Perera Frederica P, Wheelock Kylie, Wang Ya, Tang Deliang, Margolis Amy E, Badia Gladys, Cowell Whitney, Miller Rachel L, Rauh Virginia, Wang Shuang, Herbstman Julie B
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
Environ Res. 2018 Jan;160:506-513. doi: 10.1016/j.envres.2017.09.002. Epub 2017 Oct 4.
Polycyclic aromatic hydrocarbons (PAH) are carcinogenic and neurotoxic combustion by-products commonly found in urban air. Exposure to PAH is disproportionately high in low income communities of color who also experience chronic economic stress.
In a prospective cohort study in New York City (NYC) we previously found a significant association between prenatal PAH exposure and Attention Deficit Hyperactivity Disorder (ADHD) behavior problems at age 9. Here, we have evaluated the joint effects of prenatal exposure to PAH and prenatal/childhood material hardship on ADHD behavior problems.
We enrolled nonsmoking African-American and Dominican pregnant women in New York City between 1998 and 2006 and followed their children through 9 years of age. As a biomarker of prenatal PAH exposure, PAH-DNA adducts were measured in maternal blood at delivery and were dichotomized at the limit of detection (to indicate high vs. low exposure). Maternal material hardship (lack of adequate food, housing, utilities, and clothing) was self-reported prenatally and at multiple time points through child age 9. Latent variable analysis identified four distinct patterns of hardship. ADHD behavior problems were assessed using the Conners Parent Rating Scale- Revised. Analyses adjusted for relevant covariates.
Among 351 children in our sample, across all hardship groups, children with high prenatal PAH exposure (high adducts) generally had more symptoms of ADHD (higher scores) compared to those with low PAH exposure. The greatest difference was seen among the children with hardship persisting from pregnancy through childhood. Although the interactions between high PAH exposure and hardship experienced at either period ("persistent" hardship or "any" hardship) were not significant, we observed significant differences in the number of ADHD symptoms between children with high prenatal PAH exposure and either persistent hardship or any hardship compared to the others. These differences were most significant for combined high PAH and persistent hardship: ADHD Index (p < 0.008), DSM-IV Inattentive (p = 0.006), DSM-IV Hyperactive Impulsive problems (p = 0.033), and DSM-IV Index Total (p = 0.009).
The present findings add to existing evidence that co-exposure to socioeconomic disadvantage and air pollution in early life significantly increases the risk of adverse neurodevelopmental outcomes. They suggest the need for multifaceted interventions to protect pregnant mothers and their children.
多环芳烃（PAH）是常见于城市空气中的致癌和神经毒性燃烧副产品。在经历慢性经济压力的低收入有色人种社区中，PAH暴露水平过高。
在纽约市（NYC）进行的一项前瞻性队列研究中，我们先前发现产前PAH暴露与9岁时的注意力缺陷多动障碍（ADHD）行为问题之间存在显著关联。在此，我们评估了产前PAH暴露与产前/儿童期物质困难对ADHD行为问题的联合影响。
我们在1998年至2006年间招募了纽约市不吸烟的非裔美国人和多米尼加孕妇，并跟踪其子女至9岁。作为产前PAH暴露的生物标志物，在分娩时测量母体血液中的PAH-DNA加合物，并在检测限处进行二分法划分（以表明高暴露与低暴露）。产前以及在孩子9岁之前的多个时间点自我报告母体物质困难（缺乏足够的食物、住房、水电和衣物）。潜在变量分析确定了四种不同的困难模式。使用修订后的康纳斯父母评定量表评估ADHD行为问题。分析对相关协变量进行了调整。
在我们样本中的351名儿童中，在所有困难组中，产前PAH暴露高（加合物高）的儿童与PAH暴露低的儿童相比，通常有更多的ADHD症状（得分更高）。在从孕期持续到儿童期都有困难的儿童中差异最大。尽管高PAH暴露与任一时期经历的困难（“持续”困难或“任何”困难）之间的相互作用不显著，但我们观察到产前PAH暴露高且有持续困难或任何困难的儿童与其他儿童相比，ADHD症状数量存在显著差异。这些差异在PAH高暴露与持续困难并存时最为显著：ADHD指数（p < 0.008）、DSM-IV注意力不集中（p = 0.006）、DSM-IV多动冲动问题（p = 0.033）和DSM-IV指数总分（p = 0.009）。
目前的研究结果进一步证明，早年同时暴露于社会经济劣势和空气污染会显著增加不良神经发育结局的风险。这表明需要采取多方面的干预措施来保护孕妇及其子女。
