Association Between Prenatal Per- and Polyfluoroalkyl Substances Exposure and Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis
Yingkun Guo
School of Nursing, Shandong Second Medical University, Weifang 261053, Shandong, China
Ling Li
School of Nursing, Shandong First Medical University, Jinan 250024, Shandong, China
Jianhong Qiao
School of Nursing and Rehabilitation, Shandong University, Jinan 250012, Shandong, China
Abstract:
Background: The association between prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and childhood autism spectrum disorder (ASD) has been inconsistent. Objective: The aim of this study was to conduct a comprehensive systematic review and meta-analysis based on epidemiological evidence to investigate the association between prenatal PFAS exposure and ASD in children. Method: A systematic and comprehensive search of PubMed, Embase, EBSCO, Scopus and Web of Science databases was performed to identify studies on the association between prenatal PFAS exposure and child ASD risk published before July 2022. Baseline information was extracted from eligible studies, and we performed sensitivity and subgroup analyses. We also assessed for publication bias. The association between PFAS exposure and ASD risk was assessed by combining odds ratios (OR) and 95% confidence intervals (CI) using fixed-effects or random-effects models. Results: Our meta-analysis finally included seven studies and showed no statistically significant association between prenatal PFAS exposure and ASD risk [perfluorooctanoic acid (PFOA): OR = 1.05 95% CI: (0.73, 1.51); perfluorooctane sulfonate (PFOS): OR = 0.98, 95% CI: (0.90, 1.07); perfluorohexane sulfonate (PFHxS): OR = 1.11, 95% CI: (0.95, 1.30); perfluorononanoic acid (PFNA): OR = 1.01, 95% CI: (0.83, 1.23); perfluorodecanoic acid (PFDA): OR = 0.80, 95% CI: (0.63, 1.01)]. When subgroup analyses were performed by study design, region and sample type, PFNA exposure in cohort studies was significantly positively associated with ASD [ OR = 1.75, 95% CI: (1.11, 2.76), I2 = 0.0%]. In the USA, exposure to PFHxS increased the risk of ASD (OR= 1.26, 95% CI: (1.03, 1.53), I2 = 21.9%). A statistically positive association between PFOA exposure and childhood ASD was found in plasma [OR = 1.47, 95% CI: (1.01, 2.14), I2 = 33.9%] but not in serum. After sensitivity analysis removing one outlier study, PFOA exposure was significantly positively associated with ASD risk [OR = 1.33, 95% CI: (1.12, 1.58), I2 = 38.5%]. No significant publication bias was detected. Conclusion: In conclusion, we did not observe a significant association between prenatal PFAS exposure and childhood ASD. Due to the limited number of studies included, the results must be interpreted with caution, and future large-scale epidemiological studies are needed to further investigate these findings.