Chen Wei-Jen, Rector-Houze Alison M, Guxens Mònica, Iñiguez Carmen, Swartz Michael D, Symanski Elaine, Ibarluzea Jesús, Valentin Antonia, Lertxundi Aitana, González-Safont Llúcia, Sunyer Jordi, Whitworth Kristina W
Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA.
Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
Sci Total Environ. 2024 Feb 20;912:168806. doi: 10.1016/j.scitotenv.2023.168806. Epub 2023 Nov 26.
Few prior studies have explored windows of susceptibility to fine particulate matter (PM) in both the prenatal and postnatal periods and children's attention-deficit/hyperactivity disorder (ADHD) symptoms. We analyzed data from 1416 mother-child pairs from the Spanish INMA (INfancia y Medio Ambiente) Study (2003-2008). Around 5 years of age, teachers reported the number of ADHD symptoms (i.e., inattention, hyperactivity/impulsivity) using the ADHD Diagnostic and Statistical Manual of Mental Disorders. Around 7 years of age, parents completed the Conners' Parent Rating Scales, from which we evaluated the ADHD index, cognitive problems/inattention, hyperactivity, and oppositional subscales, reported as age- and sex-standardized T-scores. Daily residential PM exposures were estimated using a two-stage random forest model with temporal back-extrapolation and averaged over 1-week periods in the prenatal period and 4-week periods in the postnatal period. We applied distributed lag non-linear models within the Bayesian hierarchical model framework to identify susceptible windows of prenatal or postnatal exposure to PM (per 5-μg/m) for ADHD symptoms. Models were adjusted for relevant covariates, and cumulative effects were reported by aggregating risk ratios (RR) or effect estimates (β) across adjacent susceptible windows. A similar susceptible period of exposure to PM (1.2-2.9 and 0.9-2.7 years of age, respectively) was identified for hyperactivity/impulsivity symptoms assessed ~5 years (RR = 2.72, 95% credible interval [CrI] = 1.98, 3.74) and increased hyperactivity subscale ~7 years (β = 3.70, 95% CrI = 2.36, 5.03). We observed a susceptibility period to PM on risk of hyperactivity/impulsivity symptoms ~5 years in gestational weeks 16-22 (RR = 1.36, 95% CrI = 1.22, 1.52). No associations between PM exposure and other ADHD symptoms were observed. We report consistent evidence of toddlerhood as a susceptible window of PM exposure for hyperactivity in young children. Although mid-pregnancy was identified as a susceptible period of exposure on hyperactivity symptoms in preschool-aged children, this association was not observed at the time children were school-aged.
此前很少有研究探讨过在产前和产后阶段对细颗粒物（PM）的易感性窗口期与儿童注意力缺陷多动障碍（ADHD）症状之间的关系。我们分析了来自西班牙INMA（儿童与环境）研究（2003 - 2008年）的1416对母婴的数据。在儿童大约5岁时，教师根据《精神疾病诊断与统计手册》报告ADHD症状的数量（即注意力不集中、多动/冲动）。在儿童大约7岁时，父母完成康纳斯父母评定量表，我们据此评估ADHD指数、认知问题/注意力不集中、多动和对立性子量表，以年龄和性别标准化T分数报告。使用具有时间反向外推的两阶段随机森林模型估计每日住宅PM暴露量，并在产前阶段按1周时间段、产后阶段按4周时间段进行平均。我们在贝叶斯分层模型框架内应用分布滞后非线性模型，以确定产前或产后暴露于PM（每5μg/m）导致ADHD症状的易感窗口期。模型针对相关协变量进行了调整，并通过汇总相邻易感窗口的风险比（RR）或效应估计值（β）报告累积效应。对于在约5岁时评估的多动/冲动症状（RR = 2.72，95%可信区间[CrI] = 1.98，3.74）和在约7岁时多动子量表得分增加（β = 3.70，95% CrI = 2.36，5.03），确定了类似的PM暴露易感期（分别为1.2 - 2.9岁和0.9 - 2.7岁）。我们观察到在妊娠第16 - 22周时，约5岁的多动/冲动症状风险存在PM暴露易感期（RR = 1.36，95% CrI = 1.22，1.52）。未观察到PM暴露与其他ADHD症状之间的关联。我们报告了一致的证据表明幼儿期是幼儿多动的PM暴露易感窗口。尽管妊娠中期被确定为学龄前儿童多动症状的暴露易感期，但在儿童入学时未观察到这种关联。
