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CME

Gestational BPA Exposure Linked to Behavioral Problems in Children

  • Authors: News Author: Megan Brooks
    CME Author: Penny Murata, MD
  • CME Released: 10/26/2011
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/26/2012
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Target Audience and Goal Statement

This article is intended for primary care clinicians, behavior developmental specialists, toxicologists, obstetricians, and other specialists who provide care to patients at risk for bisphenol A exposure.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe whether bisphenol A exposure during pregnancy is associated with behavioral problems in the offspring at age 3 years.
  2. Describe whether bisphenol A exposure during childhood is associated with behavioral problems at age 3 years.


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Author(s)

  • Megan Brooks

    Megan Brooks is a freelance writer for Medscape.

    Disclosures

    Disclosure: Megan Brooks has disclosed no relevant financial relationships.

Editor(s)

  • Brande Nicole Martin

    CME Clinical Editor, Medscape, LLC

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author(s)

  • Penny Murata, MD

    Clinical Professor, Pediatrics, University of California, Irvine, California
    Pediatric Clerkship Director, University of California, Irvine, California

    Disclosures

    Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC

    Disclosures

    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.


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CME

Gestational BPA Exposure Linked to Behavioral Problems in Children

Authors: News Author: Megan Brooks CME Author: Penny Murata, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 10/26/2011

Valid for credit through: 10/26/2012

processing....

Clinical Context

Bisphenol A (BPA) is contained in various products encountered in daily life, including dental sealants, food and beverage containers and linings, and medical equipment, as noted by Vandenberg and colleagues in the August 2010 issue of Environmental Health Perspectives. In the January 2007 issue of Environmental Research, Wilson and colleagues reported that BPA exposure is most likely to occur through diet but can also occur by inhalation or by dermal absorption.

In a cohort study in the December 2009 issue of Environmental Health Perspectives, Braun and colleagues found that gestational BPA exposure was linked with increased hyperactivity and aggression scores in girls at age 2 years.

The current study by Braun and colleagues uses the same cohort to assess whether BPA exposure in pregnancy or childhood is associated with neurobehavioral measures at age 3 years and whether any association is modified for girls or for boys.

Study Synopsis and Perspective

New research suggests an association between gestational exposure to the widely used industrial chemical BPA and increased anxious, depressive, and hyperactive behaviors at age 3 years, particularly in girls.

The research was published online October 24 in Pediatrics.

"At this point, we don't know what these findings mean in terms of clinical disorders of behavior," Joe M. Braun, MSPH, PhD, from the Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, told Medscape Medical News. "Future studies will need to determine if BPA exposures are associated with clinical behavior disorders," he said.

BPA is used in a variety of consumer products, including dental sealants, food/beverage containers and linings, medical equipment, and thermal receipts, such as those from ATM machines. Virtually all people in industrialized nations are exposed to the plasticizer.

"People who are concerned about BPA exposure could decrease or eliminate their consumption of canned or packaged foods; they could also avoid contact with thermal receipts," Dr. Braun said.

Increased Hyperactivity, Aggression

In an earlier study, Dr. Braun and colleagues found that gestational BPA exposure was associated with increased hyperactivity and aggression in 2-year-old girls in a prospective birth cohort from Cincinnati, Ohio.

They have now followed the children out to age 3 years, with similar results. The cohort includes 244 mothers and their 3-year-old girls. Mean urinary BPA concentrations were determined at 16 and 26 weeks' gestation and at age 1, 2, and 3 years in the children. Behavior and executive function were measured using the Behavior Assessment System for Children 2 (BASC-2) and the Behavior Rating Inventory of Executive Function–Preschool (BRIEF-P).

As expected, BPA was detected in more than 97% of the gestational and childhood urine samples. Median concentrations were 2.0 μg/L and 4.1 μg/L, respectively.

There was no association between childhood urinary BPA concentrations and behavioral issues.

However, after adjusting for various confounding factors, each 10-fold increase in gestational BPA concentration was associated with more anxious and depressed behavior on the BASC-2 scale and poorer emotional control and inhibition on the BRIEF-P, the researchers report.

