Early life exposure to perfluoroalkyl substances (PFAS) and ADHD: a meta-analysis of nine European population-based studies
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INTRODUCTION: To date, the evidence for an association between perfluoroalkyl substances (PFAS) exposure and attention deficit and hyperactivity disorder (ADHD) is inconclusive. OBJECTIVE: We investigated the association between early life exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), and ADHD in a collaborative study including nine European population-based studies, encompassing 4,826 mother-child pairs. METHODS: Concentrations of PFOS and PFOA were measured in maternal serum/plasma during pregnancy, or in breast milk, with different timing of sample collection in each cohort. We used a validated pharmacokinetic model of pregnancy and lactation to estimate concentrations of PFOS and PFOA in children at birth and at 3, 6, 12, and 24 months of age. We classified ADHD using recommended cutoff points for each instrument used to derive symptoms scores. We used multiple imputation for missing covariates, logistic regression to model the association between PFAS exposure and ADHD in each study, and combined all adjusted study-specific effect estimates using random-effects meta-analysis. RESULTS: A total of 399 children were classified as having ADHD, with a prevalence ranging from 2.3% to 7.3% in the studies. Early life exposure to PFOS or PFOA was not associated with ADHD during childhood [odds ratios (ORs) ranging from 0.96 (95% CI: 0.87, 1.06) to 1.02 (95% CI: 0.93, 1.11)]. Results from stratified models suggest potential differential effects of PFAS related to child sex and maternal education. CONCLUSION: We did not identify an increased prevalence of ADHD in association with early life exposure to PFOS and PFOA. However, stratified analyses suggest that there may be an increased prevalence of ADHD in association with PFAS exposure in girls, in children from nulliparous women, and in children from low-educated mothers, all of which warrant further exploration. https://doi.org/10.1289/EHP5444.
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Infant exposure to PFAS through breast milk is not associated with later ADHD in offspring.
“No associations were found with ADHD in offspring”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Forns et al., 2020
The Results report no overall association between estimated PFOS or PFOA levels from birth through 24 months and childhood ADHD. But the study combined cohorts using maternal blood or breast-milk measurements to estimate children’s exposure; it did not establish a separate null finding for PFAS exposure specifically through breast milk. The Discussion also notes possible increased ADHD prevalence in some subgroups. Page numbers were not available in our copy. (LLM, conf=0.86)
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References 62 · Cited by 99
- Authors
- Forns, J., Verner, M.-A., Iszatt, N., Nowack, N., Bach, C. C., Vrijheid, M., Costa, O., Andiarena, A., Sovcikova, E., Høyer, B. B., Wittsiepe, J., Lopez-Espinosa, M.-J., Ibarluzea, J., Hertz-Picciotto, I., Toft, G., Stigum, H., Guxens, M., Liew, Z., & Eggesbø, M.
- Affiliations
- Norwegian Institute of Public Health (NO)
- Department of Occupational and Environmental Health, School of Public Health, Université de Montréal, Montreal, Canada
- Ruhr University Bochum (DE)
- Aarhus University Hospital (DK)
- Universitat Pompeu Fabra (ES)
- Universitat Jaume I (ES)
- University of the Basque Country (ES)
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
- Aarhus University (DK)
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Public Health Sciences, School of Medicine, University of California, Davis (UC Davis), Davis, California, USA
- Yale University (US)
- Corresponding author
- Eggesbø, Merete
- ORCID
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2020-05
- Volume
- 128
- Issue
- 5
- Pages
- 57002-57002
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC7263458
- OpenAlex
- W3022985318
- Semantic Scholar
- 70066f6c9d12a1678791c768e098ce83b71ed57f
- Cited by
- 99
- References
- 62
- Citations by year
- 2026: 6 · 2025: 18 · 2024: 14 · 2023: 24 · 2022: 15 · 2021: 16 · 2020: 4 · 2019: 2
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, public-domain)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- March of Dimes Foundation
- Fundación Alicia Koplowitz (PI17/00663, PI13/2032, PI04/1931, 2005111093, PI14/01687, PI07/0314, 2009111069, DFG08/001, PI06/1213, CP11/00178, FP7-ENV-2011 cod 282957, PI13/1944, PI14/00891, CIRIT 1999SGR 00241, 090430, PI04/1509, HEALTH.2010.2.4.5-1, PI041436, PI081151, CB06/02/0041, PI04/1112, PI16/1288, PI11/02591, 1999SGR 00241, PI11/02038, Red INMA G03/176, PI09/02647, PI05/1052, PI11/01007)
