Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Science for Life Laboratory, Department of Analytical Chemistry and Environmental Sciences, Stockholm University, Stockholm, Sweden.
Environ Int. 2020 Sep;142:105892. doi: 10.1016/j.envint.2020.105892. Epub 2020 Jun 25.
Environmental health research has reported mixed findings on the associations between prenatal exposure to phthalates and parent-ratings of child behavioral problems.
We examined the consistency of the associations between prenatal urinary phthalate concentrations and child behavior scores across two standardized instruments - the Behavior Assessment System for Children-Second Edition (BASC-2) and the Child Behavior Checklist (CBCL) - using two analytical approaches used to correct for urine dilution.
A sample of 351 mother-child pairs were selected from a prospective birth cohort of pregnant women enrolled between 2009 and 2012. Women provided spot urine samples during the second trimester of pregnancy, which were analyzed for levels of nine urinary phthalate metabolites. When their typically developing children were 3-4 years of age, mothers completed the BASC-2 and CBCL on the same day. Adjusted regression analyses examined the associations between maternal prenatal phthalate concentrations and child behavior scores on the BASC-2 and CBCL. To correct for urine dilution, primary regression analyses included urinary creatinine concentration as a separate independent variable (i.e., covariate). In the secondary regression analyses, creatinine-adjusted phthalate concentrations were used.
Primary logistic regression analyses that included urinary creatinine as a covariate showed that higher prenatal phthalate concentrations were related to increased odds of scores falling into the borderline or clinical range on the Hyperactivity, Aggression, Anxiety, Depression, Withdrawal, Externalizing Problems, Internalizing Problems, and Behavioral Symptoms Index scales on the BASC-2 (ORs from 1.39 to 2.07), but only the Anxious/Depressed and Externalizing Problems scales on the CBCL (ORs from 1.80 to 3.28). Primary linear regression analyses showed that higher prenatal phthalate concentrations were related to higher scores on the Externalizing Problems (β's = 0.16), Internalizing Problems (β's from 0.16 to 0.20), and Behavioral Symptoms Index (β's from 0.18 to 0.21) scales on the BASC-2, but not related to any CBCL scales. Sex-stratified analyses found that many associations were only significant for male children. Secondary analyses using creatinine-adjusted phthalate concentrations revealed that some of the associations from the primary analyses remained significant; however, a number of unique associations were observed.
Prenatal phthalate exposure was associated with preschool behavioral development; however, findings were not consistent for the BASC-2 and CBCL, especially related to the clinical/syndrome scales and Internalizing Problems scale. Further, many findings differed based on the analytical approach used to correct for urine dilution. Future work is needed to delineate the similarities and differences between similarly named child behavior constructs assessed by different neurodevelopmental assessments. Also, research is needed to better understand why and how different analytical approaches influence the reported associations between maternal prenatal phthalate concentrations and children's behavior problems.
环境健康研究报告称，产前暴露于邻苯二甲酸酯与父母对儿童行为问题的评估之间的关联存在差异。
我们使用两种分析方法（一种是通过单独的尿液肌酐浓度作为独立变量进行校正，另一种是通过肌酐校正的尿液邻苯二甲酸酯浓度进行校正），检验了两种标准化工具（行为评估系统第二版（BASC-2）和儿童行为检查表（CBCL））中，产前尿液邻苯二甲酸酯浓度与儿童行为评分之间的一致性。
选择了 2009 年至 2012 年期间参加前瞻性孕妇队列研究的 351 对母婴。女性在妊娠中期提供随机尿液样本，用于分析 9 种尿液邻苯二甲酸酯代谢物的水平。当他们发育正常的孩子 3-4 岁时，母亲在同一天完成了 BASC-2 和 CBCL。调整后的回归分析检验了母亲产前邻苯二甲酸酯浓度与 BASC-2 和 CBCL 上儿童行为评分之间的关联。为了校正尿液稀释，主要回归分析将尿液肌酐浓度作为单独的独立变量（即协变量）包括在内。在二次回归分析中，使用了肌酐校正的邻苯二甲酸酯浓度。
包括尿液肌酐作为协变量的主要逻辑回归分析表明，较高的产前邻苯二甲酸酯浓度与 BASC-2 上多动、攻击、焦虑、抑郁、退缩、外化问题、内化问题和行为症状指数的边界或临床范围内评分的几率增加有关（OR 从 1.39 到 2.07），但仅与 CBCL 上的焦虑/抑郁和外化问题量表有关（OR 从 1.80 到 3.28）。主要线性回归分析表明，较高的产前邻苯二甲酸酯浓度与 BASC-2 上的外化问题（β=0.16）、内化问题（β=0.16 到 0.20）和行为症状指数（β=0.18 到 0.21）的评分较高有关，但与 CBCL 上的任何量表均无关。性别分层分析发现，许多关联仅对男童具有统计学意义。使用肌酐校正的邻苯二甲酸酯浓度进行的二次分析表明，主要分析中的一些关联仍然具有统计学意义；然而，观察到了一些独特的关联。
产前邻苯二甲酸酯暴露与学龄前儿童的行为发育有关；然而，BASC-2 和 CBCL 的发现并不一致，特别是与临床/综合征量表和内化问题量表有关。此外，许多发现基于用于校正尿液稀释的分析方法而有所不同。需要进一步的研究来阐明不同神经发育评估中使用的类似命名的儿童行为结构之间的异同。此外，还需要研究为什么和如何不同的分析方法会影响报告的母亲产前邻苯二甲酸酯浓度与儿童行为问题之间的关联。
