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Published on: March 6, 2018
Phthalate mixtures in pregnancy, autistic traits, and adverse childhood behavioral outcomes
Drew B Day1, Brent R Collett2, Emily S Barrett3
1Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA.
Insights
Prenatal exposure to phthalate mixtures is linked to autistic traits and behavioral issues in children. Early pregnancy exposure showed associations with social impairment and adaptive skills in both sexes.
Area of Science:
- Environmental Health
- Developmental Toxicology
- Pediatric Behavioral Science
Background:
- Prenatal exposure to phthalates is common, yet few studies examine phthalate mixtures' impact on child development.
- Research is needed to understand cumulative effects of phthalate exposures on autistic traits and behavioral problems.
Purpose of the Study:
- To evaluate cumulative associations between prenatal phthalate mixtures and child behaviors.
- To investigate effect modification by exposure timing (early vs. late pregnancy) and child sex.
Main Methods:
- Analysis of 501 mother/child pairs from The Infant Development and Environment Study (TIDES) cohort.
- Measurement of nine maternal urinary phthalate metabolites in early and late pregnancy.
- Assessment of child behavior at ages 4-5 years using the Behavioral Assessment System for Children (BASC-2) and Social Responsiveness Scale (SRS-2).
- Application of weighted quantile sum (WQS) regressions and permutation tests for association analysis.
- Stratified analyses to examine sex-specific effects.
Main Results:
- A one-quintile increase in early pregnancy phthalate mixture was associated with higher SRS-2 scores (autistic traits) and poorer adaptive skills in both sexes.
- Sex-stratified analysis revealed associations between early pregnancy phthalate mixtures and increased SRS-2 scores in boys and girls, and worse adaptive skills in girls.
- Late pregnancy phthalate mixture exposure was linked to increased externalizing behaviors in boys.
Conclusions:
- Cumulative prenatal exposure to phthalate mixtures is associated with adverse child behavioral outcomes.
- The timing of phthalate exposure during pregnancy may influence specific behavioral outcomes.
- Findings highlight the importance of considering phthalate mixtures in environmental health research related to child development.
Background:
Prenatal exposure to multiple phthalates is ubiquitous, and yet few studies have evaluated these exposures as a mixture in relation to child autistic traits and behavioral problems.
Objectives:
To assess cumulative associations between prenatal phthalate mixtures and child behaviors, including effect modification by exposure timing and child sex.
Methods:
Analyses included 501 mother/child pairs from the multicenter pregnancy cohort The Infant Development and Environment Study (TIDES). Nine maternal urinary phthalate metabolites were measured in early and late pregnancy, and behavior was assessed at ages 4-5 years using composite T scores for the Behavioral Assessment System for Children (BASC-2), which measures several dimensions of child behavior, and the Social Responsiveness Scale (SRS-2), which measures social impairment consistent with autistic traits. We utilized weighted quantile sum (WQS) regressions to examine pregnancy period-specific associations between phthalate mixtures and behavioral outcomes. Full-sample 95% WQS confidence intervals are known to be anti-conservative, so we calculated a confirmatory p-value using a permutation test. Effect modification by sex was examined with stratified analyses.
Results:
A one-quintile increase in the early pregnancy phthalate mixture was associated with increased SRS-2 total score (coefficient = 1.0, confirmatory p = 0.01) and worse adaptive skills (coefficient = -1.0, confirmatory p = 0.06) in both sexes. In sex-stratified analyses, the early pregnancy phthalate mixture was associated with increased SRS-2 total score in boys (coefficient = 1.2, confirmatory p = 0.04) and girls (coefficient = 1.0, confirmatory p = 0.10) and worse BASC-2 adaptive skills score in girls (coefficient = -1.5, confirmatory p = 0.06), while the late pregnancy phthalate mixture was associated with increased BASC-2 externalizing score in boys (coefficient = 1.3, confirmatory p = 0.03).
Conclusion:
Our results suggest cumulative adverse associations between prenatal phthalate mixtures and multiple facets of childhood behavior.
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