphate esters (OPEs) are ubiquitous chemicals, used as flame retardants and plasticizers. OPE usage has increased over time as a substitute for other controlled compounds. This study investigates the impact of prenatal OPE exposure on executive function (EF) in preschoolers. Methods We selected 340 preschoolers from the Norwegian Mother, Father, and Child Cohort Study. Diphenyl-phosphate (DPhP), di-n-butyl-phosphate (DnBP), bis(2-butoxyethyl) phosphate (BBOEP), and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) were measured in maternal urine. EF was measured using the Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P) and the Stanford-Binet fifth edition (SB-5). EF scores were scaled so a higher score indicated worse performance. We estimated exposure-outcome associations and evaluated modification by child sex using linear regression. Results Higher DnBP was associated with lower EF scores across multiple rater-based domains. Higher DPhP and BDCIPP were associated with lower SB-5 verbal working memory (β = 0.49, 95% CI = 0.12, 0.87; β = 0.53, 95% CI = 0.08, 1.02), and higher BBOEP was associated with lower teacher-rated inhibition (β = 0.34, 95% CI = 0.01, 0.63). DPhP was associated with lower parent-reported BRIEF-P measures in boys but not girls [inhibition: boys: 0.37 (95% CI = 0.03, 0.93); girls: -0.48 (95% CI = -1.27, 0.19); emotional control: boys: 0.44 (95% CI = -0.13, 1.26); girls: -0.83 (95% CI = -1.73, -0.00); working memory: boys: 0.49 (95% CI = 0.03, 1.08); girls: -0.40 (95% CI = -1.11, 0.36)]. Fewer sex interactions were observed for DnBP, BBOEP, and BDCIPP, with irregular patterns observed across EF domains. Conclusions We found some evidence prenatal OPE exposure may impact EF in preschoolers and variation in associations by sex.
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Affiliation(s)
- Amber M. Hall
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexander P. Keil
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Giehae Choi
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Amanda M. Ramos
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David B. Richardson
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chantel L. Martin
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gro D. Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Zeiner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin R. Øvergaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Amrit K. Sakhi
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M. Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Ramos AM, Herring AH, Villanger GD, Thomsen C, Sakhi AK, Cequier E, Aase H, Engel SM. The association of prenatal phthalates, organophosphorous pesticides, and organophosphate esters with early child language ability in Norway. ENVIRONMENTAL RESEARCH 2023; 225:115508. [PMID: 36813071 PMCID: PMC10071760 DOI: 10.1016/j.envres.2023.115508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides have been associated with neurodevelopmental deficits including language ability, however, few studies consider the effect of exposure mixtures and the potential longitudinal detriments over time. OBJECTIVE This study examines the influence of prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides, on children's language ability from toddlerhood to the preschool period. METHODS This study includes 299 mother-child dyads from Norway in the Norwegian Mother, Father and Child Cohort Study (MoBa). Prenatal exposure to chemicals were assessed at 17 weeks' gestation, and child language skills were assessed at 18 months using the Ages and Stages Questionnaire communication subscale and at preschool age using the Child Development Inventory. We ran two structural equation models to examine the simultaneous influences of chemical exposures on parent-reported and teacher-reported child language ability. RESULTS Prenatal organophosphorous pesticides were negatively associated with preschool language ability through language ability at 18 months. Additionally, there was a negative association between low molecular weight phthalates and teacher-reported preschool language ability. There was no effect of prenatal organophosphate esters on child language ability at either 18 months or preschool age. CONCLUSIONS This study adds to the literature on prenatal exposure to chemicals and neurodevelopment and highlights the importance of developmental pathways in early childhood.
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Affiliation(s)
- Amanda M Ramos
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Amy H Herring
- Department of Statistical Science, Global Health, Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Gro D Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Environmental Health, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Amrit K Sakhi
- Department of Environmental Health, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Enrique Cequier
- Department of Environmental Health, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Landrigan PJ, Raps H, Cropper M, Bald C, Brunner M, Canonizado EM, Charles D, Chiles TC, Donohue MJ, Enck J, Fenichel P, Fleming LE, Ferrier-Pages C, Fordham R, Gozt A, Griffin C, Hahn ME, Haryanto B, Hixson R, Ianelli H, James BD, Kumar P, Laborde A, Law KL, Martin K, Mu J, Mulders Y, Mustapha A, Niu J, Pahl S, Park Y, Pedrotti ML, Pitt JA, Ruchirawat M, Seewoo BJ, Spring M, Stegeman JJ, Suk W, Symeonides C, Takada H, Thompson RC, Vicini A, Wang Z, Whitman E, Wirth D, Wolff M, Yousuf AK, Dunlop S. The Minderoo-Monaco Commission on Plastics and Human Health. Ann Glob Health 2023; 89:23. [PMID: 36969097 PMCID: PMC10038118 DOI: 10.5334/aogh.4056] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Plastics have conveyed great benefits to humanity and made possible some of the most significant advances of modern civilization in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that plastics are also responsible for significant harms to human health, the economy, and the earth's environment. These harms occur at every stage of the plastic life cycle, from extraction of the coal, oil, and gas that are its main feedstocks through to ultimate disposal into the environment. The extent of these harms not been systematically assessed, their magnitude not fully quantified, and their economic costs not comprehensively counted. Goals The goals of this Minderoo-Monaco Commission on Plastics and Human Health are to comprehensively examine plastics' impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations-the poor, minorities, and the world's children. On the basis of this examination, the Commission offers science-based recommendations designed to support development of a Global Plastics Treaty, protect human health, and save lives. Report Structure This Commission report contains seven Sections. Following an Introduction, Section 2 presents a narrative review of the processes involved in plastic production, use, and disposal and notes the hazards to human health and the environment associated with each of these stages. Section 3 describes plastics' impacts on the ocean and notes the potential for plastic in the ocean to enter the marine food web and result in human exposure. Section 4 details plastics' impacts on human health. Section 5 presents a first-order estimate of plastics' health-related economic costs. Section 6 examines the intersection between plastic, social inequity, and environmental injustice. Section 7 presents the Commission's findings and recommendations. Plastics Plastics are complex, highly heterogeneous, synthetic chemical materials. Over 98% of plastics are produced from fossil carbon- coal, oil and gas. Plastics are comprised of a carbon-based polymer backbone and thousands of additional chemicals that are incorporated into polymers to convey specific properties such as color, flexibility, stability, water repellence, flame retardation, and ultraviolet resistance. Many of these added chemicals are highly toxic. They include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, per- and poly-fluoroalkyl substances (PFAS), brominated flame retardants, and organophosphate flame retardants. They are integral components of plastic and are responsible for many of plastics' harms to human health and the environment.Global plastic production has increased almost exponentially since World War II, and in this time more than 8,300 megatons (Mt) of plastic have been manufactured. Annual production volume has grown from under 2 Mt in 1950 to 460 Mt in 2019, a 230-fold increase, and is on track to triple by 2060. More than half of all plastic ever made has been produced since 2002. Single-use plastics account for 35-40% of current plastic production and represent the most rapidly growing segment of plastic manufacture.Explosive recent growth in plastics production reflects a deliberate pivot by the integrated multinational fossil-carbon corporations that produce coal, oil and gas and that also manufacture plastics. These corporations are reducing their production of fossil fuels and increasing plastics manufacture. The two principal factors responsible for this pivot are decreasing global demand for carbon-based fuels due to increases in 'green' energy, and massive expansion of oil and gas production due to fracking.Plastic manufacture is energy-intensive and contributes significantly to climate change. At present, plastic production is responsible for an estimated 3.7% of global greenhouse gas emissions, more than the contribution of Brazil. This fraction is projected to increase to 4.5% by 2060 if current trends continue unchecked. Plastic Life Cycle The plastic life cycle has three phases: production, use, and disposal. In production, carbon feedstocks-coal, gas, and oil-are transformed through energy-intensive, catalytic processes into a vast array of products. Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastic. Single-use plastics constitute the largest portion of current use, followed by synthetic fibers and construction.Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. The result is that an estimated 22 Mt of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950. Strategies for disposal of plastic waste include controlled and uncontrolled landfilling, open burning, thermal conversion, and export. Vast quantities of plastic waste are exported each year from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health-environmental injustice on a global scale. Plastic-laden e-waste is particularly problematic. Environmental Findings Plastics and plastic-associated chemicals are responsible for widespread pollution. They contaminate aquatic (marine and freshwater), terrestrial, and atmospheric environments globally. The ocean is the ultimate destination for much plastic, and plastics are found throughout the ocean, including coastal regions, the sea surface, the deep sea, and polar sea ice. Many plastics appear to resist breakdown in the ocean and could persist in the global environment for decades. Macro- and micro-plastic particles have been identified in hundreds of marine species in all major taxa, including species consumed by humans. Trophic transfer of microplastic particles and the chemicals within them has been demonstrated. Although microplastic particles themselves (>10 µm) appear not to undergo biomagnification, hydrophobic plastic-associated chemicals bioaccumulate in marine animals and biomagnify in marine food webs. The amounts and fates of smaller microplastic and nanoplastic particles (MNPs <10 µm) in aquatic environments are poorly understood, but the potential for harm is worrying given their mobility in biological systems. Adverse environmental impacts of plastic pollution occur at multiple levels from molecular and biochemical to population and ecosystem. MNP contamination of seafood results in direct, though not well quantified, human exposure to plastics and plastic-associated chemicals. Marine plastic pollution endangers the ocean ecosystems upon which all humanity depends for food, oxygen, livelihood, and well-being. Human Health Findings Coal miners, oil workers and gas field workers who extract fossil carbon feedstocks for plastic production suffer increased mortality from traumatic injury, coal workers' pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. Plastic production workers are at increased risk of leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast cancer, mesothelioma, neurotoxic injury, and decreased fertility. Workers producing plastic textiles die of bladder cancer, lung cancer, mesothelioma, and interstitial lung disease at increased rates. Plastic recycling workers have increased rates of cardiovascular disease, toxic metal poisoning, neuropathy, and lung cancer. Residents of "fenceline" communities adjacent to plastic production and waste disposal sites experience increased risks of premature birth, low birth weight, asthma, childhood leukemia, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.During use and also in disposal, plastics release toxic chemicals including additives and residual monomers into the environment and into people. National biomonitoring surveys in the USA document population-wide exposures to these chemicals. Plastic additives disrupt endocrine function and increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancers. Chemical-laden MNPs formed through the environmental degradation of plastic waste can enter living organisms, including humans. Emerging, albeit still incomplete evidence indicates that MNPs may cause toxicity due to their physical and toxicological effects as well as by acting as vectors that transport toxic chemicals and bacterial pathogens into tissues and cells.Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children's unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life. Economic Findings Plastic's harms to human health result in significant economic costs. We estimate that in 2015 the health-related costs of plastic production exceeded $250 billion (2015 Int$) globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion (2015 Int$). Plastic production results in greenhouse gas (GHG) emissions equivalent to 1.96 gigatons of carbon dioxide (CO2e) annually. Using the US Environmental Protection Agency's (EPA) social cost of carbon metric, we estimate the annual costs of these GHG emissions to be $341 billion (2015 Int$).These costs, large as they are, almost certainly underestimate the full economic losses resulting from plastics' negative impacts on human health and the global environment. All of plastics' economic costs-and also its social costs-are externalized by the petrochemical and plastic manufacturing industry and are borne by citizens, taxpayers, and governments in countries around the world without compensation. Social Justice Findings The adverse effects of plastics and plastic pollution on human health, the economy and the environment are not evenly distributed. They disproportionately affect poor, disempowered, and marginalized populations such as workers, racial and ethnic minorities, "fenceline" communities, Indigenous groups, women, and children, all of whom had little to do with creating the current plastics crisis and lack the political influence or the resources to address it. Plastics' harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North. Social and environmental justice (SEJ) principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics' negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs. Conclusions It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices.The main driver of these worsening harms is an almost exponential and still accelerating increase in global plastic production. Plastics' harms are further magnified by low rates of recovery and recycling and by the long persistence of plastic waste in the environment.The thousands of chemicals in plastics-monomers, additives, processing agents, and non-intentionally added substances-include amongst their number known human carcinogens, endocrine disruptors, neurotoxicants, and persistent organic pollutants. These chemicals are responsible for many of plastics' known harms to human and planetary health. The chemicals leach out of plastics, enter the environment, cause pollution, and result in human exposure and disease. All efforts to reduce plastics' hazards must address the hazards of plastic-associated chemicals. Recommendations To protect human and planetary health, especially the health of vulnerable and at-risk populations, and put the world on track to end plastic pollution by 2040, this Commission supports urgent adoption by the world's nations of a strong and comprehensive Global Plastics Treaty in accord with the mandate set forth in the March 2022 resolution of the United Nations Environment Assembly (UNEA).International measures such as a Global Plastics Treaty are needed to curb plastic production and pollution, because the harms to human health and the environment caused by plastics, plastic-associated chemicals and plastic waste transcend national boundaries, are planetary in their scale, and have disproportionate impacts on the health and well-being of people in the world's poorest nations. Effective implementation of the Global Plastics Treaty will require that international action be coordinated and complemented by interventions at the national, regional, and local levels.This Commission urges that a cap on global plastic production with targets, timetables, and national contributions be a central provision of the Global Plastics Treaty. We recommend inclusion of the following additional provisions:The Treaty needs to extend beyond microplastics and marine litter to include all of the many thousands of chemicals incorporated into plastics.The Treaty needs to include a provision banning or severely restricting manufacture and use of unnecessary, avoidable, and problematic plastic items, especially single-use items such as manufactured plastic microbeads.The Treaty needs to include requirements on extended producer responsibility (EPR) that make fossil carbon producers, plastic producers, and the manufacturers of plastic products legally and financially responsible for the safety and end-of-life management of all the materials they produce and sell.The Treaty needs to mandate reductions in the chemical complexity of plastic products; health-protective standards for plastics and plastic additives; a requirement for use of sustainable non-toxic materials; full disclosure of all components; and traceability of components. International cooperation will be essential to implementing and enforcing these standards.The Treaty needs to include SEJ remedies at each stage of the plastic life cycle designed to fill gaps in community knowledge and advance both distributional and procedural equity.This Commission encourages inclusion in the Global Plastic Treaty of a provision calling for exploration of listing at least some plastic polymers as persistent organic pollutants (POPs) under the Stockholm Convention.This Commission encourages a strong interface between the Global Plastics Treaty and the Basel and London Conventions to enhance management of hazardous plastic waste and slow current massive exports of plastic waste into the world's least-developed countries.This Commission recommends the creation of a Permanent Science Policy Advisory Body to guide the Treaty's implementation. The main priorities of this Body would be to guide Member States and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste. This Body could also assess trade-offs among these solutions and evaluate safer alternatives to current plastics. It could monitor the transnational export of plastic waste. It could coordinate robust oceanic-, land-, and air-based MNP monitoring programs.This Commission recommends urgent investment by national governments in research into solutions to the global plastic crisis. This research will need to determine which solutions are most effective and cost-effective in the context of particular countries and assess the risks and benefits of proposed solutions. Oceanographic and environmental research is needed to better measure concentrations and impacts of plastics <10 µm and understand their distribution and fate in the global environment. Biomedical research is needed to elucidate the human health impacts of plastics, especially MNPs. Summary This Commission finds that plastics are both a boon to humanity and a stealth threat to human and planetary health. Plastics convey enormous benefits, but current linear patterns of plastic production, use, and disposal that pay little attention to sustainable design or safe materials and a near absence of recovery, reuse, and recycling are responsible for grave harms to health, widespread environmental damage, great economic costs, and deep societal injustices. These harms are rapidly worsening.While there remain gaps in knowledge about plastics' harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these impacts are great and that they will increase in severity in the absence of urgent and effective intervention at global scale. Manufacture and use of essential plastics may continue. However, reckless increases in plastic production, and especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, need to be curbed.Global intervention against the plastic crisis is needed now because the costs of failure to act will be immense.
