title: Prenatal exposure to perfluoroalkyl substances and the risk of congenital cerebral palsy in children.
abstract: Perfluoroalkyl substances (PFASs) are persistent pollutants and endocrine disruptors that may affect fetal brain development. We investigated whether prenatal exposure to PFASs increases the risk of congenital cerebral palsy (CP). The source population for this study includes 83,389 liveborn singletons and mothers enrolled in the Danish National Birth Cohort during 1996-2002. We identified 156 CP cases by linking the cohort to the Danish National Cerebral Palsy Register, and we randomly selected 550 controls using a case-cohort design. We measured 16 PFASs in maternal plasma collected in early or midpregnancy, and 6 PFASs were quantifiable in more than 90% of the samples. We found a higher risk of CP in boys with higher maternal PFAS levels; per 1-unit (natural-log ng/mL) increase, the risk ratios were 1.7 (95% confidence interval: 1.0, 2.8) for perfluorooctane sulfonate and 2.1 (95% confidence interval: 1.2, 3.6) for perfluorooctanoic acid. We also observed a dose-response pattern of CP risk in boys per quartile of maternal level of perfluorooctane sulfonate and perfluorooctanoic acid (P for trend < 0.01). PFASs were associated with both unilateral and bilateral spastic CP subphenotypes. No association between PFASs and CP was found in girls. Prenatal exposures to PFASs may increase the risk of CP in boys, but the finding is novel and replication is needed.
authors.forename: Zeyan
authors.initials: Z
authors.lastname: Liew
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
authors.forename: Eva Cecilie
authors.initials: EC
authors.lastname: Bonefeld-Jørgensen
authors.forename: Tine Brink
authors.initials: TB
authors.lastname: Henriksen
authors.forename: Ellen Aagaard
authors.initials: EA
authors.lastname: Nohr
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Fei
authors.forename: Rossana
authors.initials: R
authors.lastname: Bossi
authors.forename: Ondine S
authors.initials: OS
authors.lastname: von Ehrenstein
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.forename: Peter
authors.initials: P
authors.lastname: Uldall
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000328:Adult; D017738:Alkanesulfonic Acids / Q000097:blood / Q000633:toxicity*; D002210:Caprylates / Q000097:blood / Q000633:toxicity*; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000097:blood / Q000139:chemically induced* / Q000151:congenital / Q000453:epidemiology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D052244:Endocrine Disruptors / Q000097:blood / Q000633:toxicity*; D004784:Environmental Monitoring / Q000706:statistics & numerical data; D004785:Environmental Pollutants / Q000097:blood / Q000633:toxicity; D005260:Female; D005466:Fluorocarbons / Q000097:blood / Q000633:toxicity*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D016017:Odds Ratio; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D017678:Sex Distribution; D012737:Sex Factors; D055815:Young Adult
chemical_list: D017738:Alkanesulfonic Acids; D002210:Caprylates; D052244:Endocrine Disruptors; D004785:Environmental Pollutants; D005466:Fluorocarbons; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid
keywords: congenital cerebral palsy; movement and posture disorders; perfluoroalkyl substance; perfluorooctane sulfonate; perfluorooctanoic acid