Carl-Gustaf Bornehag1,2, Christian Lindh3, Abraham Reichenberg4, Sverre Wikström5, Maria Unenge Hallerback1, Sarah F Evans2, Sheela Sathyanarayana6, Emily S Barrett7, Ruby H N Nguyen8, Nicole R Bush9, Shanna H Swan2. 1. Department of Health, Karlstad University, Karlstad, Sweden. 2. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Laboratory Medicine, Lund University, Lund, Sweden. 4. Department of Psychiatry, Mount Sinai School of Medicine, New York, New York. 5. School of Medical Sciences, Örebro University School of Medical Sciences, Örebro, Sweden. 6. Department of Pediatrics, University of Washington, Seattle. 7. Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey. 8. University of Minnesota, Minneapolis. 9. Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, San Francisco.
Abstract
Importance: Prenatal exposure to phthalates has been associated with neurodevelopmental outcomes, but little is known about the association with language development. Objective: To examine the association of prenatal phthalate exposure with language development in children in 2 population-based pregnancy cohort studies. Design, Setting, and Participants: Data for this study were obtained from the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study conducted in prenatal clinics throughout Värmland county in Sweden and The Infant Development and the Environment Study (TIDES) conducted in 4 academic centers in the United States. Participants recruited into both studies were women in their first trimester of pregnancy who had literacy in Swedish (SELMA) or English or Spanish (TIDES). This study included mothers and their children from both the SELMA study (n = 963) and TIDES (n = 370) who had complete data on prenatal urinary phthalate metabolite levels, language delay, and modeled covariables. For SELMA, the data were collected from November 1, 2007, to June 30, 2013, and data analysis was conducted from November 1, 2016, to June 30, 2018. For TIDES, data collection began January 1, 2010, and ended March 29, 2016, and data analysis was performed from September 15, 2016, to June 30, 2018. Main Outcomes and Measures: Mothers completed a language development questionnaire that asked the number of words their children could understand or use at a median of 30 months of age (SELMA) and 37 months of age (TIDES). The responses were categorized as fewer than 25, 25 to 50, and more than 50 words, with 50 words or fewer classified as language delay. Results: In the SELMA study, 963 mothers, 455 (47.2%) girls, and 508 (52.8%) boys were included. In TIDES, 370 mothers, 185 (50.0%) girls, and 185 (50.0%) boys were included in this analysis. The prevalence of language delay was 10.0% in both SELMA (96 reported) and TIDES (37 reported), with higher rates of delay in boys than girls (SELMA: 69 [13.5%] vs 27 [6.0%]; TIDES: 23 [12.4%] vs 14 [7.6%]). In crude analyses, the metabolite levels of dibutyl phthalate and butyl benzyl phthalate were statistically significantly associated with language delay in both cohorts. In adjusted analyses, a doubling of prenatal exposure of dibutyl phthalate and butyl benzyl phthalate metabolites increased the odds ratio (OR) for language delay by approximately 25% to 40%, with statistically significant results in the SELMA study (dibutyl phthalate OR, 1.29 [95% CI, 1.03-1.63; P = .03]; butyl benzyl phthalate OR, 1.26 [95% CI, 1.07-1.49; P = .003]). A doubling of prenatal monoethyl phthalate exposure was associated with an approximately 15% increase in the OR for language delay in the SELMA study (OR, 1.14; 95% CI, 1.00-1.31; P = .05), but no such association was found in TIDES (OR, 0.98; 95% CI, 0.79-1.23). Conclusions and Relevance: In findings from this study, prenatal exposure to dibutyl phthalate and butyl benzyl phthalate was statistically significantly associated with language delay in children in both the SELMA study and TIDES. These findings, along with the prevalence of prenatal exposure to phthalates, the importance of language development, and the inconsistent results from a 2017 Danish study, suggest that the association of phthalates with language delay may warrant further examination.
