Academic journal article Environmental Health Perspectives

Prenatal Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Association with Autism Spectrum Disorder and Intellectual Disability

Academic journal article Environmental Health Perspectives

Prenatal Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Association with Autism Spectrum Disorder and Intellectual Disability

Article excerpt

Introduction

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are manmade chemicals in wide use since the 1950s for a variety of industrial and commercial purposes, including most commonly as a coating or as a water or stain repellant in carpets and other products (DeWitt 2015; ATSDR 2016). PFAS have been detected with some variability in countries around the world in both sea and drinking water sources (Fromme et al. 2009; Zhao et al. 2012). In the United States, more than 95% of participants in the National Health and Nutrition Examination Survey (NHANES) study (1999-2008) had detectable serum concentrations of a number of PFAS in their bloodstream (Kato et al. 2011). Results from an in vitro study using cells derived from rat adrenal medulla suggested that some PFAS may affect neuronal cell development and cell differentiation (Slotkin et al. 2008), whereas animal in vivo studies have linked prenatal exposure to high levels of PFAS with low birth weight and reductions in thyroid hormone levels (Lau et al. 2004), as well as with hyperactivity and reduced habituation in adult mice (Johansson et al. 2008). In humans, PFAS can cross the placenta (Kim et al. 2011; Gutzkow et al. 2012) and have been detected in breast milk (Fromme et al. 2010). A possible association between PFAS and thyroid hormones, which are known to be important in brain development (Rovet 2014), has limited evidence from two recent, small studies examining cord blood PFAS and neonatal thyroid hormone levels (de Cock et al. 2014; Shah-Kulkarni et al. 2016). Thus, exposure to the developing child during susceptible time periods of critical brain development is of potential concern. However, research on prenatal exposure to PFAS and neurodevelopmental outcomes in children has been somewhat limited.

Autism spectrum disorder (ASD) is characterized by impairments in social interaction and communication and by the presence of restricted, stereotyped interests and behaviors (American Psychiatric Association 2013). Both ASD and intellectual disability (ID)--often comorbid with ASD--are complex neurodevelopmental disorders that have suspected prenatal environmental influences and evidence of early disruption of neurodevelopmental processes (Rodier 2000; Scorza and Cavalheiro 2011; Lyall et al. 2017a). Prior work has suggested that environmental chemicals, including other persistent organic pollutants, may influence these outcomes (Landrigan 2010; CheslackPostava et al. 2013; Eskenazi et al. 2013; Grandjean and Landrigan 2014; Lyall et al. 2017b). However, only one study to our knowledge has examined prenatal PFAS exposure in association with ASD diagnosis, a case-control investigation that did not find evidence for increased risk with the PFAS measured (Liew et al. 2015). Another study, a prospective cohort examining several PFAS, including perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoate (PFNA), and perfluorohexane sulfonate (PFHxS), in association with autistic behaviors (as measured by Social Responsiveness Scale scores), reported an inverse association with serum concentrations of PFOA (Braun et al. 2014). More broadly, prenatal exposure to PFAS has been associated with various behavioral domains that have applicability to impairments in ASD or ID. Specifically, cord blood PFOS levels have been linked with lower gross and fine motor test scores in 2-y-old children (Chen et al. 2013); PFOA measured in maternal serum has been associated with lower mental development scores in girls at 6 mo of age [though not in boys, and associations were not seen with other outcomes or PFAS (Goudarzi et al. 2016)]; and maternal serum PFOS has been associated with lower behavior regulation, metacognition, and global executive functioning scores in children at 5 and 8 y of age [though again, no associations were found with other PFAS measured (Vuong et al. 2016)].

Given the limited research in this area, as well as biological plausibility for an association, we examined maternal prenatal PFAS serum concentrations in association with offspring ASD as well as intellectual disability without ASD. …

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