Academic journal article Environmental Health Perspectives

Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project

Academic journal article Environmental Health Perspectives

Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project

Article excerpt


Autism spectrum disorders (ASD) are lifelong developmental disabilities characterized by social interaction impairment, communication deficits, and repetitive behaviors (van Engeland and Buitelaar 2008). The prevalence of ASD has increased in the past 20 years, reaching 1 in 86 children in Europe in 2007 (Posada et al. 2007). Despite advances in genetic research, the causes of ASD remain unclear (Betancur 2011). A possible etiologic role for environmental factors has been suggested, particularly during pregnancy (Dietert et al. 2011).

Two recent case-control studies in California showed that ASD in children 2-6 years of age was associated with prenatal exposure to traffic-related air pollutants (Becerra et al. 2013; Volk et al. 2011, 2013), but the results of a twin study from Sweden did not confirm that finding (Gong et al. 2014). Another case-control study among children of Nurses' Health Study II participants reported an association between prenatal exposure to [PM.sub.2.5] (particulate matter with aerodynamic diameter [less than or equal to] 2.5 [micro]m) (Raz et al. 2015) and other air pollutants such as diesel or metals at birth (Roberts et al. 2013) and ASD. Two case-control studies were also carried out in the United States, one showing a significant association of ASD with higher ambient air concentrations of metals at birth (Windham et al. 2006), and another showing null associations between several pollutants at birth and ASD after adjusting for confounders (Kalkbrenner et al. 2010). Brain toxicity of urban air pollutants during development is well documented in animals, and possible biological pathways have been suggested (Block et al. 2012).

Autistic traits are defined as subclinical deficits in socialization, communication, and repetitive behaviors that do not meet formal criteria for an ASD diagnosis (Constantino and Todd 2003). It has been shown that known genetic and environmental influences are consistent across the range of impairment of the continuous autistic trait, indicating an etiologic overlap between very extreme scores, mild impairment, and subthreshold autism-like behavior (Robinson et al. 2011). To date, no study has examined the association of air pollution with the presence of autistic quantitative traits in the general population. In this study we aimed to assess whether prenatal air pollution exposure including nitrogen dioxide ([NO.sub.2]) and PM is associated with autistic traits in childhood in four European population-based birth/child cohort studies.


Population and study design. This study was part of the European Study of Cohorts for Air Pollution Effects (ESCAPE), in which the association between exposure to outdoor air pollution and health is being investigated within prospective cohort studies (http://www. We included three European population-based birth cohorts: Generation R (the Netherlands) (Jaddoe et al. 2012), GASPII (Gene and Environment: Prospective Study on Infancy in Italy) (Porta et al. 2006), and INMA (INfancia y Medio Ambiente; Childhood and Environment; Spain, including three subcohorts) (Guxens et al. 2012), and a European longitudinal child and adolescent twin study: CATSS (Child and Adolescent Twin Study in Sweden) (Anckarsater et al. 2011) (Table 1). Mother-child pairs were recruited from 1992 through 2008. A total of 8,079 children with available data on exposures, outcome, and potential confounders were included (62.2% of the children recruited at baseline). Informed consent was obtained from all participants in each cohort and ethical approval was obtained from the local authorized institutional review boards.

Air pollution exposure. Air pollution concentrations at the participants' birth home addresses were estimated for the whole pregnancy period of each woman by land-use regression models following a standardized procedure described elsewhere (Beelen et al. 2013; Eeftens et al. …

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