Association of prenatal exposure to per- and polyfluoroalkyl substances with attention deficit/hyperactivity disorder in children: A systematic review and meta-analysis

Objective To investigate the association of prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with attention deficit/hyperactivity disorder (ADHD) in children through a meta-analysis.

Methods PubMed, Embase, Web of Science, CNKI, Wan Fang Data, and VIP databases were searched for observational studies on the association between prenatal PFAS exposure and ADHD. Newcastle-Ottawa Scale (NOS) was performed to assess the quality of the literatures, and R 4.2.1 software was used to perform meta-analysis.

Results A total of 10 eligible articles were included. The meta-analysis results showed that the exposure to PFHxS during pregnancy (higher exposure versus lower exposure) was associated with the development of ADHD in children, with OR (95%CI) being 0.72(0.52, 1.00). No association was found for exposures to other PFASs: for each ln-unit increase in PFOA, PFOS, PFNA and PFDA, the OR (95%CI) were 1.23(0.98, 1.53), 1.23(0.93, 1.62), 1.36(0.83, 2.25) and 1.10(0.71, 1.70), respectively. The subgroup analysis showed that ADHD in preschool children was associated with prenatal PFAS and PFOS exposures: for each ln-unit increase in PFAS and PFOS, the OR (95%CI) were 1.46 (1.15, 1.85) and 1.83(1.16, 2.89), respectively.

Conclusion Prenatal exposure to PFHxS is associated with ADHD in children, and there is no evidence that prenatal exposure to PFOS, PFOS, PFDA and PFNA is significantly associated with the development of ADHD. However, the increased risk of ADHD in preschool children is potentially influenced by maternal serum PFAS concentrations during pregnancy.