Prenatal exposure to per- and polyfluoroalkyl substances in association with autism spectrum disorder in the MARBLES study

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Background/Aim: Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect child brain development, but epidemiologic evidence remains inconsistent. We examined whether prenatal PFAS exposure was associated with increased risk of autism spectrum disorder (ASD).Methods: Participants were 204 mother-child pairs from MARBLES (Markers of Autism Risk in Babies - Learning Early Signs), which followed younger siblings of children with ASD. Children were clinically classified into ASD (n = 57), non-typical development (Non-TD, n = 31), and typical development (TD, n = 116). We quantified nine PFAS in maternal sera prospectively collected throughout pregnancy. Of 312 samples, 67, 142, and 103 samples were collected from the first, second, and third trimesters, respectively. We used multinomial logistic regression to investigate associations of individual PFAS concentrations with the risk of ASD and Non-TD.Results: Overall, most associations of average prenatal maternal PFAS serum concentrations with the risk of ASD and Non-TD were statistically insignificant. When restricting analyses to each trimester, perfluorooctanoate (PFOA) was associated with increased risk of ASD in the third trimester (RRR = 3.58, 95% CI: 1.01, 12.6). When stratified by maternal age at delivery (<35, ≥35 years), among mothers ≥35 years old at delivery, ASD risk was associated with prenatal PFOA (RRR = 8.84, 95% CI: 1.70, 46.1), perfluorononanoate (RRR = 7.03, 95% CI: 1.35, 11.7), and perfluorodecanoate (RRR = 3.37, 95% CI: 1.04, 10.9).Conclusions: We found evidence that prenatal exposure to some PFAS was associated with increased risk of ASD among children whose mothers were 35 years old or older at delivery. Further studies should be conducted in the general population to confirm our findings.Keywords: autism spectrum disorder, maternal serum, PFASDisclaimer: The findings and conclusions in this abstract are those of the authors and do not necessarily represent the views of the CDC.