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Affiliation(s)
- Philip J. Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Hervé Raps
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Maureen Cropper
- Economics Department, University of Maryland, College Park, US
| | - Caroline Bald
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | | | | | | | | | | | - Patrick Fenichel
- Université Côte d’Azur
- Centre Hospitalier, Universitaire de Nice, FR
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | | | | | | | - Carly Griffin
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Mark E. Hahn
- Biology Department, Woods Hole Oceanographic Institution, US
- Woods Hole Center for Oceans and Human Health, US
| | - Budi Haryanto
- Department of Environmental Health, Universitas Indonesia, ID
- Research Center for Climate Change, Universitas Indonesia, ID
| | - Richard Hixson
- College of Medicine and Health, University of Exeter, UK
| | - Hannah Ianelli
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Bryan D. James
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution
- Department of Biology, Woods Hole Oceanographic Institution, US
| | | | - Amalia Laborde
- Department of Toxicology, School of Medicine, University of the Republic, UY
| | | | - Keith Martin
- Consortium of Universities for Global Health, US
| | - Jenna Mu
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | - Adetoun Mustapha
- Nigerian Institute of Medical Research, Lagos, Nigeria
- Lead City University, NG
| | - Jia Niu
- Department of Chemistry, Boston College, US
| | - Sabine Pahl
- University of Vienna, Austria
- University of Plymouth, UK
| | | | - Maria-Luiza Pedrotti
- Laboratoire d’Océanographie de Villefranche sur mer (LOV), Sorbonne Université, FR
| | | | | | - Bhedita Jaya Seewoo
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
| | | | - John J. Stegeman
- Biology Department and Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | - William Suk
- Superfund Research Program, National Institutes of Health, National Institute of Environmental Health Sciences, US
| | | | - Hideshige Takada
- Laboratory of Organic Geochemistry (LOG), Tokyo University of Agriculture and Technology, JP
| | | | | | - Zhanyun Wang
- Technology and Society Laboratory, WEmpa-Swiss Federal Laboratories for Materials and Technology, CH
| | - Ella Whitman
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | | | - Aroub K. Yousuf
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Sarah Dunlop
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
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14
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Hall AM, Ramos AM, Drover SS, Choi G, Keil AP, Richardson DB, Martin CL, Olshan AF, Villanger GD, Reichborn-Kjennerud T, Zeiner P, Øvergaard KR, Sakhi AK, Thomsen C, Aase H, Engel SM. Gestational organophosphate ester exposure and preschool attention-deficit/hyperactivity disorder in the Norwegian Mother, Father, and Child cohort study. Int J Hyg Environ Health 2023; 248:114078. [PMID: 36455478 PMCID: PMC9898152 DOI: 10.1016/j.ijheh.2022.114078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity-disorder (ADHD) is a leading neurodevelopmental disorder in children worldwide; however, few modifiable risk factors have been identified. Organophosphate esters (OPEs) are ubiquitous chemical compounds that are increasingly prevalent as a replacement for other regulated chemicals. Current research has linked OPEs to neurodevelopmental deficits. The purpose of this study was to assess gestational OPE exposure on clinically-assessed ADHD in children at age 3 years. METHODS In this nested case-control study within the Norwegian Mother, Father, and Child Cohort study, we evaluated the impact of OPE exposure at 17 weeks' gestation on preschool-age ADHD. Between 2007 and 2011, 260 ADHD cases were identified using the Preschool Age Psychiatric Assessment and compared to a birth-year-stratified control group of 549 children. We categorized bis(2-butoxyethyl) phosphate (BBOEP) and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) as values < limit of detection (LOD) (BBOEP N = 386, BDCIPP N = 632), ≥LOD but < limit of quantification (LOQ) (BBOEP N = 413; BDCIPP N = 75), or above LOQ (BBOEP N = 70; BDCIPP N = 102). Diphenyl phosphate (DPhP) and di-n-butyl phosphate (DnBP) were categorized as quartiles and also modeled with a log10 linear term. We estimated multivariable adjusted odds ratios (ORs) using logistic regression and examined modification by sex using an augmented product term approach. RESULTS Mothers in the 3rd DnBP quartile had 1.71 times the odds of having a child with ADHD compared to the 1st quartile (95%CI: 1.13, 2.58); a similar trend was observed for log10 DnBP and ADHD. Mothers with BDCIPP ≥ LOD but < LOQ had 1.39 times the odds of having a child with ADHD compared to those with BDCIPP < LOD (95%CI: 0.83, 2.31). Girls had lower odds of ADHD with increasing BBOEP exposure (log10 OR: 0.55 (95%CI: 0.37, 0.93), however boys had a weakly increased odds (log10 OR: 1.25 (95%CI: 0.74, 2.11) p-interaction = 0.01]. CONCLUSIONS We found modest increased odds of preschool ADHD with higher DnBP and BDCIPP exposure.
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Affiliation(s)
- Amber M Hall
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Amanda M Ramos
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Samantha Sm Drover
- Department of Public Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Giehae Choi
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Chantel L Martin
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gro D Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Mental Disorders, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin R Øvergaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Amrit K Sakhi
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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15
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Tsai TL, Hsieh CJ, Wu MT, Chen ML, Kuo PH, Wang SL. Co-exposure to toxic metals and phthalates in pregnant women and their children's mental health problems aged four years - Taiwan Maternal and Infant Cohort Study (TMICS). ENVIRONMENT INTERNATIONAL 2023; 173:107804. [PMID: 36842379 DOI: 10.1016/j.envint.2023.107804] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Childhood and adolescent mental health problems may increase the global burden of disease. Neurotoxic metals are associated with inflammation and cytotoxicity in the brain. In addition, prenatal phthalate ester (PAE) exposure is associated with cognitive function deficits. However, the effect of co-exposure to toxic metals, PAEs, and their association with child behavior is less well studied. Hence, we aimed to investigate prenatal co-exposure to the metals and PAEs and the consequent behavioral outcomes in early childhood. METHODS We followed pregnant women and their newborns from the Taiwan Maternal and Infant Cohort Study between 2015 and 2017, with a focus on women from the central, southern, and eastern areas of Taiwan. We quantified maternal urinary concentrations of metals and metabolites of PAEs as surrogates of prenatal exposure. We recorded the Child Behavior Checklist scores according to caregiver reports at 4 years of age, and identified Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-oriented problems. RESULTS Ultimately, 408 children were included in the statistical analysis. Maternal urinary copper levels were significantly associated with depressive problems (odds ratio [OR] = 2.13) in children. Maternal urinary concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP) were also significantly associated with depressive symptoms (odds ratio [OR] = 1.51 and 1.53, respectively). Further analysis considering prenatal co-exposure to metals and PAEs showed that co-exposure to these materials was significantly associated with autism spectrum problems (OR = 3.11). CONCLUSIONS We observed that prenatal single exposure or co-exposure to metals and PAEs may play a role in some DSM-5-oriented problems in children at 4 years of age. Reduction of exposure to toxic metals and PAEs in pregnancy is suggested to prevent increased mental health problems in children.
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Affiliation(s)
- Tsung-Lin Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Ming-Tsang Wu
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan; Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan.
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16
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Oh J, Kim K, Kannan K, Parsons PJ, Mlodnicka A, Schmidt RJ, Schweitzer JB, Hertz-Picciotto I, Bennett DH. Early childhood exposure to environmental phenols and parabens, phthalates, organophosphate pesticides, and trace elements in association with attention deficit hyperactivity disorder (ADHD) symptoms in the CHARGE study. RESEARCH SQUARE 2023:rs.3.rs-2565914. [PMID: 36798220 PMCID: PMC9934759 DOI: 10.21203/rs.3.rs-2565914/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Background Agrowing body of literature investigated childhood exposure to environmental chemicals in association with attention deficit hyperactivity disorder (ADHD) symptoms, but limited studies considered urinary mixtures of multiple chemical classes. This study examined associations of concurrent exposure to non-persistent chemicals with ADHD symptoms in children diagnosed with autism spectrum disorder (ASD), developmental delay, and typical development. Methods A total of 574 children aged 2-5 years from the Childhood Autism Risks from Genetics and Environment (CHARGE) case-control study was administered the Aberrant Behavior Checklist (ABC). This study focused on the Hyperactivity subscale and its two subdomains (hyperactivity/impulsivity, inattention). Sixty-two chemicals from four classes (phenols/parabens, phthalates, organophosphate pesticides, trace elements) were quantified in child urine samples, and 43 chemicals detected in >70% samples were used in statistical analyses. Weighted quantile sum regression for negative binomial outcomes with repeated holdout validation was performed to investigate covariate-adjusted associations between mixtures and ABC scores in 574 children. The mixture analyses were further restricted to 232 children with ASD. Results Phthalate metabolite mixtures, weighted for mono-n-butylphthalate (MNBP), mono-2-heptyl phthalate, and mono-carboxy isononyl phthalate, were associated with the Hyperactivity subscale (mean incidence rate ratio [mIRR] = 1.11; 2.5th, 97.5th percentile: 1.00, 1.23), especially the hyperactivity/impulsivity subdomain (mIRR = 1.14; 2.5th, 97.5th percentile: 1.06, 1.26). These associations remained similar after restricting to children with ASD. The inattention subdomain was associated with a phenols/parabens mixture, weighted for several parabens and bisphenols (mIRR = 1.13; 2.5th, 97.5th percentile: 1.00, 1.28) and a total mixture, weighted for 3,4-dihydroxy benzoic acid, MNBR and mono-(2-ethyl-5-carboxypentyl) phthalate (mIRR = 1.11; 2.5th, 97.5th percentile: 1.01,1.25) only among children with ASD. Conclusions Concurrent exposure to phthalate mixtures was associated with hyperactivity in early childhood. Though causal inference cannot be made based on our cross-sectional findings, this study warrants further research on mixtures of larger number of chemicals from multiple classes in association with ADHD-related behaviors in young children.
