Autism and Air Pollution Before, During, and After Pregnancy
Autism and Air Pollution Before, During, and After Pregnancy
Background Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet has unclear etiology.
Objective We explored the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child.
Methods We conducted a nested case–control study of participants in the Nurses' Health Study II (NHS II), a prospective cohort of 116,430 U.S. female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants' children born 1990–2002 with ASD (n = 245), and children without ASD (n = 1,522) randomly selected using frequency matching for birth years. Diagnosis of ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤ 2.5 μm (PM2.5) and 2.5–10 μm (PM10–2.5) were predicted from a spatiotemporal model for the continental United States and linked to residential addresses.
Results PM2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range (IQR) higher PM2.5 (4.42 μg/m) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, whereas the association with the 9 months of pregnancy remained (OR = 1.63; 95% CI: 1.08, 2.47). The association between ASD and PM2.5 was stronger for exposure during the third trimester (OR = 1.42 per IQR increase in PM2.5; 95% CI: 1.09, 1.86) than during the first two trimesters (ORs = 1.06 and 1.00) when mutually adjusted. There was little association between PM10–2.5 and ASD.
Conclusions Higher maternal exposure to PM2.5 during pregnancy, particularly the third trimester, was associated with greater odds of a child having ASD.
Autism spectrum disorder (ASD) is a developmental disorder with increasing reported prevalence worldwide (French et al. 2013). Although genetics plays a strong role in ASD, evidence suggests that environmental exposures, particularly in utero or during early life, also affect ASD risk (Grønborg et al. 2013; Hallmayer et al. 2011; Quaak et al. 2013). However, no specific environmental toxicant has been consistently associated with increased risk of ASD.
Air pollution contains various toxicants that have been found to be associated with neurotoxicity and adverse effects on the fetus in utero (Crump et al. 1998; Grandjean and Landrigan 2006; Rice and Barone 2000; Rodier 1995; Stillerman et al. 2008). Airborne particles are covered with various contaminants, and have been found to penetrate the subcellular environment and induce oxidative stress and mitochondrial damage in vitro (Li et al. 2003; MohanKumar et al. 2008). In rodents, these particles also have been found to stimulate inflammatory cytokine release systemically and in the brain, and alter the neonatal immune system (Hertz-Picciotto et al. 2005, 2008; MohanKumar et al. 2008)—processes that have been implicated in ASD (Depino 2013; Napoli et al. 2013).
Several studies have explored associations of air pollution with ASD, using the U.S. Environmental Protection Agency (EPA) hazardous air pollutant models, distance to freeway, or local models for specific pollutants. These studies suggest increased odds of having a child with ASD with higher exposures to diesel particulate matter (PM) (Roberts et al. 2013; Windham et al. 2006), several metals (Roberts et al. 2013; Windham et al. 2006), criteria pollutants (Becerra et al. 2013; Volk et al. 2013), and some organic materials as well as closer proximity to a freeway (Volk et al. 2011).
Our goal was to explore the association between ASD and exposure to PM during defined time periods before, during, and after pregnancy, within the Nurses' Health Study II (NHS II), a large, well-defined cohort with detailed residential history. This nested case–control study includes participants from across the continental United States, and exposure was linked to monthly data on two size fractions of PM.
Abstract and Introduction
Abstract
Background Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet has unclear etiology.
Objective We explored the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child.
Methods We conducted a nested case–control study of participants in the Nurses' Health Study II (NHS II), a prospective cohort of 116,430 U.S. female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants' children born 1990–2002 with ASD (n = 245), and children without ASD (n = 1,522) randomly selected using frequency matching for birth years. Diagnosis of ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤ 2.5 μm (PM2.5) and 2.5–10 μm (PM10–2.5) were predicted from a spatiotemporal model for the continental United States and linked to residential addresses.
Results PM2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range (IQR) higher PM2.5 (4.42 μg/m) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, whereas the association with the 9 months of pregnancy remained (OR = 1.63; 95% CI: 1.08, 2.47). The association between ASD and PM2.5 was stronger for exposure during the third trimester (OR = 1.42 per IQR increase in PM2.5; 95% CI: 1.09, 1.86) than during the first two trimesters (ORs = 1.06 and 1.00) when mutually adjusted. There was little association between PM10–2.5 and ASD.
Conclusions Higher maternal exposure to PM2.5 during pregnancy, particularly the third trimester, was associated with greater odds of a child having ASD.
Introduction
Autism spectrum disorder (ASD) is a developmental disorder with increasing reported prevalence worldwide (French et al. 2013). Although genetics plays a strong role in ASD, evidence suggests that environmental exposures, particularly in utero or during early life, also affect ASD risk (Grønborg et al. 2013; Hallmayer et al. 2011; Quaak et al. 2013). However, no specific environmental toxicant has been consistently associated with increased risk of ASD.
Air pollution contains various toxicants that have been found to be associated with neurotoxicity and adverse effects on the fetus in utero (Crump et al. 1998; Grandjean and Landrigan 2006; Rice and Barone 2000; Rodier 1995; Stillerman et al. 2008). Airborne particles are covered with various contaminants, and have been found to penetrate the subcellular environment and induce oxidative stress and mitochondrial damage in vitro (Li et al. 2003; MohanKumar et al. 2008). In rodents, these particles also have been found to stimulate inflammatory cytokine release systemically and in the brain, and alter the neonatal immune system (Hertz-Picciotto et al. 2005, 2008; MohanKumar et al. 2008)—processes that have been implicated in ASD (Depino 2013; Napoli et al. 2013).
Several studies have explored associations of air pollution with ASD, using the U.S. Environmental Protection Agency (EPA) hazardous air pollutant models, distance to freeway, or local models for specific pollutants. These studies suggest increased odds of having a child with ASD with higher exposures to diesel particulate matter (PM) (Roberts et al. 2013; Windham et al. 2006), several metals (Roberts et al. 2013; Windham et al. 2006), criteria pollutants (Becerra et al. 2013; Volk et al. 2013), and some organic materials as well as closer proximity to a freeway (Volk et al. 2011).
Our goal was to explore the association between ASD and exposure to PM during defined time periods before, during, and after pregnancy, within the Nurses' Health Study II (NHS II), a large, well-defined cohort with detailed residential history. This nested case–control study includes participants from across the continental United States, and exposure was linked to monthly data on two size fractions of PM.
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