The Association Between Maternal Perfluoroalkyl Substances Exposure and Early Attention Deficit Hyperactivity Disorder in Children：A Systematic Review and Meta-Analysis

Abstract

Some studies have shown that maternal exposure to perfluoroalkyl substances (PFASs) may be associated with early attention deficit hyperactivity disorder (ADHD) in children. The purpose of this systematic review and meta-analysis is to verify this association by reviewing existing studies and to provide a strong basis for preventing ADHD. The researchers searched electronic databases such as PubMed, Science Direct, Scopus, Google Scholar, Web of Science, and Embase for all studies published before October 2020. Finally, we included nine articles for analysis. Our meta-analysis showed that maternal exposure to PFASs was not significantly associated with the prevalence rate of early childhood ADHD (perfluorooctanoic acid (PFOA): odds ratio (OR) = 1.00, 95% confidence interval (95% CI) = 0.75–1.25; perfluorooctane sulfonate (PFOS): OR = 1.01, 95% CI = 0.88–1.14; perfluorohexane sulfonate (PFHxS): OR = 1.08, 95% CI = 0.80–1.09; perfluorononanoic acid (PFNA): OR = 1.13, 95% CI = 0.99–1.28; perfluorodecanoic acid (PFDA): OR = 1.23, 95% CI = 0.15–2.32). Due to significant heterogeneity, we subsequently performed subgroup analysis and sensitivity analysis. In conclusion, a causal relationship between maternal PFASs exposure and ADHD in children was unlikely. Among them, PFOS, PFNA and ADHD might have positive associations worthy of further investigation.