Cited by 143Effects and risks of endocrine disrupting chemicalsToxic Organic Pollutants ImpactAttention Deficit Hyperactivity Disorder

Prenatal phthalates, maternal thyroid function, and risk of attention-deficit hyperactivity disorder in the Norwegian mother and child cohort

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Engel, Stephanie M., Villanger, Gro D., Nethery, Rachel C., Thomsen, Cathrine, Sakhi, Amrit K., Drover, Samantha S.M., Hoppin, Jane A., Zeiner, Pal +4 more·2018·Environmental Health Perspectives

Abstract

BACKGROUND: There is growing concern that phthalate exposures may have an impact on child neurodevelopment. Prenatal exposure to phthalates has been linked with externalizing behaviors and executive functioning defects suggestive of an attention-deficit hyperactivity disorder (ADHD) phenotype. OBJECTIVES: We undertook an investigation into whether prenatal exposure to phthalates was associated with clinically confirmed ADHD in a population-based nested case-control study of the Norwegian Mother and Child Cohort (MoBa) between the years 2003 and 2008. METHODS: =553) from the MoBa population was obtained. RESULTS: In multivariable adjusted coexposure models, the sum of di-2-ethylhexyl phthalate metabolites (∑DEHP) was associated with a monotonically increasing risk of ADHD. Children of mothers in the highest quintile of ∑DEHP had almost three times the odds of an ADHD diagnosis as those in the lowest [OR=2.99 (95% CI: 1.47, 5.49)]. When ∑DEHP was modeled as a log-linear (natural log) term, for each log-unit increase in exposure, the odds of ADHD increased by 47% [OR=1.47 (95% CI: 1.09, 1.94)]. We detected no significant modification by sex or mediation by prenatal maternal thyroid function or by preterm delivery. CONCLUSIONS: In this population-based case-control study of clinical ADHD, maternal urinary concentrations of DEHP were monotonically associated with increased risk of ADHD. Additional research is needed to evaluate potential mechanisms linking phthalates to ADHD. https://doi.org/10.1289/EHP2358.

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  • After confounder adjustment, children of mothers in the top phthalate metabolite quintile are three times more likely to have ADHD than those in the bottom quintile.

    “Children of mothers in the highest quintile of phthalate metabolite levels were three times more likely to have had ADHD as children compared with those in the bottom quintile, after adjusting for confounders”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Engel et al., 2018

    The Results report that, after covariate adjustment, children in the highest maternal ∑DEHP quintile had almost three times the odds of an ADHD diagnosis as those in the lowest quintile (OR 2.99). The claim omits that this finding was specific to ∑DEHP: the Results report no association for several other phthalate measures. It also describes an odds ratio as being three times more likely. (LLM, conf=0.88)

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  1. NRC (National Research Council). 2008 Phthalates and Cumulative Risk Assessment: The Task Ahead., Committee on the Health Risks of Phthalates. Washington, DC: National Academies Press. 25009926

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Authors
Engel, S. M., Villanger, G. D., Nethery, R. C., Thomsen, C., Sakhi, A. K., Drover, S. S. M., Hoppin, J. A., Zeiner, P., Knudsen, G. P., Reichborn-Kjennerud, T., Herring, A. H., & Aase, H.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Norwegian Institute of Public Health (NO)
  • North Carolina State University (US)
  • Oslo University Hospital, Oslo, Norway
  • Department of Mental Disorders, Division of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway
  • Duke University (US)
Corresponding author
Engel, Stephanie M.
Venue
Environmental Health Perspectives
Published
2018-05-21
Volume
126
Issue
5
Pages
057004-057004
ISSN
  • 0091-6765 (ISSN-L)
  • 1552-9924
OpenAlex
W2803355261
Cited by
143
References
89
Citations by year
2026: 16 · 2025: 13 · 2024: 19 · 2023: 14 · 2022: 15 · 2021: 25 · 2020: 26 · 2019: 11 · 2018: 3 · 2017: 1
FWCI
8.03
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Environmental Health Perspectives (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • UNC Libraries
Funders
  • Helse- og Omsorgsdepartementet (UO1 NS 047537-01, UO1 NS 047537-06A1)
  • National Institutes of Health (n01es75558-11-0-1, N01-ES-75558)
  • National Institute of Neurological Disorders and Stroke (UO1-NS-047537, 2UO1 NS047537-06A1, 047537-01, UO1 NS 047537–01, U01NS047537, 047537-06A1, UO1 NS 047537-06A1, 1 UO1 NS 047537‐01)
  • National Institute of Environmental Health Sciences (N01-ES, UO1 NS 047537-01, N01ES75558, N01 ES075558, R01ES021777, no.2 UO1 NS 047537–06A1, P30ES010126)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD050924)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Keywords
phthalates, prenatal exposure, attention deficit hyperactivity disorder, DEHP, maternal thyroid function, child neurodevelopment, endocrine disruptors, preterm birth
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Mothers, Phthalic Acids, Pregnancy, Prenatal Exposure Delayed Effects, Surveys and Questionnaires, Thyroid Gland, Cohort Studies, Case-Control Studies

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