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Endocrine Disruptor Chemicals and Children's Health. Int J Mol Sci 2023; 24:ijms24032671. [PMID: 36768991 PMCID: PMC9916521 DOI: 10.3390/ijms24032671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
We are all exposed to endocrine-disrupting chemicals (EDCs) starting from embryonic life. The fetus and child set up crucial developmental processes allowing adaptation to the environment throughout life: they are extremely sensitive to very low doses of hormones and EDCs because they are developing organisms. Considering the developmental origin of well-being and diseases, every adult organism expresses consequences of the environment in which it developed. The molecular mechanisms through which the main EDCs manifest their effects and their potential association with endocrine disorders, such as diabetes, obesity, thyroid disease and alteration of adrenal hormones, will be reviewed here. Despite 40 years having passed since the first study on EDCs, little is yet known about them; therefore, our purpose is to take stock of the situation to establish a starting point for further studies. Since there is plenty of evidence showing that exposure to EDCs may adversely impact the health of adults and children through altered endocrine function-suggesting their link to endocrinopathies-it is essential in this context to bear in mind what is already known about endocrine disruptors and to deepen our knowledge to establish rules of conduct aimed at limiting exposure to EDCs' negative effects. Considering that during the COVID-19 pandemic an increase in endocrine disruptor effects has been reported, it will also be useful to address this new phenomenon for better understanding its basis and limiting its consequences.
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18
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Eisner A, Gao Y, Collier F, Drummond K, Thomson S, Burgner D, Vuillermin P, Tang ML, Mueller J, Symeonides C, Saffery R, Ponsonby AL. Cord blood immune profile: Associations with higher prenatal plastic chemical levels. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 315:120332. [PMID: 36195195 DOI: 10.1016/j.envpol.2022.120332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Prenatal exposure to plastic chemicals has been associated with alterations to early-life immune function in children. However, previous studies have generally been small and focused on limited repertoires of immune indices. In a large population-based pre-birth cohort (n = 1074), third-trimester measurements of eight phthalate metabolites and three analogues of bisphenols were used to estimate prenatal exposure to phthalate and bisphenol compounds. In cord blood, immune cell populations were measured by flow cytometry and an extensive panel of cytokines and chemokines were measured by multiplex immunoassay. We used these cord blood analytes to estimate "early life" immune profiles. The full study sample comprises data from 774 infants with prenatal plastic metabolite measurements and any cord blood immune data. Multiple linear regression analysis was used to evaluate whether prenatal phthalate and bisphenol exposure was prospectively associated with cord blood immune cell populations and cytokine and chemokine levels. Generally, inverse associations were observed between prenatal phthalate exposure and cord blood immune indices. Higher exposure to di-n-butyl phthalate was associated with lower cord blood levels of platelet-derived growth factor (PDGF) and interferon gamma-induced protein 10 (IP-10); higher exposure to the sum of dibutyl phthalates was associated with lower cord blood levels of IP-10; and higher exposure to benzyl butyl phthalate was associated with lower cord blood levels of interleukin 1 beta (IL-1β). There was less evidence of associations between bisphenols and cord blood immune indices. These results extend previous work examining prenatal plastic chemical exposure and early-life immune development and highlight the importance of further examination of potential associations with health-related outcomes.
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Affiliation(s)
- Alex Eisner
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Yuan Gao
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia
| | - Fiona Collier
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia
| | - Katherine Drummond
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Sarah Thomson
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Vuillermin
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi Lk Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia; Melbourne University, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Queensland, Australia
| | - Christos Symeonides
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia; The Minderoo Foundation, Perth, Western Australia, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
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Hall AM, Thistle JE, Manley CK, Roell KR, Ramos AM, Villanger GD, Reichborn-Kjennerud T, Zeiner P, Cequier E, Sakhi AK, Thomsen C, Aase H, Engel SM. Organophosphorus Pesticide Exposure at 17 Weeks' Gestation and Odds of Offspring Attention-Deficit/Hyperactivity Disorder Diagnosis in the Norwegian Mother, Father, and Child Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16851. [PMID: 36554732 PMCID: PMC9778918 DOI: 10.3390/ijerph192416851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Prenatal organophosphorus pesticides (OPs) are ubiquitous and have been linked to adverse neurodevelopmental outcomes. However, few studies have examined prenatal OPs in relation to diagnosed attention-deficit/hyperactivity disorder (ADHD), with only two studies exploring this relationship in a population primarily exposed through diet. In this study, we used a nested case-control study to evaluate prenatal OP exposure and ADHD diagnosis in the Norwegian Mother, Father, and Child Cohort Study (MoBa). For births that occurred between 2003 and 2008, ADHD diagnoses were obtained from linkage of MoBa participants with the Norwegian Patient Registry (N = 297), and a reference population was randomly selected from the eligible population (N = 552). Maternal urine samples were collected at 17 weeks' gestation and molar sums of diethyl phosphates (ΣDEP) and dimethyl phosphates metabolites (ΣDMP) were calculated. Multivariable adjusted logistic regression models were used to estimate the association between prenatal OP metabolite exposure and child ADHD diagnosis. Additionally, multiplicative effect measure modification (EMM) by child sex was assessed. In most cases, mothers in the second and third tertiles of ΣDMP and ΣDEP exposure had slightly lower odds of having a child with ADHD, although confidence intervals were wide and included the null. EMM by child sex was not observed for either ΣDMP or ΣDEP. In summary, we did not find evidence that OPs at 17 weeks' gestation increased the odds of ADHD in this nested case-control study of ADHD in MoBa, a population primarily experiencing dietary exposure.
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Affiliation(s)
- Amber M. Hall
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jake E. Thistle
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Cherrel K. Manley
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kyle R. Roell
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amanda M. Ramos
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gro D. Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
- Department of Mental Disorders, Division of Mental and Physical Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Pål Zeiner
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Enrique Cequier
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Amrit K. Sakhi
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Cathrine Thomsen
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Stephanie M. Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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20
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Liu X, Adamo AM, Oteiza PI. Di-2-ethylhexyl phthalate affects zinc metabolism and neurogenesis in the developing rat brain. Arch Biochem Biophys 2022; 727:109351. [PMID: 35841924 DOI: 10.1016/j.abb.2022.109351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/28/2022]
Abstract
We previously observed that developmental marginal zinc deficiency affects neurogenesis. Maternal phthalate exposure could disrupt fetal zinc homeostasis by triggering an acute phase response, causing maternal liver zinc retention that limits zinc availability to the fetus. Thus, we currently investigated whether exposure to di-2-ethylhexyl phthalate (DEHP) during gestation in rats alters fetal brain neurogenesis by impairing zinc homeostasis. Dams consumed an adequate (25 μg zinc/g diet) (C) or a marginal zinc deficient (MZD) (10 μg zinc/g diet) diet, without or with DEHP (300 mg/kg BW) (C + DEHP, MZD + DEHP) from embryonic day (E) 0 to E19. To evaluate neurogenesis we measured parameters of neural progenitor cells (NPC) proliferation and differentiation. Maternal exposure to DEHP and/or zinc deficiency lowered fetal brain cortical tissue (CT) zinc concentrations. Transcription factors involved in NPC proliferation (PAX6, SOX2, EMX1), differentiation (TBR2, TBR1) and mature neurons (NeuN) were lower in MZD, MZD + DEHP and C + DEHP than in C E19 brain CT, being the lowest in the MZD + DEHP group. VGLUT1 levels, a marker of glutamatergic neurons, showed a similar pattern. Levels of a marker of GABAergic neurons, GAD65, did not vary among groups. Phosphorylated ERK1/2 levels were reduced by both MZD and DEHP, and particularly in the MZD + DEHP group. MEHP-treated human neuroblastoma IMR-32 cells and E19 brains from DEHP-treated dams showed that the zinc-regulated phosphatase PP2A can be in part responsible for DEHP-mediated ERK1/2 downregulation and impaired neurogenesis. Overall, gestational exposure to DEHP caused secondary zinc deficiency and impaired neurogenesis. These harmful effects could have long-term consequences on the adult offspring brain structure and function.
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Affiliation(s)
- Xiuzhen Liu
- Department of Nutrition, University of California, Davis, Davis, CA, USA; Department of Environmental Toxicology, University of California, Davis, Davis, CA, USA
| | - Ana M Adamo
- Departamento de Química Biológica and IQUIFIB (UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Patricia I Oteiza
- Department of Nutrition, University of California, Davis, Davis, CA, USA; Department of Environmental Toxicology, University of California, Davis, Davis, CA, USA.
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Medical devices as a source of phthalate exposure: a review of current knowledge and alternative solutions. Arh Hig Rada Toksikol 2022; 73:179-190. [PMID: 36226817 PMCID: PMC9837533 DOI: 10.2478/aiht-2022-73-3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022] Open
Abstract
Phthalates are a group of phthalic acid esters used as plasticisers in a large number of products to improve their flexibility, softness, and extensibility. Their wide use in medical devices, however, raises a lot of concern, as they can enter the organism and have toxic effects on human liver, thyroid, kidneys, lungs, reproductive, endocrine, nervous, and respiratory system and are associated with asthma, obesity, autism, and diabetes. The aim of this review is to summarise current knowledge about phthalate migration from medical devices during different medical procedures and possible impact on patient health. It also looks at alternative plasticisers with supposedly lower migration rates and safer profile. Not enough is known about which and how many phthalates make part of medical devices or about the health impacts of alternative plasticisers or their migration rates.
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Zhang Y, Li X, Zhang H, Liu W, Liu Y, Guo C, Xu J, Wu F. Distribution, source apportionment and health risk assessment of phthalate esters in outdoor dust samples on Tibetan Plateau, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155103. [PMID: 35398431 DOI: 10.1016/j.scitotenv.2022.155103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
The urbanization of Tibetan Plateau (TP) probably results in a significant contamination of organic pollutants in the area, such as phthalate esters (PAEs). However, there is a lack of monitoring and evaluation of their occurrence and risks in the outdoor dust on TP. This study for the first time investigated the concentrations, distributions and health risk of PAEs in outdoor dust samples on TP, China. A total of 132 outdoor dust samples were collected from five different functional areas, and results showed the ubiquitous detection of all PAEs in the samples. The Σ6PAEs concentrations ranged from 0.08 to 31.49 μg·g-1 with a mean of 3.57 μg·g-1. High concentrations of Σ6PAEs in the outdoor dust were found in commercial districts, which were attributed to the heavy use of PAEs in the public commerce such as consumer products, commodities, and building materials. Di-n-butyl phthalate (DBP) and bis(2-ethylhexyl) phthalate (DEHP) were the dominant components accounting for 30.65% and 53.19% of the Σ6PAEs. Principal component analysis, positive matrix factorization, and correlation analysis were used to apportion the potential sources of PAEs in outdoor dust samples. The PAEs in the outdoor dust originated mainly from wide application of plasticizers as well as cosmetics and personal care products. The main pathways of human exposure to PAEs in the outdoor dust were ingestion and dermal absorption of dust particles. The total intakes of PAEs from outdoor dusts for children and adults were 1.50 × 10-5 and 2.47 × 10-6 mg·kg-1·d-1, respectively. Children were more susceptible to the PAEs intake than the adults. Although the estimated health risks of the six PAEs are currently acceptable, caution is needed given the likely future increase in use of these PAEs and the currently unknown contribution to human exposure by other medium.
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Affiliation(s)
- Yan Zhang
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; School of Energy and Environmental Engineering, University of Science and Technology of Beijing, Beijing 100083, China
| | - Xu Li
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Heng Zhang
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Wenxiu Liu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Yang Liu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Changsheng Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Jian Xu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China.
| | - Fengchang Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; School of Energy and Environmental Engineering, University of Science and Technology of Beijing, Beijing 100083, China
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Prenatal Exposure to Organophosphorus Pesticides and Preschool ADHD in the Norwegian Mother, Father and Child Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138148. [PMID: 35805806 PMCID: PMC9266339 DOI: 10.3390/ijerph19138148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022]
Abstract
Prenatal organophosphorus pesticide (OPP) exposure has been associated with child attention-deficit/hyperactivity disorder (ADHD) in agricultural communities and those that are exposed to residentially applied insecticides. To examine this association in populations that are exposed primarily through diet, we estimate the associations between prenatal OPP exposure and preschool ADHD in the Norwegian Mother, Father and Child Cohort Study (MoBa), and describe modification by paraoxonase 1 (PON1) gene variants. We used participants from the MoBa Preschool ADHD Sub-study (n = 259 cases) and a random sample of MoBa sub-cohort participants (n = 547) with birth years from 2004 to 2008. Prenatal urinary dialkylphosphate (DAP) metabolites (total diethylphosphate [∑DEP] and total dimethylphosphate [∑DMP]) were measured by an ultra-performance liquid chromatography-time-of-flight system and summed by molar concentration. Maternal DNA was genotyped for coding variants of PON1 (Q192R and L55M). We used a multivariable logistic regression to calculate the odds ratios (OR) and 95% confidence intervals, adjusted for maternal education, parity, income dependency, age, marital status, ADHD-like symptoms, pesticide use, produce consumption, and season. We found no associations between DAP metabolite concentrations and preschool ADHD. The adjusted ORs for exposure quartiles 2-4 relative to 1 were slightly inverse. No monotonic trends were observed, and the estimates lacked precision, likely due to the small sample size and variation in the population. We found no evidence of modification by PON1 SNP variation or child sex. Maternal urinary DAP concentrations were not associated with preschool ADHD.
