Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes.

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Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes.


We included ten cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) Program (n=1429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex.


Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adj-β [95% CI]=1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adj-β [95% highest posterior density interval]=0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences.


Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.

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Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes.
Ames JL, Burjak M, Avalos LA, Braun JM, Bulka CM, Croen LA, Dunlop AL, Ferrara A, Fry RC, Hedderson MM, Karagas MR, Liang D, Lin PD, Lyall K, Moore B, Morello-Frosch R, O'Connor TG, Oh J, Padula AM, Woodruff TJ, Zhu Y, Hamra GB,