Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China.
Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Hefei 230032, Anhui, China.
J Hazard Mater. 2024 Oct 5;478:135541. doi: 10.1016/j.jhazmat.2024.135541. Epub 2024 Aug 15.
Organophosphate esters (OPEs) are a class of environmental chemicals with endocrine-disrupting properties. Epidemiologic studies have demonstrated that prenatal OPEs exposure is associated with neurodevelopmental disorders in offspring. However, studies assessing the effects of prenatal OPEs exposure on the dynamic changes in attention deficit hyperactivity disorder (ADHD) symptoms in preschoolers are scarce. Since vitamin D has been demonstrated to have a "neuroprotective" effect, the modifying effects of maternal vitamin D were estimated.
The present study included 2410 pregnant women from the Ma'anshan Birth Cohort. The levels of OPEs in the mothers' urine were examined in the three trimesters. The Chinese version of the Conners Abbreviated Symptom Questionnaire was used to examine preschoolers' ADHD symptoms at 3, 5, and 6 years of age. ADHD symptom trajectories were fitted via group-based trajectory modeling. We used multinomial logistic regression, Bayesian kernel machine regression, quantile-based g-computation, and generalized linear models to assess individual and mixed relationships between OPEs during pregnancy and preschoolers' ADHD symptoms and trajectories.
Preschoolers' ADHD symptom scores were fitted to 3 trajectories, including the low-score, moderate-score, and high-score groups. First-trimester dibutyl phosphate (DBP), second-trimester bis(2-butoxyethyl) phosphate (BBOEP), and third-trimester diphenyl phosphate (DPHP) were associated with an increased risk in the high-score group (p < 0.05). BBOEP in the third trimester was associated with decreased risk in the moderate-score group (OR = 0.89, 95% CI: 0.79, 1.00). For mothers with 25(OH)D deficiency, a positive relationship was observed between OPEs during pregnancy and symptom trajectories. Our results did not reveal any mixed effects of OPEs on ADHD symptom trajectories.
Prenatal exposure to OPEs had heterogeneous associations with ADHD symptom trajectories in preschoolers. Additionally, the effect of individual OPEs on symptom trajectories was intensified by vitamin D deficiency.
有机磷酸酯（OPEs）是一类具有内分泌干扰特性的环境化学物质。流行病学研究表明，产前 OPEs 暴露与后代的神经发育障碍有关。然而，评估产前 OPEs 暴露对学龄前儿童注意缺陷多动障碍（ADHD）症状动态变化影响的研究很少。由于维生素 D 已被证明具有“神经保护”作用，因此估计了母体维生素 D 的修饰作用。
本研究纳入了来自马鞍山出生队列的 2410 名孕妇。在妊娠的三个阶段检测母亲尿液中的 OPEs 水平。采用中文版康纳简要症状问卷评估学龄前儿童 3、5 和 6 岁时的 ADHD 症状。通过基于群组的轨迹建模拟合 ADHD 症状轨迹。我们使用多项逻辑回归、贝叶斯核机器回归、基于分位数的 g 计算和广义线性模型来评估怀孕期间个体和混合 OPEs 与学龄前儿童 ADHD 症状和轨迹之间的关系。
学龄前儿童 ADHD 症状评分拟合为 3 个轨迹，包括低得分、中得分和高得分组。第一孕期二丁基磷酸酯（DBP）、第二孕期双（2-丁氧基乙基）磷酸酯（BBOEP）和第三孕期磷酸二苯酯（DPHP）与高分组的风险增加相关（p<0.05）。第三孕期的 BBOEP 与中分组的风险降低相关（OR=0.89，95%CI：0.79，1.00）。对于 25（OH）D 缺乏的母亲，怀孕期间 OPEs 与症状轨迹之间存在正相关关系。我们的结果没有显示 OPEs 对 ADHD 症状轨迹的任何混合影响。
产前接触 OPEs 与学龄前儿童 ADHD 症状轨迹存在异质性关联。此外，维生素 D 缺乏会加剧个体 OPEs 对症状轨迹的影响。
