Background

Environmental health research has reported mixed findings on the associations between prenatal exposure to phthalates and parent-ratings of child behavioral problems.

Objective

We examined the consistency of the associations between prenatal urinary phthalate concentrations and child behavior scores across two standardized instruments – the Behavior Assessment System for Children-Second Edition (BASC-2) and the Child Behavior Checklist (CBCL) – using two analytical approaches used to correct for urine dilution.

Method

A sample of 351 mother–child pairs were selected from a prospective birth cohort of pregnant women enrolled between 2009 and 2012. Women provided spot urine samples during the second trimester of pregnancy, which were analyzed for levels of nine urinary phthalate metabolites. When their typically developing children were 3–4 years of age, mothers completed the BASC-2 and CBCL on the same day. Adjusted regression analyses examined the associations between maternal prenatal phthalate concentrations and child behavior scores on the BASC-2 and CBCL. To correct for urine dilution, primary regression analyses included urinary creatinine concentration as a separate independent variable (i.e., covariate). In the secondary regression analyses, creatinine-adjusted phthalate concentrations were used.

Results

Primary logistic regression analyses that included urinary creatinine as a covariate showed that higher prenatal phthalate concentrations were related to increased odds of scores falling into the borderline or clinical range on the Hyperactivity, Aggression, Anxiety, Depression, Withdrawal, Externalizing Problems, Internalizing Problems, and Behavioral Symptoms Index scales on the BASC-2 (ORs from 1.39 to 2.07), but only the Anxious/Depressed and Externalizing Problems scales on the CBCL (ORs from 1.80 to 3.28). Primary linear regression analyses showed that higher prenatal phthalate concentrations were related to higher scores on the Externalizing Problems (β’s = 0.16), Internalizing Problems (β’s from 0.16 to 0.20), and Behavioral Symptoms Index (β’s from 0.18 to 0.21) scales on the BASC-2, but not related to any CBCL scales. Sex-stratified analyses found that many associations were only significant for male children. Secondary analyses using creatinine-adjusted phthalate concentrations revealed that some of the associations from the primary analyses remained significant; however, a number of unique associations were observed.

Conclusion

Prenatal phthalate exposure was associated with preschool behavioral development; however, findings were not consistent for the BASC-2 and CBCL, especially related to the clinical/syndrome scales and Internalizing Problems scale. Further, many findings differed based on the analytical approach used to correct for urine dilution. Future work is needed to delineate the similarities and differences between similarly named child behavior constructs assessed by different neurodevelopmental assessments. Also, research is needed to better understand why and how different analytical approaches influence the reported associations between maternal prenatal phthalate concentrations and children’s behavior problems.

中文翻译：

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相似的名称，不同的结果：产前邻苯二甲酸盐暴露与学龄前儿童行为问题的父母评级之间关联的一致性。

背景

环境健康研究报告了关于产前邻苯二甲酸盐暴露与父母对儿童行为问题的评级之间关联的混合发现。

客观的

我们通过两种标准化工具——儿童行为评估系统第二版 (BASC-2) 和儿童行为检查表 (CBCL)——使用两种分析方法检查了产前尿邻苯二甲酸酯浓度与儿童行为评分之间关联的一致性。正确的尿液稀释。

方法

从 2009 年至 2012 年间登记的孕妇的前瞻性出生队列中选择了 351 对母子对的样本。妇女在妊娠中期提供了现场尿液样本，分析了九种尿邻苯二甲酸酯代谢物的水平。当他们通常发育的孩子 3-4 岁时，母亲在同一天完成了 BASC-2 和 CBCL。调整后的回归分析检查了母亲产前邻苯二甲酸盐浓度与 BASC-2 和 CBCL 儿童行为评分之间的关​​联。为了校正尿液稀释，主要回归分析包括尿肌酐浓度作为单独的独立变量（即协变量）。在二次回归分析中，使用了肌酐调整后的邻苯二甲酸盐浓度。

结果

包括尿肌酐作为协变量的主要逻辑回归分析表明，较高的产前邻苯二甲酸盐浓度与多动、攻击性、焦虑、抑郁、戒断、外化问题、内化问题和BASC-2 上的行为症状指数量表（ORs从 1.39 到 2.07），但只有焦虑/抑郁和外化问题量表在 CBCL 上（ORs从 1.80 到 3.28）。主要线性回归分析表明，较高的产前邻苯二甲酸酯浓度与 BASC 上的外在化问题（β = 0.16）、内在化问题（β 从 0.16 到 0.20）和行为症状指数（β 从 0.18 到 0.21）量表上的得分较高有关-2，但与任何 CBCL 量表无关。性别分层分析发现，许多关联仅对男孩有意义。使用肌酐调整的邻苯二甲酸盐浓度进行的二次分析表明，来自主要分析的一些关联仍然显着；然而，观察到了一些独特的关联。

结论

产前邻苯二甲酸酯暴露与学龄前行为发展有关；然而，BASC-2 和 CBCL 的发现并不一致，尤其是与临床/综合征量表和内化问题量表有关。此外，许多发现因用于校正尿液稀释的分析方法而异。未来的工作需要描述由不同神经发育评估评估的相似命名的儿童行为结构之间的异同。此外，还需要进行研究以更好地了解不同的分析方法为何以及如何影响所报告的产前邻苯二甲酸酯浓度与儿童行为问题之间的关联。