- Sundhed og Sygdom, Det Frie Forskningsråd (R100-A9193, O602–01042B, 0602-02738B, SSVF 0646, 271-08-0839/06–066023, 195/04, 01042B)
- Fundació la Marató de TV3 (PI13/2032, PI05/1052, PI11/02038, 2005111093, Red INMA G03/176, MSII16/00051, FP7-ENV-2011, CIRIT 1999SGR 00241, PI04/1436, PI09/02647, DFG08/001, PI04/1931, FP7-ENV-2011 cod 282957, PI06/0867, 282957, PI11/02591, PI16/1288, 1999SGR 00241, PI17/00663, 2009111069, PI06/1213, PI08/1151, CB06/02/0041, PI11/01007, PI04/1112, PI07/0314, G03/176, HEALTH.2010.2.4.5-1, PI09/02311, PI14/00891, PI14/01687, PI04/1509, PI13/1944, CP11/00178, 090430)
- Innovationsfonden (AU R9-A959-13-S804, 09‐067124, 0603–00294B)
- Centres de Recerca de Catalunya
- European Commission (PI16/1288, 226217, QLK4-1999-01422, QLK4‐2002‐00603, PI06/1213, 2005111093, 1999SGR 00241, 26240120033, CB06/02/0041, PI13/1944, PI04/1931, FP7-ENV-2008, 227391, PI14/00891, 212502, FP7-ENV-2008-1, PI041436, PI05/1052, HEALTH.2010.2.4.5-1, PI09/02647, PI04/1509, PI07/0314, APVV-0571-12, PI14/01687, AU R9-A959-13-S804, FP7/2007, PI11/02038, PI11/01007, DFG08/001, 090430, 282957, G03/176, PI11/02591, CP11/00178, PI13/2032, INMA G03/176, 2009111069, PI081151, FP7-ENV-2011, CIRIT 1999SGR 00241, QLK4-CT-2001_00202, PI042018, PI04/1112, Red INMA G03/176, PI17/00663, 722634)
- National Research Foundation
- Danmarks Grundforskningsfond (SSVF 0646, 195/04)
- Generalitat de Catalunya (PI11/02038, PI041436, PI081151, PI04/1509, DFG08/001, PI16/1288, CIRIT 1999SGR 00241, FP7-ENV-2011, PI04/1931, PI11/01007, PI04/1112, PI13/2032, PI05/1052, PI13/1944, G03/176, 282957, 090430, 2005111093, 00241, CB06/02/0041, 1999SGR 0024 1, HEALTH.2010.2.4.5-1, PI11/02591, Red INMA G03/176, 2009111069, PI14/00891, CP11/00178, PI09/02647, MSII16/00051, PI07/0314, PI17/00663, PI06/1213, FP7-ENV-2011 cod 282957, PI14/01687)
- Eusko Jaurlaritza (2005111093, 2009111069)
- Generalitat Valenciana (Red INMA G03/176, 1999SGR 00241, 090,430, PI081151, PI09/02311, 2005111093, CB06/02/0041, PI16/1288, PI11/01007, PI07/0314, PI041436, DFG08/001, 2009111069)
- Lundbeckfonden (R100-A9193, 195/04, SSVF 0646)
- Novo Nordisk
- Nordea-fonden (AU R9-A959-13-S804, 02–2013-2014)
- Danmarks Frie Forskningsfond (DFF – 4183-00594, 4183–00152, AU R9-A959-13-S804, DFF 418300152, 4183-00594, 0602-02738B)
- Agentúra na Podporu Výskumu a Vývoja (APVV-0571-12, APVT-21-016804, APVV-0444-11, APVV-0444)
- Norges Forskningsråd (226402)
- Universidad de Oviedo
- Egmont Fonden
- Umweltbundesamt
- Junta de Andalucía (183/07)
- H. Lundbeck A/S
- National Institutes of Health (INMA G03/176)
- Medical Research Council (O602-01042B, 0602-02738B, 271-08-0839/06-066023, SSVF 0646, PI16/1288)
- Instituto de Salud Carlos III (PI16/, PI11/01007, PI03/1615, 2009111069, PI0902647, PI11/02038, PI04/1931, FIS‐PI041436, HEALTH.2010.2.4.5-1, FIS‐ PI081151, PI/04/2018, PI041112, PI11/, PI06/1213, 1999SGR 00241, PI070314, Red INMA G03/176, PI051052, 08/1151, PI14/, PI17/00663, MSII16/00051, PI14/01687, 282957, CP1100178, PI14/00891, PI04/1436, FISS PI 04/2018, FIS-PI06/0867, DFG08/001, MS13/00054, 04/2018, PI060867, 090430, CB06/02/0041, 2005111093, PI0902311, PI04/1509, PI1102591, PI/08/1151, G03/176, FISS-PI09/02311, Marató de TV3, FIS-PI07/0252, PI07/0252, 03/1615, FISPS09/ 00090, FP7-ENV-2011 cod 282957, INMA G03/176, CIRIT 1999SGR 00241, PS09/00090)
- European Regional Development Fund (PI04/1112, PI07/0314, PI13/2032, PI05/1052, PI06/1213, PI04/1436, PI06/0867, INMA G03/176, CP11/00178, MS13/00054, PI081151, PS09/00090, MSII 16/00051, PI04/1509, 26240120033, PI09/02311, PI14/00891, 282957, PI11/02591, PI042018, 03/1615, PI17/00663, FIS-PI041436, PI09/02647, PI16/1288, PI11/01007, FP7-ENV-2011, PI11/02038, CB06/02/0041, PI04/1931, PI14/01687, HEALTH.2010.2.4.5-1)
- Strategic Research Council
- National Cancer Institute (R01CA096525)
- Fogarty International Center (R03TW007152)
- National Institute of Environmental Health Sciences (P30ES023513)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
- Keywords
- perfluorinated compounds, PFOS, perfluorooctanoic acid, attention deficit hyperactivity disorder, early life exposure, prenatal exposure, breast milk, maternal serum, child neurodevelopment, sex differences, maternal education, nulliparity, pharmacokinetic modeling
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Breast Feeding, Caprylates, Child, Child, Preschool, Environmental Exposure, Environmental Pollutants, Female, Fluorocarbons, Humans, Male, Milk, Human, Mothers, Population, Pregnancy, Prenatal Exposure Delayed Effects, Cohort Studies, Alkanesulfonic Acids
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