Attention Deficit/Hyperactivity Disorder and Childhood Autism in Association with Prenatal Exposure to Perfluoroalkyl Substances: A Nested Case-Control Study in the Danish National Birth Cohort

Zeyan Liew, Beate Ritz, Ondine S von Ehrenstein, Bodil H Bech, Ellen A Nohr, Chunyuan Fei, Rossana Bossi, Tine B Henriksen, Eva C Bonefeld-Jørgensen, Jørn Olsen

Research output: Contribution to journalJournal articleResearchpeer-review


BACKGROUND: Perfluoroalkyl substances (PFASs) are persistent pollutants found to be endocrine disruptive and neurotoxic in animals. Positive correlations between PFASs and neurobehavioral problems in children were reported in cross-sectional data, but findings from prospective studies are limited.

OBJECTIVES: We investigated whether prenatal exposure to PFASs is associated with attention deficit/hyperactivity disorder (ADHD) or childhood autism in children.

METHODS: Among 83,389 mother-child pairs enrolled in the Danish National Birth Cohort during 1996-2002, we identified 890 ADHD cases and 301 childhood autism cases from the Danish National Hospital Registry and the Danish Psychiatric Central Registry. From this cohort, we randomly selected 220 cases of ADHD and autism each, and we also randomly selected 550 controls frequency matched by child's sex. Sixteen PFASs were measured in maternal plasma collected in early or mid-pregnancy. We calculated risk ratios (RR) using generalized linear models taking into account sampling weights.

RESULTS: Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected in all samples; 4 other PFASs were quantified in ≥ 90% of the samples. We did not find consistent evidence of associations between mother's PFAS plasma levels and ADHD (per ln-ng/ml increase: PFOS RR = 0.87; 95%CI: 0.74, 1.02; PFOA RR = 0.98; 95%CI: 0.82, 1.16) or autism (per ln-ng/ml increase: PFOS RR = 0.92; 95%CI: 0.69, 1.22; PFOA RR = 0.98; 95%CI: 0.73, 1.31). We found positive as well as negative associations between higher PFAS quartiles and ADHD in models that simultaneously adjusted for all PFASs, but these estimates were imprecise.

CONCLUSIONS: In this study we found no evidence to suggest that prenatal PFAS exposure increases the risk of ADHD or childhood autism in children.

Original languageEnglish
JournalEnvironmental Health Perspectives
Issue number4
Number of pages7
Publication statusPublished - 2015


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