- Ames, Jennifer L;
- Burjak, Mohamad;
- Avalos, Lyndsay A;
- Braun, Joseph M;
- Bulka, Catherine M;
- Croen, Lisa A;
- Dunlop, Anne L;
- Ferrara, Assiamira;
- Fry, Rebecca C;
- Hedderson, Monique M;
- Karagas, Margaret R;
- Liang, Donghai;
- Lin, Pi-I D;
- Lyall, Kristen;
- Moore, Brianna;
- Morello-Frosch, Rachel;
- O’Connor, Thomas G;
- Oh, Jiwon;
- Padula, Amy M;
- Woodruff, Tracey J;
- Zhu, Yeyi;
- Hamra, Ghassan B;
- Outcomes, on behalf of program collaborators for Environmental influences on Child Health
Background
Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes.Methods
We included 10 cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) program (n = 1,429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex.Results
Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adjusted β [95% confidence interval (CI)] = 1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adjusted β [95% highest posterior density interval] = 0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences.Conclusions
Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.