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Iglesias-González A, Schweitzer M, Palazzi P, Peng F, Haan S, Letellier E, Appenzeller BMR. Investigating children's chemical exposome - Description and possible determinants of exposure in the region of Luxembourg based on hair analysis. ENVIRONMENT INTERNATIONAL 2022; 165:107342. [PMID: 35714525 DOI: 10.1016/j.envint.2022.107342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
The specific physiology and behaviour of children makes them particularly vulnerable to chemical exposure. Specific studies must therefore be conducted to understand the impact of pollution on children's health. Human biomonitoring is a reliable approach for exposure assessment, and hair, allowing the detection of parent chemicals and metabolites, and covering wider time windows than urine and blood is particularly adapted to study chronic exposure. The present study aims at assessing chemical exposure and investigating possible determinants of exposure in children living in Luxembourg. Hair samples were collected from 256 children below 13 y/o and tested for 153 compounds (140 pesticides, 4 PCBs, 7 BDEs and 2 bisphenols). Moreover, anthropometric parameters, information on diet, residence, and presence of pets at home was collected through questionnaires. Correlations, regressions, t-tests, PLS-DA and MANOVAs, were used to investigate exposure patterns. Twenty-nine to 88 (median = 61) compounds were detected per sample. The highest median concentration was observed for BPA (133.6 pg/mg). Twenty-three biomarkers were detected in ≥ 95% of the samples, including 13 in all samples (11 pesticides, BPA and BPS). Exposure was higher at younger ages (R2 = 0.57), and boys were more exposed to non-persistent pesticides than girls. Presence of persistent organic pollutants in most children suggests that exposure is still ongoing. Moreover, diet (e.g. imazalil: 0.33 pg/mg in organic, 1.15 pg/mg in conventional, p-value < 0.001), residence area (e.g. imidacloprid: 0.29 pg/mg in urban, 0.47 pg/mg in countryside, p-value = 0.03), and having pets (e.g. fipronil: 0.32 pg/mg in pets, 0.09 pg/mg in no pets, p-value < 0.001) were identified as determinants of exposure. The present study demonstrates that children are simultaneously exposed to multiple pollutants from different chemical classes, and confirms the suitability of hair to investigate exposure. These results set the basis for further investigations to better understand the determinants of chemical exposure in children.
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Affiliation(s)
- Alba Iglesias-González
- Human Biomonitoring Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, L-1445 Strassen, Luxembourg; University of Luxembourg, 2 Avenue de l'Universite, L- 4365 Esch-sur-Alzette, Luxembourg.
| | - Mylène Schweitzer
- Human Biomonitoring Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Paul Palazzi
- Human Biomonitoring Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Fengjiao Peng
- Human Biomonitoring Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Serge Haan
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, 6, avenue du Swing L-4367 Belvaux, Luxembourg
| | - Elisabeth Letellier
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, 6, avenue du Swing L-4367 Belvaux, Luxembourg
| | - Brice M R Appenzeller
- Human Biomonitoring Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, L-1445 Strassen, Luxembourg
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25
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Yu L, Zhang H, Zheng T, Liu J, Fang X, Cao S, Xia W, Xu S, Li Y. Phthalate Exposure, PPARα Variants, and Neurocognitive Development of Children at Two Years. Front Genet 2022; 13:855544. [PMID: 35464856 PMCID: PMC9019295 DOI: 10.3389/fgene.2022.855544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The PPARα gene may be crucial to the neurotoxic effect of phthalates. However, epidemiological studies considering the neurodevelopmental influence of phthalates interacting with genetic susceptibility are limited. We hypothesized phthalates could interact with the PPARα gene, synergistically affecting neurocognitive development. Methods: A total of 961 mother-infant pairs were involved in this study. The concentrations of phthalate metabolites in maternal urine during pregnancy were detected. Children’s neurocognitive development was estimated with the Bailey Infant Development Inventory (BSID). Genetic variations in PPARα were genotyped with the Illumina Asian Screening Array. We applied generalized linear regression models to estimate genotypes and phthalate metabolites’ association with children’s neurocognitive development. Results: After adjusting for potential confounders, the mono-n-butyl phthalate (MnBP) concentration was negatively associated with Psychomotor Development Index (PDI) (β = −0.86, 95% CI: −1.67, −0.04). The associations between MnBP and neurocognitive development might be modified by PPARα rs1800246. Compared with low-MnBP individuals carrying rs1800246 GG genotypes, high-MnBP individuals with the AG + AA genotype had a higher risk of neurocognitive developmental delay, with the odds ratio of 2.76 (95% CI:1.14, 6.24). Conclusions: Our current study revealed that prenatal exposure to MnBP was negatively correlated with children’s neurocognitive development, and PPARα rs1800246 might modify the association.
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Affiliation(s)
- Ling Yu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongling Zhang
- School of Health and Nursing, Wuchang University of Technology, Wuhan, China
| | - Tongzhang Zheng
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Juan Liu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingjie Fang
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuting Cao
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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26
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Safarpour S, Ghasemi-Kasman M, Safarpour S, Darban YM. Effects of Di-2-Ethylhexyl Phthalate on Central Nervous System Functions: A Narrative Review. Curr Neuropharmacol 2022; 20:766-776. [PMID: 34259148 PMCID: PMC9878957 DOI: 10.2174/1570159x19666210713122517] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Phthalates are widely used in the plastics industry. Di-2-Ethylhexyl Phthalate (DEHP) is one of the most important phthalate metabolites that disrupt the function of endocrine glands. Exposure to DEHP causes numerous effects on animals, humans, and the environment. Low doses of DEHP increase neurotoxicity in the nervous system that has arisen deep concerns due to the widespread nature of DEHP exposure and its high absorption during brain development. OBJECTIVE In this review article, we evaluated the impacts of DEHP exposure from birth to adulthood on neurobehavioral damages. Then, the possible mechanisms of DEHP-induced neurobehavioral impairment were discussed. METHODOLOGY Peer-reviewed articles were extracted through Embase, PubMed, and Google Scholar till the year 2021. RESULTS The results showed that exposure to DEHP during pregnancy and infancy leads to memory loss and irreversible nervous system damage. CONCLUSION Overall, it seems that increased levels of oxidative stress and inflammatory mediators possess a pivotal role in DEHP-induced neurobehavioral impairment.
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Affiliation(s)
- Soheila Safarpour
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran;,Department of Pharmacology and Toxicology, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Ghasemi-Kasman
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran;,Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran;,Address correspondence to this author at the Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, P.O. Box 4136747176, Babol, Iran; Tel/Fax: +98-11-32190557; E-mail:
| | - Samaneh Safarpour
- Department of Biochemistry, Mashhad University of Medical Sciences, Mashhad, Iran
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27
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Radha MJ, Basha MP. Genotoxic impact of di-n-butyl phthalate on DNA: A comparative study of three generations in the neuronal tissue of Wistar rats. Toxicol Ind Health 2022; 38:162-175. [PMID: 35317679 DOI: 10.1177/07482337221079428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Di-n-butyl phthalate (DBP), one of the plasticizers, is considered a ubiquitous environmental contaminant due to its widespread application in personal-care products and serves as a raw material in many industries for the generation of many plastic products. Several scientific investigations have shown that DBP caused embryotoxicity and cognitive impairments. However, there is less understanding of the genotoxic potential of DBP in neuronal tissue when exposure happens continuously for several generations. The present study was undertaken to investigate the impact of DBP on the nucleic acids of neuronal tissue in one-month-old rats by performing a comet assay and biochemical analyses. By oral gavage, the parental generation (F0) was administered DBP (500 mg/kg/day) during gestation (GD6-20) and lactation, and exposures were continued for three consecutive generations until the pups were grown to one-month-old. The oxidative stress assessments carried out in discrete brain regions isolated from one-month-old rats (F1-F3) following DBP exposure indicated significant inhibition in the levels of antioxidant enzymes (superoxide dismutase and catalase) while oxidant status (malondialdehyde) was elevated significantly. The extent of DNA damage using the comet assay, as measured by the olive moment, tail DNA percentage and tail length, was greater in DBP-treated rats compared with the control group, but RNA/DNA content decreased significantly. The results of this study suggested a strong link between oxidative stress and genetic integrity in the neuronal tissue of rats exposed to DBP generationally. To summarise, DBP exposure during pregnancy caused oxidative stress, which resulted in genetic instability in specific discrete brain regions of the third generation.
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Affiliation(s)
- M J Radha
- Department of Biotechnology and Genetics, 209507Ramaiah College of Arts, Science and Commerce, Bangalore, India
| | - Mahaboob P Basha
- Department of Zoology, 29100Bangalore University, Bangalore, India
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Rotem RS, Chodick G, Davidovitch M, Bellavia A, Weisskopf MG. Maternal Thyroid Anomalies and Attention-Deficit Hyperactivity Disorder in Progeny. Am J Epidemiol 2022; 191:430-440. [PMID: 34791037 DOI: 10.1093/aje/kwab272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022] Open
Abstract
Previous epidemiologic investigations suggested that maternal thyroid anomalies are a possible causal factor in attention-deficit hyperactivity disorder (ADHD) in progeny, yet clinical trials indicated that levothyroxine treatment was ineffective in preventing neurodevelopmental impairments. We used an Israeli cohort of 385,542 singleton births from 1999-2012 to explore the interrelated roles of maternal thyroid conditions, laboratory gestational thyroid hormone measurements, use of thyroid medications, and offspring ADHD. Analyses were performed using Cox proportional hazards models. Results indicated that maternal hypothyroidism diagnosis was associated with an elevated progeny ADHD hazard (adjusted hazard ratio = 1.14, 95% confidence interval = 1.10, 1.18). However, this association was unmitigated by gestational use of levothyroxine and was unexplained by maternal gestational thyroid hormone levels. Associations with gestational thyrotropin values and hypothyroxinemia were also observed but were robust only in mothers without other records indicative of a thyroid problem. Results indicated that maternal thyroid hypofunction was associated with progeny ADHD but possibly not due to a direct causal relationship. Instead, maternal thyroid hypofunction may serve as a proxy indicator for other factors that affect neurodevelopment through thyroid hormone independent pathways, which are thus unaffected by pharmaceutical treatments for thyroid hypofunction. Factors known to disrupt thyroid functioning should be examined for their independent ADHD-related effects.
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29
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Wang LJ, Huang YH, Chou WJ, Lee SY, Chang HY, Chen CC, Chao HR. Interrelationships among growth hormone, thyroid function, and endocrine-disrupting chemicals on the susceptibility to attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-021-01886-4. [PMID: 35119524 DOI: 10.1007/s00787-021-01886-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
Abnormal growth hormones and thyroid function may be linked to pathophysiology of attention-deficit/hyperactivity disorder (ADHD). Phthalates and bisphenol-A (BPA), two endocrine-disrupting chemicals (EDCs), may affect the human endocrine system. In this study, we aimed to perform a comprehensive investigation of whether growth hormone, thyroid function, and EDCs exhibited differential levels between ADHD patients and healthy controls. In total, 144 children with ADHD and 70 healthy control subjects were enrolled. Their endocrine systems were evaluated using the serum levels of insulin-like growth factor-1 (IGF-1), IGF-binding protein-3 (IGFBP-3), thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and Free T4. The urinary levels of EDCs, including monoethyl phthalate (MEP), mono-methyl phthalate (MMP), monoethylhexyl phthalate (MEHP), mono-n-butyl phthalate (MnBP), monobenzyl phthalate (MBzP), and BPA, were also examined. Patients with ADHD had lower IGF-1 levels than healthy controls (p = 0.003), but we observed no significant difference in IGFBP-3, TSH, T3, T4, or Free T4. Compared to the control group, patients with ADHD demonstrated higher MEHP levels (p = 0.043), MnBP (p = 0.033), and MBzP (p = 0.040). Furthermore, MEHP levels (p < 0.001) and BPA levels (p = 0.041) were negatively correlated with IGF-1 levels, while IGF-1 levels were negatively correlated with principal components consisting of ADHD clinical symptoms and neuropsychological performance variables. We suggest that MEHP exposure may be associated with decreased serum levels of IGF-1 and increased risk of ADHD. The mechanism underlying this association may be important for protecting children from environmental chemicals that adversely affect neurodevelopment.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Ying-Hua Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yu Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - How-Ran Chao
- Department of Environmental Science and Engineering, College of Engineering, National Pingtung University of Science and Technology, Pingtung County, 912, Taiwan.,Institute of Food Safety Management, College of Agriculture, National Pingtung University of Science and Technology, Pingtung County, 912, Taiwan.,Emerging Compounds Research Center, General Research Service Center, National Pingtung University of Science and Technology, Pingtung County, 912, Taiwan.,School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung City, 80708, Taiwan
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30
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Vanhorebeek I, Malarvannan G, Güiza F, Poma G, Derese I, Wouters PJ, Joosten K, Verbruggen S, Jorens PG, Covaci A, Van den Berghe G. Phasing out DEHP from plastic indwelling medical devices used for intensive care: Does it reduce the long-term attention deficit of critically ill children? ENVIRONMENT INTERNATIONAL 2022; 158:106962. [PMID: 34739923 PMCID: PMC8685605 DOI: 10.1016/j.envint.2021.106962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/08/2021] [Accepted: 10/25/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Children who have been critically ill face long-term developmental impairments. Iatrogenic exposure to di(2-ethylhexyl)phthalate (DEHP), a plasticizer leaching from plastic indwelling medical devices used in the pediatric intensive care unit (PICU), has been associated with the pronounced attention deficit observed in children 4 years after critical illness. As concerns about DEHP toxicity increased, governmental authorities urged the phase out of DEHP in indwelling medical devices and replacement with alternative plasticizers. We hypothesized that exposure to DEHP decreased over the years, attenuating the pronounced long-term attention deficit of these vulnerable children. METHODS We compared plasma concentrations of 3 oxidative DEHP metabolites (5cx-MEPP, 5OH-MEHP, 5oxo-MEHP) on the last PICU day in 216 patients who participated in the Tight Glucose Control study (2004-2007) and 334 patients who participated in the PEPaNIC study (2012-2015) and survived PICU stay. Corresponding minimal exposures to these metabolites (plasma concentration multiplied with number of days in PICU) were also evaluated. In patients with 4-year follow-up data, we compared measures of attention (standardized reaction times and consistency). Comparisons were performed with univariable analyses and multivariable linear regression analyses adjusted for baseline risk factors. RESULTS In the PEPaNIC patients, last PICU day plasma concentrations of 5cx-MEPP, 5OH-MEHP, 5oxo-MEHP and their sum, and corresponding minimal exposures, were reduced to 17-69% of those in the Tight Glucose Control study (p < 0.0001). Differences remained significant after multivariable adjustment (p ≤ 0.001). PEPaNIC patients did not show better attention than patients in the Tight Glucose Control study, also not after multivariable adjustment for risk factors. CONCLUSION Exposure of critically ill children to DEHP in the PICU decreased over the years, but the lower exposure did not translate into improved attention 4 years later. Whether the residual exposure may still be toxic or whether the plasticizers replacing DEHP may not be safe for neurodevelopment needs further investigation.
