孕期全氟和多氟烷基化合物暴露与儿童注意缺陷/多动障碍关联性的系统综述和Meta分析

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

目的 通过Meta分析方法探究孕期暴露于全氟和多氟烷基化合物(Per-and Polyfluoroalkyl Substances, PFAS)与儿童发生注意缺陷/多动障碍(Attention deficit/hyperactivity disorder, ADHD)的关联性。方法 计算机检索PubMed、Embase、Web of Science、CNKI、Wan Fang Data和VIP数据库,纳入孕期PFAS暴露与ADHD风险关联的观察性研究,并利用纽卡斯尔—渥太华量表(Newcastle-Ottawa Scale, NOS)评估文献质量,采用R 4.2.1软件进行Meta分析。结果 总共纳入了10项合格文献,Meta分析结果显示,孕期暴露于PFHxS与儿童发展ADHD有关,高暴露相比于低暴露水平的OR(95%CI)=0.72(0.52, 1.00),其他暴露未发现关联性:PFOA、PFOS、PFNA和PFDA每升高1个ln单位,OR(95%CI)分别为1.23(0.98, 1.53)、1.23(0.93, 1.62)、1.36(0.83, 2.25)和1.10(0.71, 1.70)。亚组分析结果表明,学龄前儿童发生ADHD风险与其孕期PFAS和PFOS暴露相关:PFAS和PFOS每升高1个ln单位,OR(95%CI)分别为1.46(1.15, 1.85)和1.83 (1.16, 2.89)。结论 孕期暴露于PFHxS与儿童发生ADHD存在关联,未发现孕期暴露于PFOS、PFOS、PFDA和PFNA与ADHD发病有显著关联,学龄前儿童患ADHD的风险升高受孕期母亲血清PFAS浓度的潜在影响。

Objective To investigate the association of prenatal exposure to per-and polyfluoroalkyl substances(PFAS)with at-tention 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 PF-HxS 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 ex-posures: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),respec-tively.ConclusionPrenatal 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.