INTRODUCTION To date, the evidence for an association between perfluoroalkyl substances (PFAS) exposure and attention deficit and hyperactivity disorder (ADHD) is inconclusive. OBJECTIVE We investigated the association between early life exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), and ADHD in a collaborative study including nine European population-based studies, encompassing 4,826 mother-child pairs. METHODS Concentrations of PFOS and PFOA were measured in maternal serum/plasma during pregnancy, or in breast milk, with different timing of sample collection in each cohort. We used a validated pharmacokinetic model of pregnancy and lactation to estimate concentrations of PFOS and PFOA in children at birth and at 3, 6, 12, and 24 months of age. We classified ADHD using recommended cutoff points for each instrument used to derive symptoms scores. We used multiple imputation for missing covariates, logistic regression to model the association between PFAS exposure and ADHD in each study, and combined all adjusted study-specific effect estimates using random-effects meta-analysis. RESULTS A total of 399 children were classified as having ADHD, with a prevalence ranging from 2.3% to 7.3% in the studies. Early life exposure to PFOS or PFOA was not associated with ADHD during childhood [odds ratios (ORs) ranging from 0.96 (95% CI: 0.87, 1.06) to 1.02 (95% CI: 0.93, 1.11)]. Results from stratified models suggest potential differential effects of PFAS related to child sex and maternal education. CONCLUSION We did not identify an increased prevalence of ADHD in association with early life exposure to PFOS and PFOA. However, stratified analyses suggest that there may be an increased prevalence of ADHD in association with PFAS exposure in girls, in children from nulliparous women, and in children from low-educated mothers, all of which warrant further exploration. https://doi.org/10.1289/EHP5444.

中文翻译：

---

全氟烷基物质（PFAS）和ADHD的早期生命暴露：一项基于九种欧洲人群的研究的荟萃分析。

引言迄今为止，有关全氟烷基物质（PFAS）暴露与注意缺陷和多动症（ADHD）之间关联的证据尚无定论。目的我们在一项包括9项基于欧洲人群的研究（包括4,826对母子对）中的一项合作研究中，研究了早期暴露于全氟辛烷磺酸（PFOS）和全氟辛酸（PFOA）与ADHD之间的关联。方法测量孕期或母乳中母体血清/血浆中PFOS和PFOA的浓度，每个队列中样品采集的时间不同。我们使用经过验证的妊娠和哺乳期药物动力学模型来估算出生时以及3、6、12和24个月大的儿童中PFOS和PFOA的浓度。我们使用推荐的临界点对ADHD进行分类，每种工具都用于得出症状分数。在每个研究中，我们对缺失的协变量使用了多重插补，对数回归分析以建模PFAS暴露与ADHD之间的关联，并使用随机效应荟萃分析结合了所有调整后的研究特异性效应评估。结果共有399名儿童被归类为多动症，研究中患病率为2.3％至7.3％。在儿童期，ADOS与早期生命中暴露于PFOS或PFOA无关[赔率比（OR）从0.96（95％CI：0.87，1.06）到1.02（95％CI：0.93，1.11）。分层模型的结果表明，PFAS与儿童性别和孕产妇教育有关的潜在差异影响。结论我们并未发现与全生命周期早期摄入PFOS和PFOA有关的ADHD患病率增加。但是，分层分析表明，女孩，未生育妇女的孩子和低学历母亲的孩子中，与PFAS暴露相关的ADHD患病率可能会增加。所有这些都值得进一步探讨。https://doi.org/10.1289/EHP5444。