Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada
Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada
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DOI：
10.1001/jamapediatrics.2019.1729
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发表时间：
2019-10-01
期刊：
影响因子：
26.1
通讯作者：
Till, Christine
中科院分区：
文献类型：
--
作者：
Green, Rivka;Lanphear, Bruce;Till, Christine
重要性潜在的神经毒性与暴露于氟化物，这已经产生了争议，社区水氟化，仍不清楚。目的研究之间的关联在怀孕期间的氟化物暴露和智商分数在一个前瞻性的birth cohol.DESIGN，设置，和参与者这一前瞻性的，多中心的出生队列研究使用的信息从母婴研究环境化学品队列。2008年至2012年间出生的儿童; 41%的儿童生活在供应氟化市政水的社区。研究样本包括来自加拿大6个主要城市的601对母子，测试时儿童年龄在3至4岁之间。分析了2017年3月至2019年1月期间的数据。暴露孕妇尿氟（MUFSG），根据比重进行调整，并在512名孕妇的3个妊娠期内取平均值，以及自我-报告了400名孕妇每日从水和饮料中摄入氟化物的情况。主要结果和指标韦克斯勒小学和学前智力量表。多元线性回归分析被用来检查协变量调整关联之间的每一个氟暴露措施和IQ scores.Results的母亲，儿童对，母亲的平均（SD）年龄为32.3（5.1）岁，463（90%）是白色，和264名儿童（52%）是女性。关于MUFSG浓度、智商分数和完整协变量的数据可用于512对母子;关于母亲氟化物摄入量和儿童智商的数据可用于601对母子中的400对。生活在自来水加氟地区的妇女（n = 141）与生活在非自来水地区的妇女（n = 228）相比，MUFSG浓度的平均值（SD）显著更高（0.69 [0.42] mg/L vs 0.40 [0.27] mg/L; P = .001;转换为毫摩尔/升，乘以0.05263）和氟化物摄入水平（0.93 [0.43] vs 0.30 [0.26] mg氟化物/天; P = 0.001）。儿童的平均（SD）全量表智商得分为107.16（13.26），范围为52-143，女孩的平均（SD）得分显著高于男孩：109.56（11.96）vs 104.61（14.09）; P = 0.001。儿童性别和MUFSG之间存在显著的相互作用（P = 0.02）（6.89; 95% CI，0.96-12.82），表明男孩和女孩之间存在差异性关联。MUFSG每增加1 mg/L，男孩的IQ评分降低4.49分（95% CI，-8.38至-0.60），但与女孩的IQ评分无统计学显著相关性（B = 2.40; 95% CI，-2.53至7.33）。孕妇每天摄入1毫克以上的氟化物与男孩和女孩智商低3.66分（95%CI，-7.16至-0.14）有关。结论和相关性在这项研究中，母亲在怀孕期间暴露于较高水平的氟化物与3至4岁儿童智商低有关。这些发现表明可能需要减少怀孕期间的氟化物摄入量。
IMPORTANCE The potential neurotoxicity associated with exposure to fluoride, which has generated controversy about community water fluoridation, remains unclear.OBJECTIVE To examine the association between fluoride exposure during pregnancy and IQ scores in a prospective birth cohort.DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter birth cohort study used information from the Maternal-Infant Research on Environmental Chemicals cohort. Children were born between 2008 and 2012; 41% lived in communities supplied with fluoridated municipal water. The study sample included 601 mother-child pairs recruited from 6 major cities in Canada; children were between ages 3 and 4 years at testing. Data were analyzed between March 2017 and January 2019.EXPOSURES Maternal urinary fluoride (MUFSG), adjusted for specific gravity and averaged across 3 trimesters available for 512 pregnant women, as well as self-reported maternal daily fluoride intake from water and beverage consumption available for 400 pregnant women.MAIN OUTCOMES AND MEASURES Children's IQ was assessed at ages 3 to 4 years using the Wechsler Primary and Preschool Scale of Intelligence-III. Multiple linear regression analyses were used to examine covariate-adjusted associations between each fluoride exposure measure and IQ score.RESULTS Of 512 mother-child pairs, the mean (SD) age for enrollment for mothers was 32.3 (5.1) years, 463 (90%) were white, and 264 children (52%) were female. Data on MUFSG concentrations, IQ scores, and complete covariates were available for 512 mother-child pairs; data on maternal fluoride intake and children's IQ were available for 400 of 601 mother-child pairs. Women living in areas with fluoridated tap water (n = 141) compared with nonfluoridated water (n = 228) had significantly higher mean (SD) MUFSG concentrations (0.69 [0.42] mg/L vs 0.40 [0.27] mg/L; P = .001; to convert to millimoles per liter, multiply by 0.05263) and fluoride intake levels (0.93 [0.43] vs 0.30 [0.26] mg of fluoride per day; P = .001). Children had mean (SD) Full Scale IQ scores of 107.16 (13.26), range 52-143, with girls showing significantly higher mean (SD) scores than boys: 109.56 (11.96) vs 104.61 (14.09); P = .001. There was a significant interaction (P = .02) between child sex and MUFSG (6.89; 95% CI, 0.96-12.82) indicating a differential association between boys and girls. A 1-mg/L increase in MUFSG was associated with a 4.49-point lower IQ score (95% CI, -8.38 to -0.60) in boys, but there was no statistically significant association with IQ scores in girls (B = 2.40; 95% CI, -2.53 to 7.33). A 1-mg higher daily intake of fluoride among pregnant women was associated with a 3.66 lower IQ score (95% CI, -7.16 to -0.14) in boys and girls.CONCLUSIONS AND RELEVANCE In this study, maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years. These findings indicate the possible need to reduce fluoride intake during pregnancy.