Prenatal Exposure to Air Pollution, Maternal Psychological Distress, and Child Behavior

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Prenatal exposures to diverse pollutants and psychosocial stressors have been shown independently to adversely affect child development. Less is known about the potential interactions between these factors, although they commonly co-occur, especially in disadvantaged populations. WHAT THIS STUDY ADDS:The combination of high prenatal exposure to environmental polycyclic aromatic hydrocarbons and maternal demoralization adversely affects child behavior, and maternal demoralization has a greater effect among children with high prenatal polycyclic aromatic hydrocarbon exposure for a majority of behavioral symptoms. abstract BACKGROUND: Airborne polycyclic aromatic hydrocarbons (PAHs) are pollutants generated by combustion of fossil fuel and other organic material. Both prenatal PAH exposure and maternal psychological distress during pregnancy have each been associated with neurodevelopmental problems in children. The goal was to evaluate potential interactions between prenatal exposure to airborne PAHs and maternal psychological distress during pregnancy on subsequent behavioral problems in children. METHODS:In a longitudinal birth cohort study, 248 children of nonsmoking white women in the coal-burning region of Krakow, Poland, were followed from in utero until age 9. Prenatal PAH exposure was measured by personal air monitoring during pregnancy, maternal demoralization during pregnancy by the Psychiatric Epidemiology Research Instrument-Demoralization, and child behavior by the Child Behavior Checklist. RESULTS:Significant interactions between maternal demoralization and PAH exposure (high versus low) were identified for symptoms of anxious/ depressed, withdrawn/depressed, social problems, aggressive behavior, internalizing problems, and externalizing problems. The effects of demoralization on syndromes of anxious/depressed, withdrawn/depressed, rule-breaking, aggressive behavior, and the composite internalizing and externalizing scores were seen only in conjunction with high PAH exposure. Fewer significant effects with weaker effect sizes were observed in the low-PAH-exposure group.CONCLUSIONS: Maternal demoralization during pregnancy appears to have a greater effect on child neurobehavioral development among children who experienced high prenatal PAH exposure. The results provide the first evidence of an interaction between prenatal exposure to maternal demoralization and air pollution on child neurobehavioral development, indicating the need for a multifaceted approach to the prevention of developmental problems in children. Pediatrics 2013;132:e1284-e1294 AUTHORS:

Air Pollution and Neuropsychological Development: A Review of the Latest Evidence

“…Initial title and abstract screening identified 32 candidate studies, and they were all assessed for eligibility: one study was excluded because of indoor exposure (13) and another one because it only provided interaction values between prenatal exposure to airborne PAHs and maternal psychological distress during pregnancy on subsequent behavioral problems in children (14). An additional study was found in MEDLINE but not through the keyword search (15).…”

Prenatal polycyclic aromatic hydrocarbon (PAH) exposure, antioxidant levels and behavioral development of children ages 6–9

“…The questionnaire included questions on, but was not limited to, demographics (e.g., age, sex), lifestyle factors (e.g., exposure to environmental tobacco smoke), socioeconomic status (e.g., maternal education, occupation, household income), medical history, as well as a 27-item questionnaire, Psychiatric Epidemiology Research Instrument – Demoralization (Peri-D) to assess maternal demoralization (Clarke and Kissane, 2002; Dohrenwend et al, 1980), a standard measure of maternal psychologic distress (Perera et al, 2013). The questionnaire also ascertained dietary habits for foods (poultry, beef, pork, sausage) likely to contain PAH (e.g., type of cooking process (smoked, fried, broiled, and barbecued) for specific types of meat, and the frequency at which they consumed those food items ranging from “never” to “daily”); similar tools have shown to be valid instruments for measuring dietary PAH exposure (John et al, 2011; Sinha et al, 2005).…”

“…For example, higher prenatal PAH exposure was inversely associated with measures of fetal growth, such as birth weight and head circumference, and neurodevelopment outcomes in children (Jedrychowski et al, 2003). Within two birth cohorts in the United States and Poland, prenatal PAH exposure was associated with poor cognitive development and intelligence, as well as behavioral problems, in children measured at three to seven years of age (Edwards et al, 2010; Perera et al, 2009; Perera et al, 2006; Perera et al, 2012; Perera et al, 2013). Given the potential long term consequences of prenatal and early life exposure to PAH, reduction of exposure to PAH and identification of modifiable risk factors that modulate downstream effects of PAH exposure are crucial.…”

The Role of Non-Chemical Stressors in Mediating Socioeconomic Susceptibility to Environmental Chemicals

“…Thus, we focus this review on those two exemplar exposures, though the range of chemical exposures to which this model of stressrelated susceptibility may apply is undetermined, and may include non-environmental exposures, including the common cold virus [26] or psychotropic drugs [27]. Finally, we focus here on results related to physical health outcomes, including respiratory and cardiovascular disease, and mortality, but note hypothesized synergistic effects on behavioral, mental health, and cognitive outcomes [24].…”