TY - JOUR
T1 - A Prospective Birth Cohort Study on Early Childhood Lead Levels and Attention Deficit Hyperactivity Disorder
T2 - New Insight on Sex Differences
AU - Ji, Yuelong
AU - Hong, Xiumei
AU - Wang, Guoying
AU - Chatterjee, Nilanjan
AU - Riley, Anne W.
AU - Lee, Li Ching
AU - Surkan, Pamela J.
AU - Bartell, Tami R.
AU - Zuckerman, Barry
AU - Wang, Xiaobin
N1 - Funding Information:
Supported in part by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) (R40MC27443; UJ2MC31074). The information and the content and conclusions herein are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. The Boston Birth Cohort (the parent study) was supported in part by the March of Dimes PERI grants (20-FY02-56, 21-FY07-605 [to X.W.]); and the National Institutes of Health (NIH) grants (R21ES011666, 2R01HD041702, R21HD066471, U01AI090727, R21AI079872, and R01HD086013). The authors declare no conflicts of interest.
Funding Information:
Supported in part by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) ( R40MC27443 ; UJ2MC31074 ). The information and the content and conclusions herein are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. The Boston Birth Cohort (the parent study) was supported in part by the March of Dimes PERI grants ( 20-FY02-56 , 21-FY07-605 [to X.W.]); and the National Institutes of Health (NIH) grants ( R21ES011666 , 2R01HD041702 , R21HD066471 , U01AI090727 , R21AI079872 , and R01HD086013 ). The authors declare no conflicts of interest. Original Articles
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/8
Y1 - 2018/8
N2 - Objective: To investigate the prospective associations between early childhood lead exposure and subsequent risk of attention deficit hyperactivity disorder (ADHD) in childhood and its potential effect modifiers. Study design: We analyzed data from 1479 mother–infant pairs (299 ADHD, 1180 neurotypical) in the Boston Birth Cohort. The child's first blood lead measurement and physician-diagnosed ADHD was obtained from electronic medical records. Graphic plots and multiple logistic regression were used to examine dose–response associations between lead exposure and ADHD and potential effect modifiers, adjusting for pertinent covariables. Results: We found that 8.9% of the children in the Boston Birth Cohort had elevated lead levels (5-10 µg/dL) in early childhood, which was associated with a 66% increased risk of ADHD (OR, 1.66; 95% CI, 1.08-2.56). Among boys, the association was significantly stronger (OR, 2.49; 95% CI, 1.46-4.26); in girls, the association was largely attenuated (P value for sex-lead interaction =.017). The OR of ADHD associated with elevated lead levels among boys was reduced by one-half if mothers had adequate high-density lipoprotein levels compared with low high-density lipoprotein, or if mothers had low stress compared with high stress during pregnancy. Conclusions: Elevated early childhood blood lead levels increased the risk of ADHD. Boys were more vulnerable than girls at a given lead level. This risk of ADHD in boys was reduced by one-half if the mother had adequate high-density lipoprotein levels or low stress. These findings shed new light on the sex difference in ADHD and point to opportunities for early risk assessment and primary prevention of ADHD.
AB - Objective: To investigate the prospective associations between early childhood lead exposure and subsequent risk of attention deficit hyperactivity disorder (ADHD) in childhood and its potential effect modifiers. Study design: We analyzed data from 1479 mother–infant pairs (299 ADHD, 1180 neurotypical) in the Boston Birth Cohort. The child's first blood lead measurement and physician-diagnosed ADHD was obtained from electronic medical records. Graphic plots and multiple logistic regression were used to examine dose–response associations between lead exposure and ADHD and potential effect modifiers, adjusting for pertinent covariables. Results: We found that 8.9% of the children in the Boston Birth Cohort had elevated lead levels (5-10 µg/dL) in early childhood, which was associated with a 66% increased risk of ADHD (OR, 1.66; 95% CI, 1.08-2.56). Among boys, the association was significantly stronger (OR, 2.49; 95% CI, 1.46-4.26); in girls, the association was largely attenuated (P value for sex-lead interaction =.017). The OR of ADHD associated with elevated lead levels among boys was reduced by one-half if mothers had adequate high-density lipoprotein levels compared with low high-density lipoprotein, or if mothers had low stress compared with high stress during pregnancy. Conclusions: Elevated early childhood blood lead levels increased the risk of ADHD. Boys were more vulnerable than girls at a given lead level. This risk of ADHD in boys was reduced by one-half if the mother had adequate high-density lipoprotein levels or low stress. These findings shed new light on the sex difference in ADHD and point to opportunities for early risk assessment and primary prevention of ADHD.
KW - HDL
KW - neurodevelopment disorder
KW - stress
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U2 - 10.1016/j.jpeds.2018.03.076
DO - 10.1016/j.jpeds.2018.03.076
M3 - Article
C2 - 29752174
AN - SCOPUS:85046649686
SN - 0022-3476
VL - 199
SP - 124-131.e8
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -