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

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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, Knudsen, Gun Peggy, Reichborn-Kjennerud, Ted, Herring, Amy H., Aase, Heidi·2018·Environmental Health Perspectives

DOI 10.1289/ehp2358PMC PMC6071976

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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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“…metabolite levels were three times more likely to have had ADHD as children compared with those in the bottom quin-tile, after adjusting for confounders, such as maternal age at delivery, sex of the child, maternal education, marital status, and prenatal maternal smoking (Engel et al., 2018).”
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See all 143

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.
ORCID: Engel, Stephanie M.
Villanger, Gro D.
Nethery, Rachel C.
Thomsen, Cathrine
Sakhi, Amrit K.
Drover, Samantha S.M.
Hoppin, Jane A.
Knudsen, Gun Peggy
Herring, Amy H.
Aase, Heidi
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2018-05-21
Volume: 126
Issue: 5
Pages: 057004-057004
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp2358
PMC: PMC6071976
OpenAlex: W2803355261
Semantic Scholar: d534cc47da8528c7f879d03c0f84414de57120a5
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
FWCI: 8.03
Type: journal article
Language: en
Open access: gold
doi.org
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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Prenatal Phthalates, Maternal Thyroid Function, and Risk of Attention-Deficit Hyperactivity Disorder in the Norwegian Mother and Child Cohort

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