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A Prospective Birth Cohort Study on Early Childhood Lead Levels and Attention Deficit Hyperactivity Disorder: New Insight on Sex Differences - 25/07/18

Doi : 10.1016/j.jpeds.2018.03.076 
Yuelong Ji, MSPH 1, Xiumei Hong, PhD 1, Guoying Wang, MD 1, Nilanjan Chatterjee, PhD 2, Anne W. Riley, PhD 1, Li-Ching Lee, PhD 3, 4, Pamela J. Surkan, ScD 1, 5, Tami R. Bartell, MPH 6, Barry Zuckerman, MD 7, Xiaobin Wang, MD, MPH, ScD 1, 8, *
1 Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 
2 Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 
3 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 
4 Wendy Klag Center for Autism and Developmental Disabilities & Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 
5 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 
6 Stanley Manne Children's Research Institute, Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 
7 Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 
8 Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 

*Reprint requests: Xiaobin Wang, MD, MPH, ScD, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205-2179.Center on the Early Life Origins of DiseaseDepartment of Population, Family and Reproductive HealthJohns Hopkins University Bloomberg School of Public Health615 N. Wolfe StBaltimoreMD21205-2179

Abstract

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.

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Keywords : HDL, stress, neurodevelopment disorder

Abbreviations : ADHD, BBC, BMC, CDC, DSM, EMR, HDL, ICD, MLR, NT


Plan


 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.


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Vol 199

P. 124 - août 2018 Retour au numéro
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