Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes

By Jennifer L Ames, Mohamad Burjak, Lyndsay A Avalos, Joseph M Braun, Catherine M Bulka, Lisa A Croen, Anne L Dunlop, Assiamira Ferrara, Rebecca C Fry, Monique M Hedderson, Margaret R Karagas, Donghai Liang, Pi-I D Lin, Kristen Lyall, Brianna Moore, Rachel Morello-Frosch, Thomas G O'Connor, Jiwon Oh, Amy M Padula, Tracey J Woodruff, Yeyi Zhu, and Ghassan B Hamra
January 12, 2023
DOI: 10.1097/EDE.0000000000001587


Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes.


We included ten cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) Program (n=1429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex.


Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adj-β [95% CI]=1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adj-β [95% highest posterior density interval]=0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences.


Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.

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