Co-exposure to toxic metals and phthalates in pregnant women and their children's mental health problems aged four years - Taiwan Maternal and Infant Cohort Study (TMICS)

Tsung-Lin Tsai; Chia-Jung Hsieh; Ming-Tsang Wu; Mei-Lien Chen; Po-Hsiu Kuo; Shu-Li Wang

doi:10.1016/j.envint.2023.107804

Co-exposure to toxic metals and phthalates in pregnant women and their children's mental health problems aged four years - Taiwan Maternal and Infant Cohort Study (TMICS)

Environ Int. 2023 Mar:173:107804. doi: 10.1016/j.envint.2023.107804. Epub 2023 Feb 4.

Authors

Tsung-Lin Tsai¹, Chia-Jung Hsieh², Ming-Tsang Wu³, Mei-Lien Chen⁴, Po-Hsiu Kuo⁵, Shu-Li Wang⁶

Affiliations

¹ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
² Department of Public Health, Tzu Chi University, Hualien, Taiwan.
³ Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁶ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan; Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan. Electronic address: slwang@nhri.edu.tw.

PMID: 36842379
DOI: 10.1016/j.envint.2023.107804

Abstract

Background: Childhood and adolescent mental health problems may increase the global burden of disease. Neurotoxic metals are associated with inflammation and cytotoxicity in the brain. In addition, prenatal phthalate ester (PAE) exposure is associated with cognitive function deficits. However, the effect of co-exposure to toxic metals, PAEs, and their association with child behavior is less well studied. Hence, we aimed to investigate prenatal co-exposure to the metals and PAEs and the consequent behavioral outcomes in early childhood.

Methods: We followed pregnant women and their newborns from the Taiwan Maternal and Infant Cohort Study between 2015 and 2017, with a focus on women from the central, southern, and eastern areas of Taiwan. We quantified maternal urinary concentrations of metals and metabolites of PAEs as surrogates of prenatal exposure. We recorded the Child Behavior Checklist scores according to caregiver reports at 4 years of age, and identified Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-oriented problems.

Results: Ultimately, 408 children were included in the statistical analysis. Maternal urinary copper levels were significantly associated with depressive problems (odds ratio [OR] = 2.13) in children. Maternal urinary concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP) were also significantly associated with depressive symptoms (odds ratio [OR] = 1.51 and 1.53, respectively). Further analysis considering prenatal co-exposure to metals and PAEs showed that co-exposure to these materials was significantly associated with autism spectrum problems (OR = 3.11).

Conclusions: We observed that prenatal single exposure or co-exposure to metals and PAEs may play a role in some DSM-5-oriented problems in children at 4 years of age. Reduction of exposure to toxic metals and PAEs in pregnancy is suggested to prevent increased mental health problems in children.

Keywords: Birth cohort; Co-exposure; Mental problem; Metal; Phthalate; Prenatal exposure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child, Preschool
Cohort Studies
Environmental Exposure / adverse effects
Environmental Pollutants* / toxicity
Female
Heavy Metal Poisoning
Humans
Infant
Infant, Newborn
Mental Health
Phthalic Acids* / urine
Pregnancy
Pregnant Women
Prenatal Exposure Delayed Effects*
Taiwan / epidemiology

Substances

phthalic acid
Phthalic Acids
Environmental Pollutants