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Affiliation(s)
- Ilse Vanhorebeek
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
| | | | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Giulia Poma
- Toxicological Center, University of Antwerp, Wilrijk, Belgium
| | - Inge Derese
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Pieter J Wouters
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Koen Joosten
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sascha Verbruggen
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Philippe G Jorens
- Department of Intensive Care Medicine and Clinical Pharmacology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Adrian Covaci
- Toxicological Center, University of Antwerp, Wilrijk, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Qu J, Xia W, Qian X, Wu Y, Li J, Wen S, Xu S. Geographic distribution and time trend of human exposure of Di(2-ethylhexyl) phthalate among different age groups based on global biomonitoring data. CHEMOSPHERE 2022; 287:132115. [PMID: 34826892 DOI: 10.1016/j.chemosphere.2021.132115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Despite being restricted by many authorities, di (2-ethylhexyl) phthalate (DEHP) is still widely detected in the environment and biospecimens. To indentify populations of high risk and evaluate the effects of DEHP restrictions, we elucidated the geographic distribution of DEHP exposure levels among pregnant women and different age groups, and compared the time trend of exposure levels with the time course of productions/restrictions. The estimated daily intake (EDI) was calculated based on biomonitoring data in published epidemiological studies, and then the group EDI (EDIG) was calculated for one particular population, region, or period by weighting EDIs by sample sizes. Overall, 144,965 samples from 45 nations were included, with the sampling time ranging from 1982 to 2017. Children had the highest exposure level (5.50 μg/kg bw/day) worldwide, while infants and pregnant women had low levels (2.13 and 1.89 μg/kg bw/day, respectively). The EDIGs varied considerably between countries, and the majority of corresponding hazard quotients were less than 1; however, the risk behind can not be ignored. In the general population, the DEHP exposure level showed a downtrend from 4.40 μg/kg bw/day before 2000 to 2.23 μg/kg bw/day in 2015-2017. In the European Union, the annual trend of DEHP EDIGs of children and adults fitted the production and consumption volume, and the EDIGs decreased more sharply in children. The EDIGs of children decreased with a delay along with the regulations on the use of DEHP. Cutting productions/consumptions and restrictions are effective to reduce DEHP exposure, but current efforts are far from enough on a worldwide scale.
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Affiliation(s)
- Jingyu Qu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wei Xia
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xi Qian
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yongning Wu
- Chinese Academy of Medical Science Research Unit (2019RU014), NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, 100022, People's Republic of China
| | - Jingguang Li
- Chinese Academy of Medical Science Research Unit (2019RU014), NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, 100022, People's Republic of China
| | - Sheng Wen
- Hubei Provincial Center for Disease Control and Prevention, Hubei, People's Republic of China
| | - Shunqing Xu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Derakhshan A, Shu H, Broeren MAC, Lindh CH, Peeters RP, Kortenkamp A, Demeneix B, Bornehag CG, Korevaar TIM. Association of phthalate exposure with thyroid function during pregnancy. ENVIRONMENT INTERNATIONAL 2021; 157:106795. [PMID: 34358912 DOI: 10.1016/j.envint.2021.106795] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The extent of thyroid disruptive effects of phthalates during pregnancy remains unclear. AIM To investigate the association of maternal urinary phthalates with markers of the thyroid system during early pregnancy. METHODS Urinary concentrations of phthalate metabolites and serum concentrations of thyroid stimulating hormone (TSH), free and total thyroxine (FT4 and TT4) and free and total triiodothyronine (FT3 and TT3) were measured in pregnant women in early pregnancy in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study (2007-ongoing), a population-based prospective cohort. RESULTS In the 1,996 included women, higher di-ethyl-hexyl phthalate (DEHP) metabolites were associated with a lower FT4 (β [SE] for the molar sum: -0.13 [0.06], P = 0.03) and a higher TSH/FT4 ratio (0.003 [0.001], P = 0.03). Higher concentrations of di-iso-nonyl phthalate (DINP) metabolites were associated with a lower TT4 (β [SE] for the molar sum: 0.93 [0.44], P = 0.03) as well as with lower TT4/FT4 and TT4/TT3 ratios. Higher metabolites of both dibutyl and butyl-benzyl phthalate (DBP and BBzP) were associated with lower T4/T3 ratio (free and total) and higher FT4/TT4 and FT3/TT3 ratios. A higher diisononyl cyclohexane dicarboxylate (DINCH) metabolite concentration was associated with a higher TT3. CONCLUSIONS These results translate results from experimental studies suggesting that exposure to phthalates may interfere with the thyroid system during pregnancy. This is also true for compounds that have been introduced to replace known disruptive phthalates. Further experimental studies should take into account the human evidence to better investigate the potential underlying mechanisms of thyroid disruption by phthalates.
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Affiliation(s)
- Arash Derakhshan
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Huan Shu
- Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run 4600, the Netherlands
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, 22363 Lund, Sweden
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Andreas Kortenkamp
- Division of Environmental Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, Uxbridge, UK
| | - Barbara Demeneix
- Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, 57 Rue Cuvier, 75005 Paris, France
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, New York City, NY 10029-6574, USA
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands.
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Maffini MV, Geueke B, Groh K, Carney Almroth B, Muncke J. Role of epidemiology in risk assessment: a case study of five ortho-phthalates. Environ Health 2021; 20:114. [PMID: 34775973 PMCID: PMC8591894 DOI: 10.1186/s12940-021-00799-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 10/18/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND The association between environmental chemical exposures and chronic diseases is of increasing concern. Chemical risk assessment relies heavily on pre-market toxicity testing to identify safe levels of exposure, often known as reference doses (RfD), expected to be protective of human health. Although some RfDs have been reassessed in light of new hazard information, it is not a common practice. Continuous surveillance of animal and human data, both in terms of exposures and associated health outcomes, could provide valuable information to risk assessors and regulators. Using ortho-phthalates as case study, we asked whether RfDs deduced from male reproductive toxicity studies and set by traditional regulatory toxicology approaches sufficiently protect the population for other health outcomes. METHODS We searched for epidemiological studies on benzyl butyl phthalate (BBP), diisobutyl phthalate (DIBP), dibutyl phthalate (DBP), dicyclohexyl phthalate (DCHP), and bis(2-ethylhexyl) phthalate (DEHP). Data were extracted from studies where any of the five chemicals or their metabolites were measured and showed a statistically significant association with a health outcome; 38 studies met the criteria. We estimated intake for each phthalate from urinary metabolite concentration and compared estimated intake ranges associated with health endpoints to each phthalate's RfD. RESULT For DBP, DIBP, and BBP, the estimated intake ranges significantly associated with health endpoints were all below their individual RfDs. For DEHP, the intake range included associations at levels both below and above its RfD. For DCHP, no relevant studies could be identified. The significantly affected endpoints revealed by our analysis include metabolic, neurodevelopmental and behavioral disorders, obesity, and changes in hormone levels. Most of these conditions are not routinely evaluated in animal testing employed in regulatory toxicology. CONCLUSION We conclude that for DBP, DIBP, BBP, and DEHP current RfDs estimated based on male reproductive toxicity may not be sufficiently protective of other health effects. Thus, a new approach is needed where post-market exposures, epidemiological and clinical data are systematically reviewed to ensure adequate health protection.
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Affiliation(s)
| | - Birgit Geueke
- Food Packaging Forum Foundation, Zurich, Switzerland
| | - Ksenia Groh
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jane Muncke
- Food Packaging Forum Foundation, Zurich, Switzerland
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Guilbert A, Rolland M, Pin I, Thomsen C, Sakhi AK, Sabaredzovic A, Slama R, Guichardet K, Philippat C. Associations between a mixture of phenols and phthalates and child behaviour in a French mother-child cohort with repeated assessment of exposure. ENVIRONMENT INTERNATIONAL 2021; 156:106697. [PMID: 34147998 DOI: 10.1016/j.envint.2021.106697] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Synthetic phenols and phthalates can interfere with biological pathways involved in brain development. Despite the high within-subject temporal variability of urinary concentrations observed for their metabolites, studies investigating effects of phenols and phthalates on child behaviour often relied on a limited number of spot biospecimens to assess exposure. Besides, the majority did not consider mixture effects. OBJECTIVES To study the combined effect of prenatal exposure to synthetic phenols and phthalates on child behaviour using repeated exposure measurements. METHODS We assessed concentrations of 12 phenols, 13 phthalate and 2 non-phthalate plasticizer metabolites in within-subject pools of multiple urine samples (median = 21 samples per individual pool) collected at two distinct time points during pregnancy in 416 mother-child pairs from the French SEPAGES cohort. Child behaviour was evaluated at two years using the Child Behaviour Checklist 1.5-5 (CBCL). Associations between a mixture of biomarkers of exposure and externalizing and internalizing behaviour scores were studied using adjusted Weighted Quantile Sum (WQS) regressions with a repeated holdout validation (100 repetitions). RESULTS The positive WQS indexes were associated with both the externalizing and internalizing behaviour scores in the whole population, indicating greater risk of behavioural problems. Stratification for child sex suggested stronger associations in girls than boys. On average, girls externalizing and internalizing scores increased by 3.67 points (95% CI: 1.24, 6.10) and 2.47 points (95 %CI: 0.60, 4.33) respectively, for an increase of one tertile in the WQS index, compared with 1.70 points (95 %CI: -0.42, 3.81) and 1.17 points (95 %CI: -0.50, 2.84) in boys. Main contributors for the associations observed in girls were bisphenol A (weight of 18%), triclosan (17%) and monoethyl phthalate (MEP, 15%) for the externalizing score and MEP (19%), mono-benzyl phthalate (MBzP, 19%) and mono-n-butyl phthalate (MnBP, 16%) for the internalizing score. DISCUSSION Our results suggest adverse associations between in utero exposure to a mixture of phenols and phthalates and child behaviour, mainly in girls. Public health consequences may be substantial due to the widespread exposure of the population to these compounds.
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Affiliation(s)
- Ariane Guilbert
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France.
| | - Matthieu Rolland
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France.
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France; Pediatric Department, Grenoble Alpes University Hospital, 38700 La Tronche, France.
| | | | | | | | - Rémy Slama
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France.
| | - Karine Guichardet
- Pediatric Department, Grenoble Alpes University Hospital, 38700 La Tronche, France.
| | - Claire Philippat
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble Alpes University, Inserm, CNRS, 38700 La Tronche, France.
