title: Prenatal Lead Exposure Modifies the Impact of Maternal Self-Esteem on Children's Inattention Behavior.
abstract: OBJECTIVE
  To prospectively evaluate the association of maternal self-esteem measured when their offspring were toddlers with the subsequent development of attention deficit hyperactivity disorder (ADHD)-like behavior in their school-age offspring and the potential modifying effects of prenatal lead exposure.
  
  
  METHODS
  We evaluated a subsample of 192 mother-child pairs from a long-running birth-cohort project that enrolled mothers in Mexico from 1994-2011. Prenatal lead exposure was assessed using cord blood lead and maternal bone lead around delivery (tibia and patella lead, measured by K-x-ray-fluorescence). When children were 2 years old, maternal self-esteem was measured using the Coopersmith Self-Esteem Inventory. When children were 7-15 years old, children's blood lead levels and ADHD symptoms were assessed, and Conners' Parent Rating Scale-Revised and Behavior Rating Inventory of Executive Function-Parent Form were used as measures of ADHD-like behavior.
  
  
  RESULTS
  Adjusting for family economic status, marital status, maternal education and age, child's age and sex, and children's current blood lead levels, increased maternal self-esteem was associated with reduced child inattention behavior. Compared with those among high prenatal lead exposure (P25-P100), this association was stronger among low prenatal lead exposure groups (P1-P25, P values for the interaction effects between prenatal lead exposure and maternal self-esteem levels of <.10). Each 1-point increase in maternal self-esteem scores was associated with 0.6- to 1.3-point decrease in Conners' Parent Rating Scale-Revised and Behavior Rating Inventory of Executive Function-Parent Form T-scores among groups with low cord blood lead and patella lead (P1-P25).
  
  
  CONCLUSIONS
  Children experiencing high maternal self-esteem during toddlerhood were less likely to develop inattention behavior at school age. Prenatal lead exposure may play a role in attenuating this protective effect.
authors.affiliation: Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: jxxinhuachina@gmail.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Xu
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI. Electronic address: Howard.Hu@utoronto.ca.
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
authors.affiliation: Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Wright
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.affiliation: National Institute of Perinatology, Mexico City, Mexico.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Schnaas
authors.affiliation: Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Sung Kyun
authors.initials: SK
authors.lastname: Park
authors.affiliation: National Institute of Perinatology, Mexico City, Mexico.
authors.forename: Sandra
authors.initials: S
authors.lastname: Martínez
authors.affiliation: National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández-Avila
authors.affiliation: National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors.forename: Martha Maria
authors.initials: MM
authors.lastname: Téllez-Rojo
authors.affiliation: Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wright
mesh_terms: D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000097:blood* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007854:Lead / Q000009:adverse effects / Q000097:blood*; D008297:Male; D008800:Mexico; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000523:psychology*; D012307:Risk Factors; D012649:Self Concept
chemical_list: D007854:Lead