Association of maternal prenatal urinary fluoride levels with ADHD symptoms in childhood

Jesús Ibarluzea; Mikel Subiza-Pérez; Ane Arregi; Amaia Molinuevo; Enrique Arranz-Freijo; Manuel Sánchez-de Miguel; Ana Jiménez; Ainara Andiarena; Loreto Santa-Marina; Aitana Lertxundi

doi:10.1016/j.envres.2023.116705

Association of maternal prenatal urinary fluoride levels with ADHD symptoms in childhood

Environ Res. 2023 Oct 15:235:116705. doi: 10.1016/j.envres.2023.116705. Epub 2023 Jul 19.

Affiliations

¹ Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastián, Spain; Faculty of Psychology of the University of the Basque Country (UPV-EHU), 20018, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain.
² Faculty of Psychology of the University of the Basque Country (UPV-EHU), 20018, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, BD9 6RJ, Bradford, United Kingdom.
³ Faculty of Psychology of the University of the Basque Country (UPV-EHU), 20018, San Sebastian, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain. Electronic address: ane.arregi@ehu.eus.
⁴ Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain.
⁵ Faculty of Psychology of the University of the Basque Country (UPV-EHU), 20018, San Sebastian, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain.
⁶ Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain.
⁷ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Faculty of Medicine and Nursery of the University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.

PMID: 37479215
DOI: 10.1016/j.envres.2023.116705

Abstract

Background: Health concerns about the potential impact of exposure to fluoride via drinking water (DW) on neuropsychological development include behavioral outcomes such as ADHD.

Objective: We aimed to examine the association between prenatal maternal urinary fluoride and symptoms associated with attention-deficit/hyperactivity disorder (ADHD) at the age of 8 and 11 years.

Method: Data from 255 to 236 mother-child pairs from the "Infancia y Medio Ambiente" (INMA) birth cohort (Gipuzkoa; Spain) with maternal urinary F adjusted for creatinine (MUFcr) during pregnancy (first and third trimester) and child assessments of ADHD-like symptoms reported by Conners' Rating Scales-Revised at age of 8 and 11 years was available. Clinical approach was also used: cut off criteria (T > 66). Multiple linear regression models were fitted when outcomes were analyzed as continuous, and logistic regression models when the outcomes were analyzed with a categorical clinical approach. Covariates related to maternal characteristics, birth outcomes, childhood, quality of family context and biomarkers of neuro-toxicants were used.

Results: No association was found between MUFcr levels during pregnancy and cognitive problems-inattention, hyperactivity or ADHD index score of symptoms at 8 or 11 years. When results were analyzed from the perspective of a clinical approach, at the age of 11 years, there were significant inverse association between MUFcr and being categorized as a cognitive problems-inattention case. ORs were also indicative of a lower risk, although not significant, for ADHD index at age 11. Sensitivity analyses, taking into consideration quality of family context or the levels of other toxicants during pregnancy showed similar results.

Conclusions: Higher levels of MUFcr in pregnant women were associated with a lower risk of cognitive problems-inattention at 11 years. These findings are inconsistent with those from previous studies and indicate the need for other population-based studies to confirm or overturn these results.

Keywords: ADHD; Childhood; Drinking water; Fluoride; Pregnancy.

Publication types

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

MeSH terms

Attention Deficit Disorder with Hyperactivity* / chemically induced
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Creatinine
Female
Fluorides / toxicity
Humans
Pregnancy
Pregnancy Trimester, Third
Prenatal Exposure Delayed Effects* / chemically induced
Prenatal Exposure Delayed Effects* / epidemiology
Vitamins

Substances

Fluorides
Vitamins
Creatinine