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More S, Benford D, Hougaard Bennekou S, Bampidis V, Bragard C, Halldorsson T, Hernandez‐Jerez A, Koutsoumanis K, Lambré C, Machera K, Mullins E, Nielsen SS, Schlatter J, Schrenk D, Turck D, Tarazona J, Younes M. Opinion on the impact of non-monotonic dose responses on EFSA's human health risk assessments. EFSA J 2021; 19:e06877. [PMID: 34712366 PMCID: PMC8528485 DOI: 10.2903/j.efsa.2021.6877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This Opinion assesses the biological relevance of the non-monotonic dose responses (NMDR) identified in a previous EFSA External Report (Beausoleil et al., 2016) produced under GP/EFSA/SCER/2014/01 and the follow-up probabilistic assessment (Chevillotte et al., 2017a,b), focusing on the in vivo data sets fulfilling most of the checkpoints of the visual/statistical-based analysis identified in Beausoleil et al. (2016). The evaluation was completed with cases discussed in EFSA assessments and the update of the scientific literature. Observations of NMDR were confirmed in certain studies and are particularly relevant for receptor-mediated effects. Based on the results of the evaluation, the Opinion proposes an approach to be applied during the risk assessment process when apparent non-monotonicity is observed, also providing advice on specific elements to be considered to facilitate the assessment of NMDR in EFSA risk assessments. The proposed approach was applied to two case studies, Bisphenol A and bis(2-ethylhexyl phthalate (DEHP) and these evaluations are reported in dedicated annexes. Considering the potential impact of NMDRs in regulatory risk assessment, the Scientific Committee recommends a concerted international effort on developing internationally agreed guidance and harmonised frameworks for identifying and addressing NMDRs in the risk assessment process.
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36
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Sarrouilhe D, Defamie N, Mesnil M. Is the Exposome Involved in Brain Disorders through the Serotoninergic System? Biomedicines 2021; 9:1351. [PMID: 34680468 PMCID: PMC8533279 DOI: 10.3390/biomedicines9101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
Serotonin (5-hydroxytryptamine, 5-HT) is a biogenic monoamine acting as a neurotransmitter in the central nervous system (CNS), local mediator in the gut, and vasoactive agent in the blood. It has been linked to a variety of CNS functions and is implicated in many CNS and psychiatric disorders. The high comorbidity between some neuropathies can be partially understood by the fact that these diseases share a common etiology involving the serotoninergic system. In addition to its well-known functions, serotonin has been shown to be a mitogenic factor for a wide range of normal and tumor cells, including glioma cells, in vitro. The developing CNS of fetus and newborn is particularly susceptible to the deleterious effects of neurotoxic substances in our environment, and perinatal exposure could result in the later development of diseases, a hypothesis known as the developmental origin of health and disease. Some of these substances affect the serotoninergic system and could therefore be the source of a silent pandemic of neurodevelopmental toxicity. This review presents the available data that are contributing to the appreciation of the effects of the exposome on the serotoninergic system and their potential link with brain pathologies (neurodevelopmental, neurodegenerative, neurobehavioral disorders, and glioblastoma).
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Affiliation(s)
- Denis Sarrouilhe
- Laboratoire de Physiologie Humaine, Faculté de Médecine et Pharmacie, 6 Rue de la Milétrie, Bât D1, TSA 51115, CEDEX 09, 86073 Poitiers, France
| | - Norah Defamie
- Laboratoire STIM, ERL7003 CNRS-Université de Poitiers, 1 Rue G. Bonnet–TSA 51106, CEDEX 09, 86073 Poitiers, France; (N.D.); (M.M.)
| | - Marc Mesnil
- Laboratoire STIM, ERL7003 CNRS-Université de Poitiers, 1 Rue G. Bonnet–TSA 51106, CEDEX 09, 86073 Poitiers, France; (N.D.); (M.M.)
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Chang WH, Herianto S, Lee CC, Hung H, Chen HL. The effects of phthalate ester exposure on human health: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 786:147371. [PMID: 33965815 DOI: 10.1016/j.scitotenv.2021.147371] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 05/26/2023]
Abstract
Phthalate esters (PAEs) are one of the most widely used plasticizers in polymer products and humans are increasingly exposed to them. The constant exposure to PAEs-contained products has raised some concerns against human health. Thus, the impacts of PAEs and their metabolites on human health require a comprehensive study for a better understanding of the associated risks. Here, we attempt to review eight main health effects of PAE exposure according to the most up-to-date studies. We found that epidemiological studies demonstrated a consistent association between PAE exposure (especially DEHP and its metabolites) and a decrease in sperm quality in males and symptom development of ADHD in children. Overall, we found insufficient evidence and lack of consistency of the association between PAE exposure and cardiovascular diseases (hypertension, atherosclerosis, and CHD), thyroid diseases, respiratory diseases, diabetes, obesity, kidney diseases, intelligence performance in children, and other reproductive system-related diseases (anogenital distance, girl precocious puberty, and endometriosis). Future studies (longitudinal and follow-up investigations) need to thoroughly perform in large-scale populations to yield more consistent and powerful results and increase the precision of the association as well as enhance the overall understanding of potential human health risks of PAEs in long-term exposure.
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Affiliation(s)
- Wei-Hsiang Chang
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Samuel Herianto
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Chemical Biology and Molecular Biophysics Program, Taiwan International Graduate Program (TIGP), Academia Sinica, Taipei 11529, Taiwan; Institute of Biological Chemistry, Academia Sinica, Taipei 11529, Taiwan; Department of Chemistry (Chemical Biology Division), College of Science, National Taiwan University, Taipei 10617, Taiwan
| | - Ching-Chang Lee
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hsin Hung
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hsiu-Ling Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
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Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BSG, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev 2021; 128:789-818. [PMID: 33549739 PMCID: PMC8328933 DOI: 10.1016/j.neubiorev.2021.01.022] [Citation(s) in RCA: 449] [Impact Index Per Article: 149.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, NY, USA; World Federation of ADHD, Switzerland; American Professional Society of ADHD and Related Disorders (APSARD), USA.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Child and Adolescent Psychiatrist's Representative, Zentrales-ADHS-Netz, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China; Asian Federation of ADHD, China; Chinese Society of Child and Adolescent Psychiatry, China
| | - Joseph Biederman
- Clinical & Research Programs in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Jeffrey H Newcorn
- American Professional Society of ADHD and Related Disorders (APSARD), USA; Departments of Psychiatry and Pediatrics, Division of ADHD and Learning Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin Gignac
- Department of Child and Adolescent Psychiatry, Montreal Children's Hospital, MUHC, Montreal, Canada; Child and Adolescent Psychiatry Division, McGill University, Montreal, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | | | - Iris Manor
- Chair, Israeli Society of ADHD (ISA), Israel; Co-chair of the neurodevelopmental section in EPA (the European Psychiatric Association), France
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Li Yang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton,UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Doron Almagor
- University of Toronto, SickKids Centre for Community Mental Health, Toronto, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | - Mark A Stein
- University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Turki H Albatti
- Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Haya F Aljoudi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Mohammed M J Alqahtani
- Clinical Psychology, King Khalid University, Abha, Saudi Arabia; Saudi ADHD Society, Saudi Arabia
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Science, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute, and Department of Internal Medicine, Medical College East Africa, the Aga Khan University, Kenya; African College of Psychopharmacology, Kenya; African Association of Psychiatrists, Kenya
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Dept. of Psychiatry, Brussel, Belgium; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK; NIHR MindTech Mental Health MedTech Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany; Zentrales-ADHS-Netz, Germany
| | | | | | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Professional Board, ADHD Europe, Belgium
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, Groningen, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; ADHD Across the Lifespan Network from European College of Neuropsychopharmacology(ECNP), the Netherlands
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA; University of California, San Francisco, CA, USA
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Chris Hollis
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; NIHR MindTech MedTech Co-operative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Scott H Kollins
- Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J J Sandra Kooij
- Amsterdam University Medical Center (VUMc), Amsterdam, the Netherlands; PsyQ, The Hague, the Netherlands; European Network Adult ADHD, the Netherlands; DIVA Foundation, the Netherlands; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tingyu Li
- Growth, Development and Mental Health Center for Children and Adolescents, Children's Hospital of Chongqing Medical University, Chongqing, China; National Research Center for Clinical Medicine of Child Health and Disease, Chongqing, China; The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, China
| | - Jing Liu
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; The Chinese Society of Child and Adolescent Psychiatry, China; The Asian Society for Child and Adolescent Psychiatry and Allied Professions, China
| | - Eugene Merzon
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel; Israeli Society of ADHD, Israel; Israeli National Diabetes Council, Israel
| | - Gregory Mattingly
- Washington University, St. Louis, MO, USA; Midwest Research Group, St Charles, MO, USA
| | - Paulo Mattos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brazilian Attention Deficit Association (ABDA), Brazil
| | | | | | - Brooke S G Molina
- Departments of Psychiatry, Psychology, Pediatrics, Clinical & Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel T Nigg
- Center for ADHD Research, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Diane Purper-Ouakil
- University of Montpellier, CHU Montpellier Saint Eloi, MPEA, Medical and Psychological Unit for Children and Adolescents (MPEA), Montpellier, France; INSERM U 1018 CESP-Developmental Psychiatry, France
| | - Olayinka O Omigbodun
- Centre for Child & Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Child & Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel; The Israeli Society of ADHD (ISA), Israel
| | - Alison S Poulton
- Brain Mind Centre Nepean, University of Sydney, Sydney, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; German Psychiatric Association, Germany
| | - Katya Rubia
- World Federation of ADHD, Switzerland; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany
| | - Julia Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany; Zentrales-ADHS-Netz, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France; International Collaboration on ADHD and Substance Abuse (ICASA), the Netherlands; DIVA Foundation, the Netherlands
| | - Arnt Schellekens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Renata Schoeman
- University of Stellenbosch Business School, Cape Town, South Africa; South African Special Interest Group for Adult ADHD, South Africa; The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for ADHD, South Africa; World Federation of Biological Psychiatry, Germany; American Psychiatric Association, USA; Association for NeuroPsychoEconomics, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Henal Shah
- Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Mary V Solanto
- The Zucker School of Medicine at Hofstra-Northwell, Northwell Health, Hemstead, NY, USA; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), USA; American Professional Society of ADHD and Related Disorders (APSARD), USA; National Center for Children with Learning Disabilities (NCLD), USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - César Soutullo
- American Professional Society of ADHD and Related Disorders (APSARD), USA; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany; Louis A. Faillace MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hans-Christoph Steinhausen
- University of Zurich, CH, Switzerland; University of Basel, CH, Switzerland; University of Southern Denmark, Odense, Denmark; Centre of Child and Adolescent Mental Health, Copenhagen, Denmark
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Wales, UK
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Geurt van de Glind
- Hogeschool van Utrecht/University of Applied Sciences, Utrecht, the Netherlands
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Saskia Van der Oord
- Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; European ADHD Guidelines Group, Germany
| | - Andre Venter
- University of the Free State, Bloemfontein, South Africa
| | - Benedetto Vitiello
- University of Torino, Torino, Italy; Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Yufeng Wang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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Choi G, Keil AP, Richardson DB, Daniels JL, Hoffman K, Villanger GD, Sakhi AK, Thomsen C, Reichborn-Kjennerud T, Aase H, Engel SM. Pregnancy exposure to organophosphate esters and the risk of attention-deficit hyperactivity disorder in the Norwegian mother, father and child cohort study. ENVIRONMENT INTERNATIONAL 2021; 154:106549. [PMID: 33910116 PMCID: PMC8217330 DOI: 10.1016/j.envint.2021.106549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs) are a class of flame retardants in common use. OPEs can easily leach from materials, resulting in human exposure. Increasing concentrations have been reported in human populations over the past decade. Recent studies have linked prenatal OPE exposure to hyperactivity and attention problems in children. Such behaviors are often found among children with attention-deficit hyperactivity disorder (ADHD), however, no study has investigated OPEs in relation to clinically assessed ADHD. OBJECTIVE To evaluate prenatal exposure to OPEs as risk factors for clinically assessed ADHD using a case-cohort study nested within the Norwegian Mother, Father, and Child Cohort Study (MoBa). METHODS We included in the case group 295 ADHD cases obtained via linkage with the Norwegian Patient Registry, and the sub-cohort group 555 children sampled at baseline, irrespective of their ADHD case status. Prenatal concentrations of OPE metabolites were measured in maternal urine collected at 17 weeks of gestation, and included diphenyl phosphate (DPHP), di-n-butyl phosphate (DNBP), bis(2-butoxyethyl) hydrogen phosphate (BBOEP), and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP). We estimated risk ratios and the corresponding 95% confidence intervals [95% CI] using logistic regression, adjusting for season of urine collection, child sex, birth year, and maternal depression, education, and sum of urinary di(2-ethylhexyl) phthalate metabolites (∑DEHP) concentration during pregnancy. To assess the overall impact of simultaneously decreasing exposure to all chemical constituents of an OPE-phthalate mixture, quantile based g-computation was implemented. The mixture constituents included OPE and phthalate metabolites commonly detected in our study. In all models, we considered effect measure modification by child sex and polymorphisms in genes encoding paraoxonase 1 (PON1) and cytochrome P450 (P450) enzymes. Mediation analysis was conducted using thyroid function biomarkers estimated from maternal blood collected at 17 weeks of gestation. RESULTS DPHP was detected in nearly all samples (97.2%), with a higher geometric mean among the case group (0.70 µg/L) as compared to the sub-cohort (0.52 µg/L). DNBP was commonly detected as well (93.8%), while BBOEP (52.9%) and BDCIPP (22.9%) were detected less frequently. A higher risk of ADHD was observed in children with greater than median exposure to DPHP during pregnancy (risk ratio: 1.38 [95% CI: 0.96, 1.99]), which was slightly higher among girls (2.04 [1.03, 4.02]) and children of mothers with PON1 Q192R genotype QR (1.69 [0.89, 3.19]) or PON1 Q192R genotype RR (4.59 [1.38, 15.29]). The relationship between DPHP and ADHD (total risk ratio: 1.34 [0.90, 2.02]) was partially mediated through total triiodothyronine to total thyroxine ratio (natural direct effect: 1.29 [0.87, 1.94]; natural indirect effect: 1.04 [1.00, 1.10]; 12.48% mediated). We also observed an elevated risk of ADHD in relation to BDCIPP detection during pregnancy (1.50 [0.98, 2.28]). We did not observe notable differences in ADHD by DNBP (0.88 [0.62, 1.26]) or BBOEP (1.03 [0.73, 1.46]) during pregnancy. Simultaneously decreasing all constituents of common-detect OPE-phthalate mixture, specifically DPHP, DNBP, and 6 phthalate metabolites, by a quartile resulted in an ADHD risk ratio of 0.68 [0.64, 0.72]. CONCLUSION Prenatal exposure to DPHP and BDCIPP may increase the risk of ADHD. For DPHP, we observed potential modification by child sex and maternal PON1 Q192R genotype and partial mediation through maternal thyroid hormone imbalance at 17 weeks gestation.