Importance: Prenatal exposure to phthalates has been associated with neurodevelopmental outcomes, but little is known about the association with language development. Objective: To examine the association of prenatal phthalate exposure with language development in children in 2 population-based pregnancy cohort studies. Design, Setting, and Participants: Data for this study were obtained from the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study conducted in prenatal clinics throughout Värmland county in Sweden and The Infant Development and the Environment Study (TIDES) conducted in 4 academic centers in the United States. Participants recruited into both studies were women in their first trimester of pregnancy who had literacy in Swedish (SELMA) or English or Spanish (TIDES). This study included mothers and their children from both the SELMA study (n = 963) and TIDES (n = 370) who had complete data on prenatal urinary phthalate metabolite levels, language delay, and modeled covariables. For SELMA, the data were collected from November 1, 2007, to June 30, 2013, and data analysis was conducted from November 1, 2016, to June 30, 2018. For TIDES, data collection began January 1, 2010, and ended March 29, 2016, and data analysis was performed from September 15, 2016, to June 30, 2018. Main Outcomes and Measures: Mothers completed a language development questionnaire that asked the number of words their children could understand or use at a median of 30 months of age (SELMA) and 37 months of age (TIDES). The responses were categorized as fewer than 25, 25 to 50, and more than 50 words, with 50 words or fewer classified as language delay. Results: In the SELMA study, 963 mothers, 455 (47.2%) girls, and 508 (52.8%) boys were included. In TIDES, 370 mothers, 185 (50.0%) girls, and 185 (50.0%) boys were included in this analysis. The prevalence of language delay was 10.0% in both SELMA (96 reported) and TIDES (37 reported), with higher rates of delay in boys than girls (SELMA: 69 [13.5%] vs 27 [6.0%]; TIDES: 23 [12.4%] vs 14 [7.6%]). In crude analyses, the metabolite levels of dibutyl phthalate and butyl benzyl phthalate were statistically significantly associated with language delay in both cohorts. In adjusted analyses, a doubling of prenatal exposure of dibutyl phthalate and butyl benzyl phthalate metabolites increased the odds ratio (OR) for language delay by approximately 25% to 40%, with statistically significant results in the SELMA study (dibutyl phthalate OR, 1.29 [95% CI, 1.03-1.63; P = .03]; butyl benzyl phthalate OR, 1.26 [95% CI, 1.07-1.49; P = .003]). A doubling of prenatal monoethyl phthalate exposure was associated with an approximately 15% increase in the OR for language delay in the SELMA study (OR, 1.14; 95% CI, 1.00-1.31; P = .05), but no such association was found in TIDES (OR, 0.98; 95% CI, 0.79-1.23). Conclusions and Relevance: In findings from this study, prenatal exposure to dibutyl phthalate and butyl benzyl phthalate was statistically significantly associated with language delay in children in both the SELMA study and TIDES. These findings, along with the prevalence of prenatal exposure to phthalates, the importance of language development, and the inconsistent results from a 2017 Danish study, suggest that the association of phthalates with language delay may warrant further examination.
Authors: Carl-Gustaf Bornehag; Syed Moniruzzaman; Malin Larsson; Cecilia Boman Lindström; Mikael Hasselgren; Anna Bodin; Laura B von Kobyletzkic; Fredrik Carlstedt; Fredrik Lundin; Eewa Nånberg; Bo A G Jönsson; Torben Sigsgaard; Staffan Janson Journal: Paediatr Perinat Epidemiol Date: 2012-07-23 Impact factor: 3.980
Authors: Robin M Whyatt; Xinhua Liu; Virginia A Rauh; Antonia M Calafat; Allan C Just; Lori Hoepner; Diurka Diaz; James Quinn; Jennifer Adibi; Frederica P Perera; Pam Factor-Litvak Journal: Environ Health Perspect Date: 2011-09-06 Impact factor: 9.031
Authors: Carl-Gustaf Bornehag; Jan Sundell; Charles J Weschler; Torben Sigsgaard; Björn Lundgren; Mikael Hasselgren; Linda Hägerhed-Engman Journal: Environ Health Perspect Date: 2004-10 Impact factor: 9.031
Authors: Jenna L N Sprowles; Kelsey L C Dzwilewski; Francheska M Merced-Nieves; Salma M A Musaad; Susan L Schantz; Sarah D Geiger Journal: Neurotoxicol Teratol Date: 2022-05-16 Impact factor: 4.071
Authors: Hongxiu Liu; Yuyan Wang; Kurunthachalam Kannan; Mengling Liu; Hongkai Zhu; Yu Chen; Linda G Kahn; Melanie H Jacobson; Bo Gu; Shilpi Mehta-Lee; Sara G Brubaker; Akhgar Ghassabian; Leonardo Trasande Journal: Environ Res Date: 2022-03-28 Impact factor: 8.431
Authors: Keadrea Wilson; Tebeb Gebretsadik; Margaret A Adgent; Christine Loftus; Catherine Karr; Paul E Moore; Sheela Sathyanarayana; Nora Byington; Emily Barrett; Nicole Bush; Ruby Nguyen; Terry J Hartman; Kaja Z LeWinn; Alexis Calvert; W Alex Mason; Kecia N Carroll Journal: Ann Allergy Asthma Immunol Date: 2022-05-10 Impact factor: 6.248
Authors: Gillian England-Mason; Melody N Grohs; Jess E Reynolds; Amy MacDonald; David Kinniburgh; Jiaying Liu; Jonathan W Martin; Catherine Lebel; Deborah Dewey Journal: Environ Res Date: 2019-12-26 Impact factor: 6.498
Authors: Christine T Loftus; Nicole R Bush; Drew B Day; Yu Ni; Frances A Tylavsky; Catherine J Karr; Kurunthachalam Kannan; Emily S Barrett; Adam A Szpiro; Sheela Sathyanarayana; Kaja Z LeWinn Journal: Environ Int Date: 2021-02-06 Impact factor: 9.621
Authors: Stephanie M Engel; Heather B Patisaul; Charlotte Brody; Russ Hauser; Ami R Zota; Deborah H Bennet; Maureen Swanson; Robin M Whyatt Journal: Am J Public Health Date: 2021-02-18 Impact factor: 11.561
Authors: Olga Egorova; Robin Myte; Jörn Schneede; Bruno Hägglöf; Sven Bölte; Erik Domellöf; Barbro Ivars A'roch; Fredrik Elgh; Per Magne Ueland; Sven-Arne Silfverdal Journal: Mol Autism Date: 2020-01-16 Impact factor: 7.509