title: Attention deficit/hyperactivity disorder and childhood autism in association with prenatal exposure to perfluoroalkyl substances: a nested case-control study in the Danish National Birth Cohort.
abstract: BACKGROUND
  Perfluoroalkyl substances (PFASs) are persistent pollutants found to be endocrine disruptive and neurotoxic in animals. Positive correlations between PFASs and neurobehavioral problems in children were reported in cross-sectional data, but findings from prospective studies are limited.
  
  
  OBJECTIVE
  We investigated whether prenatal exposure to PFASs is associated with attention deficit/hyperactivity disorder (ADHD) or childhood autism in children.
  
  
  METHODS
  Among 83,389 mother-child pairs enrolled in the Danish National Birth Cohort during 1996-2002, we identified 890 ADHD cases and 301 childhood autism cases from the Danish National Hospital Registry and the Danish Psychiatric Central Registry. From this cohort, we randomly selected 220 cases each of ADHD and autism, and we also randomly selected 550 controls frequency matched by child's sex. Sixteen PFASs were measured in maternal plasma collected in early or mid-pregnancy. We calculated risk ratios (RRs) using generalized linear models, taking into account sampling weights.
  
  
  RESULTS
  Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected in all samples; four other PFASs were quantified in ≥ 90% of the samples. We did not find consistent evidence of associations between mother's PFAS plasma levels and ADHD [per natural log nanograms per milliliter increase: PFOS RR = 0.87 (95% CI: 0.74, 1.02); PFOA RR = 0.98 (95% CI: 0.82, 1.16)] or autism [per natural log nanograms per milliliter increase: PFOS RR = 0.92 (95% CI: 0.69, 1.22); PFOA RR = 0.98 (95% CI: 0.73, 1.31)]. We found positive as well as negative associations between higher PFAS quartiles and ADHD in models that simultaneously adjusted for all PFASs, but these estimates were imprecise.
  
  
  CONCLUSIONS
  In this study we found no consistent evidence to suggest that prenatal PFAS exposure increases the risk of ADHD or childhood autism in children.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Zeyan
authors.initials: Z
authors.lastname: Liew
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
authors.forename: Ondine S
authors.initials: OS
authors.lastname: von Ehrenstein
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
authors.forename: Ellen Aagaard
authors.initials: EA
authors.lastname: Nohr
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Fei
authors.forename: Rossana
authors.initials: R
authors.lastname: Bossi
authors.forename: Tine Brink
authors.initials: TB
authors.lastname: Henriksen
authors.forename: Eva Cecilie
authors.initials: EC
authors.lastname: Bonefeld-Jørgensen
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000328:Adult; D017738:Alkanesulfonic Acids / Q000097:blood / Q000633:toxicity*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000209:etiology; D001321:Autistic Disorder / Q000453:epidemiology* / Q000209:etiology; D002210:Caprylates / Q000097:blood / Q000633:toxicity*; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D005466:Fluorocarbons / Q000097:blood / Q000633:toxicity*; D006801:Humans; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000209:etiology
chemical_list: D017738:Alkanesulfonic Acids; D002210:Caprylates; D004785:Environmental Pollutants; D005466:Fluorocarbons