Springer Katherine, Eatman Jasmin A, Brennan Patricia A, Dunlop Anne L, Barr Dana Boyd, Panuwet Parinya, Ryan P Barry, Corwin Elizabeth, Taibl Kaitlin R, Tan Youran, Hoffman Susan S, Liang Donghai, Eick Stephanie M
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Emory University School of Medicine, Atlanta, GA, USA.
Brain Behav Immun Health. 2024 Aug 10;40:100846. doi: 10.1016/j.bbih.2024.100846. eCollection 2024 Oct.
Prenatal exposure to phthalates, a group of synthetic chemicals widely used in consumer products, has previously been associated with adverse infant and child development. Studies also suggest that maternal depression and anxiety, may amplify the harmful effects of phthalates on infant and child neurodevelopment.
Our analysis included a subset of dyads enrolled in the Atlanta African American Maternal-Child Cohort (N = 81). We measured eight phthalate metabolites in first and second trimester (8-14 weeks and 24-32 weeks gestation) maternal urine samples to estimate prenatal exposures. Phthalate metabolite concentrations were averaged across visits and natural log-transformed for analysis. Maternal symptoms of depression and anxiety were assessed using validated questionnaires (Edinberg Postnatal Depression Scale and State Trait Anxiety Inventory, respectively) and the total score on each scale was averaged across study visits. The NICU Network Neurobehavioral Scale (NNNS) was administered at two weeks of age. Our primary outcomes included two composite NNNS scores reflecting newborn attention and arousal. Linear regression was used to estimate associations between individual phthalate exposures and newborn attention and arousal. We assessed effect modification by maternal depression and anxiety.
Higher levels of urinary phthalate metabolites were not associated with higher levels of infant attention and arousal, but true associations may still exist given the limited power of this analysis. In models examining effect modification by maternal depression, we observed that an interquartile range increase in mono (2-ethlyhexyl) phthalate (MEHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was associated with a significant increase in newborn arousal only among those with high depressive symptoms (MEHP: β = 0.71, 95% confidence interval [CI] = 0.10, 1.32 for high, β = -0.30, 95% CI = -0.73, 0.12 for low; MEOHP: β = 0.60, 95% CI = -0.03, 1.23 for high, β = -0.12, 95% CI = -0.58, 0.33 for low; MEHHP: β = 0.54, 95% CI = -0.04, 1.11 for high, β = -0.11, 95% CI = -0.54, 0.32 for low). Similar patterns were observed in models stratified by maternal anxiety, although CIs were wide.
Our results suggest maternal anxiety and depression symptoms may exacerbate the effect of phthalates on infant neurodevelopment. Future studies are needed to determine the optimal levels of attention and arousal in early infancy.
产前接触邻苯二甲酸盐（一类广泛用于消费品的合成化学物质）此前已被证明与婴幼儿不良发育有关。研究还表明，母亲的抑郁和焦虑可能会放大邻苯二甲酸盐对婴幼儿神经发育的有害影响。
我们的分析纳入了亚特兰大非裔美国母婴队列中的一部分二元组（N = 81）。我们在孕早期（妊娠8 - 14周）和孕中期（妊娠24 - 32周）的母亲尿液样本中测量了八种邻苯二甲酸酯代谢物，以估计产前接触情况。邻苯二甲酸酯代谢物浓度在各次访视时进行平均，并进行自然对数转换以进行分析。使用经过验证的问卷（分别为爱丁堡产后抑郁量表和状态特质焦虑量表）评估母亲的抑郁和焦虑症状，每个量表的总分在各次研究访视时进行平均。在出生两周时进行新生儿重症监护病房网络神经行为量表（NNNS）测评。我们的主要结局包括两个反映新生儿注意力和觉醒的综合NNNS评分。使用线性回归来估计个体邻苯二甲酸酯暴露与新生儿注意力和觉醒之间的关联。我们评估了母亲抑郁和焦虑的效应修正作用。
尿中邻苯二甲酸酯代谢物水平较高与婴儿注意力和觉醒水平较高无关，但鉴于本分析的检验效能有限，真实关联可能仍然存在。在检验母亲抑郁的效应修正作用的模型中，我们观察到邻苯二甲酸单（2 - 乙基己基）酯（MEHP）、邻苯二甲酸单（2 - 乙基 - 5 - 氧代己基）酯（MEOHP）和邻苯二甲酸单（2 - 乙基 - 5 - 羟基己基）酯（MEHHP）的四分位数间距增加仅在那些抑郁症状严重的人群中与新生儿觉醒显著增加相关（MEHP：高抑郁症状组β = 0.71，95%置信区间[CI] = 0.10，1.32；低抑郁症状组β = -0.30，95% CI = -0.73，0.12；MEOHP：高抑郁症状组β = 0.60，95% CI = -0.03，1.23；低抑郁症状组β = -0.12，95% CI = -0.58，0.33；MEHHP：高抑郁症状组β = 0.54，95% CI = -0.04，1.11；低抑郁症状组β = -0.11，95% CI = -0.54，0.32）。在按母亲焦虑分层的模型中观察到类似模式，尽管置信区间较宽。
我们的结果表明，母亲的焦虑和抑郁症状可能会加剧邻苯二甲酸盐对婴儿神经发育的影响。未来需要开展研究以确定婴儿早期注意力和觉醒的最佳水平。