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Affiliation(s)
- Giehae Choi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie L Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | | | | | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Aase
- Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway. ENVIRONMENTAL EPIDEMIOLOGY (PHILADELPHIA, PA.) 2021; 5:e161. [PMID: 34414345 PMCID: PMC8367074 DOI: 10.1097/ee9.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Prenatal phthalate exposure has been linked to altered neurobehavioral development in both animal models and epidemiologic studies, but whether or not these associations translate to increased risk of neurodevelopmental disorders is unclear. We used a nested case-cohort study design to assess whether maternal urinary concentrations of 12 phthalate metabolites at 17 weeks gestation were associated with criteria for Attention Deficit Hyperactivity Disorder (ADHD) classified among 3-year-old children in the Norwegian Mother, Father and Child Cohort Study (MoBa). Between 2007 and 2011, 260 children in this substudy were classified with ADHD using a standardized, on-site clinical assessment; they were compared with 549 population-based controls. We modeled phthalate levels both linearly and by quintiles in logistic regression models adjusted for relevant covariates and tested for interaction by child sex. Children of mothers in the highest quintile of di-iso-nonyl phthalate (∑DiNP) metabolite levels had 1.70 times the odds of being classified with ADHD compared with those in the lowest quintile (95% confidence interval [CI] = 1.03 to 2.82). In linear models, there was a trend with the sum of di-2-ethylhexyl phthalate metabolites (∑DEHP); each natural log-unit increase in concentration was associated with 1.22 times the odds of ADHD (95% CI = 0.99 to 1.52). In boys, but not girls, mono-n-butyl phthalate exposure was associated with increased odds of ADHD (odds ratio [OR] 1.42; 95% CI = 1.07 to 1.88). Additional adjustment for correlated phthalate metabolites attenuated estimates. These results suggest gestational phthalate exposure may impact the behavior of children as young as 3 years.
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Choi G, Keil AP, Villanger GD, Richardson DB, Daniels JL, Hoffman K, Sakhi AK, Thomsen C, Herring AH, Drover SSM, Nethery R, Aase H, Engel SM. Pregnancy exposure to common-detect organophosphate esters and phthalates and maternal thyroid function. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 782:146709. [PMID: 33839654 PMCID: PMC8222630 DOI: 10.1016/j.scitotenv.2021.146709] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND Contemporary human populations are exposed to elevated concentrations of organophosphate esters (OPEs) and phthalates. Some metabolites have been linked with altered thyroid function, however, inconsistencies exist across thyroid function biomarkers. Research on OPEs is sparse, particularly during pregnancy, when maintaining normal thyroid function is critical to maternal and fetal health. In this paper, we aimed to characterize relationships between OPEs and phthalates exposure and maternal thyroid function during pregnancy, using a cross-sectional investigation of pregnant women nested within the Norwegian Mother, Father, and Child Cohort (MoBa). METHODS We included 473 pregnant women, who were euthyroid and provided bio-samples at 17 weeks' gestation (2004-2008). Four OPE and six phthalate metabolites were measured from urine; six thyroid function biomarkers were estimated from blood. Relationships between thyroid function biomarkers and log-transformed concentrations of OPE and phthalate metabolites were characterized using two approaches that both accounted for confounding by co-exposures: co-pollutant adjusted general linear model (GLM) and Bayesian Kernal Machine Regression (BKMR). RESULTS We restricted our analysis to common-detect OPE and phthalate metabolites (>94%): diphenyl phosphate (DPHP), di-n-butyl phosphate (DNBP), and all phthalate metabolites. In GLM, pregnant women with summed di-isononyl phthalate metabolites (∑DiNP) concentrations in the 75th percentile had a 0.37 ng/μg lower total triiodothyronine (TT3): total thyroxine (TT4) ratio (95% credible interval: [-0.59, -0.15]) as compared to those in the 25th percentile, possibly due to small but diverging influences on TT3 (-1.99 ng/dL [-4.52, 0.53]) and TT4 (0.13 μg/dL [-0.01, 0.26]). Similar trends were observed for DNBP and inverse associations were observed for DPHP, monoethyl phthalate, mono-isobutyl phthalate, and mono-n-butyl phthalate. Most associations observed in co-pollutants adjusted GLMs were attenuated towards the null in BKMR, except for the case of ∑DiNP and TT3:TT4 ratio (-0.48 [-0.96, 0.003]). CONCLUSIONS Maternal thyroid function varied modestly with ∑DiNP, whereas results for DPHP varied by the type of statistical models.
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Affiliation(s)
- Giehae Choi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie L Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | | | - Amy H Herring
- Department of Statistical Science and Global Health Institute, Duke University, Durham, NC, USA
| | - Samantha S M Drover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heidi Aase
- Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Watkins DJ, Meeker JD, Tamayo-Ortiz M, Sánchez BN, Schnaas L, Peterson KE, Téllez-Rojo MM. Gestational and peripubertal phthalate exposure in relation to attention performance in childhood and adolescence. ENVIRONMENTAL RESEARCH 2021; 196:110911. [PMID: 33640497 PMCID: PMC8119354 DOI: 10.1016/j.envres.2021.110911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
The prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) has been increasing. Research suggests that exposure to endocrine disrupting chemicals such as phthalates may play a role, but studies of in utero phthalate exposure and ADHD-related symptoms beyond early childhood are limited. We investigated associations between measures of in utero phthalate exposure and ADHD symptoms, such as inattention and impulsivity, in childhood (age 6-11 years, n = 221) and in adolescence (age 9-18 years, n = 200), as well as cross-sectional relationships between phthalate exposure and ADHD symptoms in adolescence (n = 491) among participants in the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. Women provided urine samples up to three times during pregnancy and adolescents provided a urine sample at 9-18 years of age for phthalate metabolite measurement. We administered the Conners' Continuous Performance Test (CPT) when children were age 6-11 years and again at 9-18 years of age. We used multivariable linear regression to examine associations between the geometric mean of phthalate metabolite levels across pregnancy and CPT scores in childhood or adolescence separately, adjusting for age, years schooling (at 9-18 only), maternal education, and specific gravity. Although average in utero phthalate concentrations were not associated with CPT scores in childhood, interquartile range (IQR) increases of in utero MBzP, MCPP, and MBP were associated with 4.2%, 4.7%, and 4.5% (p < 0.05) higher Omissions scores in adolescence, respectively, indicating higher inattention. In utero MiBP levels were also associated with higher Inter-Stimulus Interval (ISI) and Variability scores (5.4% and 5.5% per IQR, p < 0.05) in adolescence. In addition, urinary DEHP metabolite levels during adolescence were cross-sectionally associated with poorer scores on several CPT indices indicating greater inattention. These findings suggest that in utero phthalate exposure may have adverse effects on attention, but these effects may not appear until adolescence, a period of extensive neurodevelopment. Future research investigating the long-term effects of in utero phthalate exposure on attention and ADHD in adolescence, as well as identification of potential mechanisms involved, is needed.
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Affiliation(s)
- Deborah J Watkins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marcela Tamayo-Ortiz
- National Council of Science and Technology, National Institute of Public Health, Mexico City, Mexico
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lourdes Schnaas
- National Institute of Perinatology, ABC Hospital, Mexico City, Mexico
| | - Karen E Peterson
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Martha María Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Shen CY, Weng JC, Tsai JD, Su PH, Chou MC, Wang SL. Prenatal Exposure to Endocrine-Disrupting Chemicals and Subsequent Brain Structure Changes Revealed by Voxel-Based Morphometry and Generalized Q-Sampling MRI. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094798. [PMID: 33946254 PMCID: PMC8125311 DOI: 10.3390/ijerph18094798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 01/17/2023]
Abstract
Previous studies have indicated that prenatal exposure to endocrine-disrupting chemicals (EDCs) can cause adverse neuropsychiatric disorders in children and adolescents. This study aimed to determine the association between the concentrations of prenatal EDCs and brain structure changes in teenagers by using MRI. We recruited 49 mother–child pairs during the third trimester of pregnancy, and collected and examined the concentration of EDCs—including phthalate esters, perfluorochemicals (PFCs), and heavy metals (lead, arsenic, cadmium, and mercury)—in maternal urine and/or serum. MRI voxel-based morphometry (VBM) and generalized q-sampling imaging (GQI) mapping—including generalized fractional anisotropy (GFA), normalized quantitative anisotropy (NQA), and the isotropic value of the orientation distribution function (ISO)—were obtained in teenagers 13–16 years of age in order to find the association between maternal EDC concentrations and possible brain structure alterations in the teenagers’ brains. We found that there are several specific vulnerable brain areas/structures associated with prenatal exposure to EDCs, including decreased focal brain volume, primarily in the frontal lobe; high frontoparietal lobe, temporooccipital lobe and cerebellum; and white matter structural alterations, which showed a negative association with GFA/NQA and a positive association with ISO, primarily in the corpus callosum, external and internal capsules, corona radiata, superior fronto-occipital fasciculus, and superior longitudinal fasciculus. Prenatal exposure to EDCs may be associated with specific brain structure alterations in teenagers.
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Affiliation(s)
- Chao-Yu Shen
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-Y.S.); (J.-D.T.); (P.-H.S.); (M.-C.C.)
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Jun-Cheng Weng
- Bachelor Program in Artificial Intelligence, Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Correspondence: (J.-C.W.); (S.-L.W.); Tel.: +886-(3)-2118800 (ext. 5394) (J.-C.W.); +886-(3)-7246166 (ext. 36509) (S.-L.W.)
| | - Jeng-Dau Tsai
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-Y.S.); (J.-D.T.); (P.-H.S.); (M.-C.C.)
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Pen-Hua Su
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-Y.S.); (J.-D.T.); (P.-H.S.); (M.-C.C.)
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-Y.S.); (J.-D.T.); (P.-H.S.); (M.-C.C.)
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan
- Correspondence: (J.-C.W.); (S.-L.W.); Tel.: +886-(3)-2118800 (ext. 5394) (J.-C.W.); +886-(3)-7246166 (ext. 36509) (S.-L.W.)
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Engel SM, Patisaul HB, Brody C, Hauser R, Zota AR, Bennet DH, Swanson M, Whyatt RM. Neurotoxicity of Ortho-Phthalates: Recommendations for Critical Policy Reforms to Protect Brain Development in Children. Am J Public Health 2021; 111:687-695. [PMID: 33600256 PMCID: PMC7958063 DOI: 10.2105/ajph.2020.306014] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/04/2022]
Abstract
Robust data from longitudinal birth cohort studies and experimental studies of perinatally exposed animals indicate that exposure to ortho-phthalates can impair brain development and increase risks for learning, attention, and behavioral disorders in childhood. This growing body of evidence, along with known adverse effects on male reproductive tract development, calls for immediate action.Exposures are ubiquitous; the majority of people are exposed to multiple ortho-phthalates simultaneously. We thus recommend that a class approach be used in assessing health impacts as has been done with other chemical classes. We propose critically needed policy reforms to eliminate ortho-phthalates from products that lead to exposure of pregnant women, women of reproductive age, infants, and children. Specific attention should be focused on reducing exposures among socially vulnerable populations such as communities of color, who frequently experience higher exposures.Ortho-phthalates are used in a vast array of products and elimination will thus necessitate a multipronged regulatory approach at federal and state levels. The fact that manufacturers and retailers have already voluntarily removed ortho-phthalates from a wide range of products indicates that this goal is feasible.
