title: Prenatal Exposure to Perfluoroalkyl Substances and Behavioral Development in Children.
abstract: In recent years, prevalence rates of behavioral disorders in children have increased. One factor possibly implied in the etiology of behavioral disorders is exposure to perfluoroalkyl substances (PFASs). The use of PFASs is highly integrated into everyday life, and exposure is ubiquitous. Exposure to PFASs during early life may be particularly harmful, as it represents a critical time window for brain development. However, research in the area is limited, especially among preschool children. The objective of the current study was to explore the relationship between prenatal exposure to several PFASs and behavioral development at the age of 18 months.
  
  
  
  Data from the Dutch cohort LINC (Linking Maternal Nutrition to Child Health) were used. Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) were measured in cord plasma. The total exposure of PFASs was also calculated (ΣPFASs). Behavioral development was assessed with the Child Behavior Checklist 1.5-5 (CBCL 1.5-5). The CBCL scales "Attention Deficit Hyperactivity Disorder" (ADHD) and "Externalizing problems" were used for further analysis. Separate regression models were composed for each combination, in which exposure levels were classified in tertiles. Both whole population and sex-stratified analyses were performed. A family history of ADHD, the educational level, smoking or using alcohol or illicit drugs during pregnancy were considered as confounders. In total, data from 76 mother-child pairs was included.
  
  
  
  No significant associations were found between prenatal PFAS exposure and ADHD scores in the whole population and in the sex-stratified analyses. With regard to externalizing behavior, a significant negative association was found between the highest levels of ΣPFAS exposure and externalizing problem behavior in the whole population, but only in the crude model. After stratifying for sex, boys in the second and third tertile of exposure to PFOA presented significantly lower scores on the Externalizing Problem Scale than boys with the lowest exposure levels in the adjusted model. Girls exposed to higher levels of ΣPFAS exposure (T2) showed significantly lower scores on the Externalizing Problem Scale, in both crude and adjusted models. No significant associations with PFOS were found.
  
  
  
  RESULTS from the current study show that prenatal exposure to PFOA was negatively related to externalizing behavior in boys. RESULTS were different for boys and girls, emphasizing that mechanisms at work might be sex-dependent. However, results should be interpreted with caution as the sample size was small.
authors.affiliation: Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. i.quaak@vu.nl.
authors.forename: Ilona
authors.initials: I
authors.lastname: Quaak
authors.affiliation: Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. m.de.cock@vu.nl.
authors.forename: Marijke
authors.initials: M
authors.lastname: de Cock
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. m.r.de.boer@vu.nl.
authors.forename: Michiel
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Institute for Environmental Studies, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. marja.lamoree@vu.nl.
authors.forename: Marja
authors.initials: M
authors.lastname: Lamoree
authors.affiliation: Institute for Environmental Studies, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. pim.leonards@vu.nl.
authors.forename: Pim
authors.initials: P
authors.lastname: Leonards
authors.affiliation: Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands. margot.vande.bor@vu.nl.
authors.forename: Margot
authors.initials: M
authors.lastname: van de Bor
mesh_terms: D000328:Adult; D017738:Alkanesulfonic Acids / Q000097:blood / Q000506:poisoning*; D057189:Checklist; D002653:Child Behavior Disorders / Q000139:chemically induced* / Q000453:epidemiology; D002675:Child, Preschool; D004703:Endocrine System / Q000187:drug effects; D005260:Female; D005312:Fetal Blood; D005466:Fluorocarbons / Q000097:blood / Q000506:poisoning*; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D017738:Alkanesulfonic Acids; D005466:Fluorocarbons; C076994:perfluorooctane sulfonic acid
keywords: Attention Deficit Hyperactivity Disorder; behavioral development; early life exposure; endocrine disrupting chemicals; perfluoroalkyl substances; prenatal exposure; preschool children