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Affiliation(s)
- Stephanie M Engel
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Heather B Patisaul
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Charlotte Brody
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Russ Hauser
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Ami R Zota
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Deborah H Bennet
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Maureen Swanson
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Robin M Whyatt
- Stephanie M. Engel is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Heather B. Patisaul is with the Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh. Charlotte Brody is with Healthy Babies Bright Futures, Charlottesville, VA. Russ Hauser is with the Department of Environmental Health at the Harvard T. H. Chan School of Public Health, Boston, MA. Ami R. Zota is with the Department of Environmental and Occupational Health, George Washington University Milken School of Public Health, Washington, DC. Deborah H. Bennet is with the Department of Public Health Sciences, School of Medicine, University of California at Davis. Maureen Swanson is with The Arc of the United States, Washington, DC. Robin M. Whyatt is with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
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Choi G, Villanger GD, Drover SSM, Sakhi AK, Thomsen C, Nethery RC, Zeiner P, Knudsen GP, Reichborn-Kjennerud T, Øvergaard KR, Herring AH, Skogan AH, Biele G, Aase H, Engel SM. Prenatal phthalate exposures and executive function in preschool children. ENVIRONMENT INTERNATIONAL 2021; 149:106403. [PMID: 33524667 PMCID: PMC7945722 DOI: 10.1016/j.envint.2021.106403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prenatal phthalate exposure has been linked with altered neurodevelopment, including externalizing behaviors and attention-deficit hyperactivity disorder (ADHD). However, the implicated metabolite, neurobehavioral endpoint, and child sex have not always been consistent across studies, possibly due to heterogeneity in neurodevelopmental instruments. The complex set of findings may be synthesized using executive function (EF), a construct of complex cognitive processes that facilitate ongoing goal-directed behaviors. Impaired EF can be presented with various phenotypes of poor neurodevelopment, differently across structured conditions, home/community, or preschool/school. We evaluated the relationship between prenatal phthalate exposure and comprehensive assessment of preschool EF. METHODS Our study comprised 262 children with clinically significant/subthreshold ADHD symptoms and 78 typically developing children who were born between 2003 and 2008 and participated in the Preschool ADHD Substudy, which is nested within a population-based prospective cohort study, the Norwegian Mother, Father, and Child Cohort (MoBa). Twelve phthalate metabolites were measured from urine samples that their mothers had provided during pregnancy, at 17 weeks' gestation. All children, at approximately 3.5-years, took part in a detailed clinical assessment that included parent-and teacher-rated inventories and administered tests. We used instruments that measured constructs related to EF, which include a parent-and teacher-reported Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and three performance-based tests: A Developmental NEuroPSYchological Assessment (NEPSY), Stanford-Binet intelligence test V (SB5), and the cookie delay task (CDT). The standard deviation change in test score per interquartile range (IQR) increase in phthalate metabolite was estimated with multivariable linear regression. We applied weighting in all models to account for the oversampling of children with clinically significant or subthreshold symptoms of ADHD. Additionally, we assessed modification by child sex and potential co-pollutant confounding. RESULTS Elevated exposure to mono-benzyl phthalate (MBzP) during pregnancy was associated with poorer EF, across all domains and instruments, in both sex. For example, an IQR increase in MBzP was associated with poorer working memory rated by parent (1.23 [95% CI: 0.20, 2.26]) and teacher (1.13 [0.14, 2.13]) using BRIEF-P, and administered tests such as SB5 (no-verbal: 0.19 [0.09, 0.28]; verbal: 0.13 [0.01, 0.25]). Adverse associations were also observed for mono-n-butyl phthalate (MnBP) and mono-iso-butyl phthalate (MiBP), although results varied by instruments. EF domains reported by parents using BRIEF-P were most apparently implicated, with stronger associations among boys (e.g., MnBP and inhibition: 2.74 [1.77, 3.72]; MiBP and inhibition: 1.88 [0.84, 2.92]) than among girls (e.g., MnBP and inhibition: -0.63 [-2.08, 0.83], interaction p-value: 0.04; MiBP and inhibition: -0.15 [-1.04, 0.74], interaction p-value: 0.3). Differences by sex, however, were not found for the teacher-rated BRIEF-P or administered tests including NEPSY, SB5, and CDT. CONCLUSION AND RELEVANCE Elevated mid-pregnancy MBzP, MiBP, and MnBP were associated with more adverse profiles of EF among preschool-aged children across a range of instruments and raters, with some associations found only among boys. Given our findings and accumulating evidence of the prenatal period as a critical window for phthalate exposure, there is a timely need to expand the current phthalate regulations focused on baby products to include pregnancy exposures.
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Affiliation(s)
- Giehae Choi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Gro D Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Samantha S M Drover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amrit K Sakhi
- Department of Environmental Health, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Environmental Health, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rachel C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gun Peggy Knudsen
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Mental Disorders, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin R Øvergaard
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Amy H Herring
- Department of Statistical Science, Global Health Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Annette H Skogan
- The National Centre for Epilepsy, PO Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Guido Biele
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jedynak P, Maitre L, Guxens M, Gützkow KB, Julvez J, López-Vicente M, Sunyer J, Casas M, Chatzi L, Gražulevičienė R, Kampouri M, McEachan R, Mon-Williams M, Tamayo I, Thomsen C, Urquiza J, Vafeiadi M, Wright J, Basagaña X, Vrijheid M, Philippat C. Prenatal exposure to a wide range of environmental chemicals and child behaviour between 3 and 7 years of age - An exposome-based approach in 5 European cohorts. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 763:144115. [PMID: 33422710 PMCID: PMC7840589 DOI: 10.1016/j.scitotenv.2020.144115] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/20/2020] [Accepted: 11/20/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Studies looking at associations between environmental chemicals and child behaviour usually consider only one exposure or family of exposures. OBJECTIVE This study explores associations between prenatal exposure to a wide range of environmental chemicals and child behaviour. METHODS We studied 708 mother-child pairs from five European cohorts recruited in 2003-2009. We assessed 47 exposure biomarkers from eight chemical exposure families in maternal blood or urine collected during pregnancy. We used the Strengths and Difficulties Questionnaire (SDQ) to evaluate child behaviour between three and seven years of age. We assessed associations of SDQ scores with exposures using an adjusted least absolute shrinkage and selection operator (LASSO) considering all exposures simultaneously and an adjusted exposome-wide association study (ExWAS) considering each exposure independently. RESULTS LASSO selected only copper (Cu) as associated with externalizing behaviour. In the ExWAS, bisphenol A [BPA, incidence rate ratio (IRR): 1.06, 95% confidence interval (95%CI): 1.01;1.12] and mono-n-butyl phthalate (MnBP, IRR: 1.06, 95%CI: 1.00;1.13) were associated with greater risk of externalizing behaviour problems. Cu (IRR: 0.90, 95%CI: 0.82;0.98), perfluoroundecanoate (PFUnDA, IRR: 0.92, 95%CI: 0.84;0.99) and organochlorine compounds (OCs) were associated with lower risk of externalizing behaviour problems, however the associations with OCs were mainly seen among women with insufficient weight gain during pregnancy. Internalizing score worsen in association with exposure to diethyl thiophosphate (DETP, IRR: 1.11, 95%CI: 1.00;1.24) but the effect was driven by the smallest cohort. Internalizing score improved with increased concentration of perfluorooctane sulfonate (PFOS, IRR: 0.92, 95%CI: 0.85;1.00), however the association was driven by the two smallest cohorts with the lowest PFOS concentrations. DISCUSSION This study added evidence on deleterious effects of prenatal exposure to BPA and MnBP on child behaviour. Other associations should be interpreted cautiously since they were not consistent with previous studies or they have not been studied extensively.
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Affiliation(s)
- Paulina Jedynak
- University Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble, France.
| | - Léa Maitre
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mónica Guxens
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Jordi Julvez
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Spain; ISGlobal, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mónica López-Vicente
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Social Medicine, University of Crete, Heraklion, Greece; Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Mariza Kampouri
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Rosie McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mark Mon-Williams
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ibon Tamayo
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - José Urquiza
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Claire Philippat
- University Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences (IAB), Grenoble, France
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Wu H, Zhang W, Zhang Y, Kang Z, Miao X, Na X. Novel insights into di‑(2‑ethylhexyl)phthalate activation: Implications for the hypothalamus‑pituitary‑thyroid axis. Mol Med Rep 2021; 23:290. [PMID: 33649816 PMCID: PMC7930932 DOI: 10.3892/mmr.2021.11930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 09/09/2020] [Indexed: 11/06/2022] Open
Abstract
Di (2‑ethylhexyl) phthalate (DEHP), an environmental pollutant, is widely used as a plasticizer and causes serious pollution in the ecological environment. As previously reported, exposure to DEHP may cause thyroid dysfunction of the hypothalamic‑pituitary‑thyroid (HPT) axis. However, the underlying role of DEHP remains to be elucidated. The present study performed intragastrical administration of DEHP (150, 300 and 600 mg/kg) once a day for 90 consecutive days. DEHP‑stimulated oxidative stress increased the thyroid follicular cavity diameter and caused thyrocyte oedema. Furthermore, DEHP exposure altered mRNA and protein levels. Thus, DEHP may perturb TH homeostasis by affecting biosynthesis, biotransformation, bio‑transportation, receptor levels and metabolism through disruption of the HPT axis and activation of the thyroid‑stimulating hormone (TSH)/TSH receptor signaling pathway. These results identified the formerly unappreciated endocrine‑disrupting activities of phthalates and the molecular mechanisms of DEHP‑induced thyrotoxicity.
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Affiliation(s)
- Haoyu Wu
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Wanying Zhang
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
- Department of Logistics Support, Chengdu Blood Center, Chengdu, Sichuan 610041, P.R. China
| | - Yunbo Zhang
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Zhen Kang
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
- Department of Environmental Hygiene, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang 150001, P.R. China
| | - Xinxiunan Miao
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xiaolin Na
- Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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Minatoya M, Kishi R. A Review of Recent Studies on Bisphenol A and Phthalate Exposures and Child Neurodevelopment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073585. [PMID: 33808331 PMCID: PMC8036555 DOI: 10.3390/ijerph18073585] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 01/17/2023]
Abstract
Purpose of Review: Bisphenol A and phthalate have been found in the environment, as well as in humans. In this narrative review pre- and postnatal bisphenol A and phthalate exposures, their relationship to neurodevelopment, and the behavioral outcomes of children are elucidated, focusing in particular on the recent case-control, cross-sectional, and longitudinal studies. This review also introduces some of the possible mechanisms behind the observed associations between exposures and outcomes. Recent Findings: Although bisphenol A and phthalate exposure have been reported to influence neurobehavioral development in children, there are various kinds of test batteries for child neurodevelopmental assessment at different ages whose findings have been inconsistent among studies. In addition, the timing and number of exposure assessments have varied. Summary: Overall, this review suggests that prenatal exposure to bisphenol A and phthalates may contribute to neurobehavioral outcomes in children. The evidence is still limited; however, Attention Deficit Hyperactivity Disorder (ADHD) symptoms, especially among boys, constantly suggested association with both prenatal and concurrent exposure to bisphenol A. Although there is limited evidence on the adverse effects of prenatal and postnatal bisphenol A and phthalate exposures provided, pregnant women and young children should be protected from exposure based on a precautionary approach.
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Abstract
BACKGROUND Maternal thyroid dysfunction is suspected of causing adverse neurodevelopmental effects, but current evidence is inconclusive. Epidemiologic investigations generally suggest an association between maternal thyroid dysfunction and neurodevelopment impairments in progeny, but clinical trials of thyroid treatment during pregnancy reported null effects. To better understand these discrepant findings, we evaluated the association between maternal thyroid conditions and autism spectrum disorder (ASD), including examining the role of gestational thyroid-related hormone concentrations and thyroid medications use. METHODS Analyses considered 437,222 singleton live births occurring in a large Israeli health fund in 1999-2013, followed through 2016. Thyroid conditions and ASD cases were identified through International Classification of Diseases-9 codes with subsequent validation through review of medical records. Laboratory gestational thyroid hormone measurements were also considered. RESULTS Children of mothers who ever experienced hypothyroidism had a higher risk of ASD compared with children of mothers without hypothyroidism (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] = 1.12, 1.42). The association with hyperthyroidism was less consistent, but elevated in main analyses (aOR = 1.42, 95% CI = 1.04, 1.94). These associations were not explained by maternal gestational thyroid hormones levels nor mitigated by gestational use of thyroid medications. CONCLUSIONS Results indicate that maternal thyroid conditions are associated with increased ASD risk in progeny, but suggestively not due to direct effects of thyroid hormones. Instead, factors that influence maternal thyroid function could have etiologic roles in ASD through pathways independent of maternal gestational thyroid hormones and thus be unaffected by medication treatment. Factors known to disrupt thyroid function should be examined for possible involvement in ASD etiology.
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Urinary phthalate metabolite concentrations and adolescent sleep duration. Environ Epidemiol 2021; 5:e134. [PMID: 33870010 PMCID: PMC8043726 DOI: 10.1097/ee9.0000000000000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/15/2021] [Indexed: 01/06/2023] Open
Abstract
Some environmental chemicals, such as phthalates, are capable of disrupting endocrine function related to the development and regulation of sleep patterns. However, the contribution of phthalate exposure to inadequate sleep during adolescence is unknown. We aim to evaluate the association between phthalate exposure and short sleep duration during adolescence.
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