Sex Difference Intriguing

Girls were more sensitive to gestational BPA exposures than boys, but the authors urge caution in interpreting this finding, "given the imprecision of the observed associations among girls and the low statistical power for interactions between gender and BPA exposures."

Nonetheless, they say, the apparent sex difference is "intriguing, given the endocrine-disrupting nature of BPA."

The authors acknowledge that there is considerable debate regarding the toxicity of low-level BPA exposure, and say current findings warrant further research.

"My colleagues at the Mt. Sinai School of Medicine have reported that gestational BPA exposure is associated with atypical social behaviors (behaviors observed in children with [attention-deficit/hyperactivity disorder] and autism)," Dr. Braun told Medscape Medical News.

"Going forward," he said, "we will continue to examine other behaviors including autistic-like behaviors and spatial abilities" in relation to BPA exposures. "We will also try to determine if BPA impacts fetal sex steroid production or action during gestation."

The study was supported by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. 2011;128:873-882. Abstract

Study Highlights

  • The investigators obtained data from a prospective birth cohort of 244 mothers and their 3-year-old children.
  • Exclusion criteria were twin delivery, stillbirths, and lack of 3-year data.
  • Gestational BPA exposure was assessed by urinary mean BPA concentrations in the mother at 16 weeks' gestation, 26 weeks' gestation, and within 24 hours after delivery.
  • Childhood BPA exposure was assessed by urinary mean BPA concentrations in the child at ages 1, 2, and 3 years.
  • Total (free plus conjugated) BPA level was measured at the Centers for Disease Control and Prevention.
  • BPA exposure was defined as the mean of at least 2 urine samples from the gestational measurements and from the childhood measurements.
  • The BPA limit of detection was 0.4 µg/L.
  • Behavior at age 3 years was measured by the 134-item Behavior Assessment System for Children 2 (BASC-2) Parent Rating Scale for preschoolers.
  • The BASC-2 includes the Behavioral Symptom Index summary score and subscales for aggression, attention, hyperactivity, depression, anxiety, and somatization.
  • Executive function at age 3 years was measured by the 63-item Behavior Rating Inventory of Executive Function–Preschool (BRIEF-P).
  • BRIEF-P measures used for analysis included the Global Executive Composite summary score, the emotional control score, the inhibit score to assess control of behavioral responses, plan or organize scores, shift scores to assess the ability to transition to and from events, and working memory scores to assess the ability to retain information for completing a task.
  • Higher BASC-2 and BRIEF-P scores indicate greater impairment.
  • Dyads with complete follow-up data vs incomplete data were more likely to be white, married, ages 25 to 34 years, more educated, wealthier, and to have lower gestational urinary BPA levels.
  • Lower maternal education or household income was linked with higher BASC-2 and BRIEF-P scores at age 3 years.
  • BPA was found in more than 97% of gestational and childhood urine samples.
  • Median urinary BPA levels were 2.0 µg/L during gestation and 4.1 µg/L in childhood.
  • Maternal BPA levels were stable between the first sample and at delivery.
  • Childhood BPA levels decreased from age 1 year to age 3 years.
  • BPA levels were analyzed as continuous log10 variables.
  • The analysis adjusted for possible confounders: maternal race, education, marital status, and household income; maternal depressive symptoms at 20 weeks' gestation; Home Observation for Measurement of the Environment; maternal smoke exposure with use of cotinine levels; and maternal exposure to low-molecular-weight phthalates.
  • Gestational BPA level was linked with more anxiety, depressed behavior, and hyperactivity on the BASC-2.
  • Girls vs boys had greater associations between higher gestational BPA levels and anxiety, depression, and hyperactivity.
  • In boys, higher gestational BPA level was linked with lower BASC-2 hyperactivity scores.
  • Gestational BPA level was linked with poorer emotional control and inhibition on the BRIEF-P.
  • Girls vs boys had greater associations between higher gestational BPA levels and poorer emotional control and inhibition.
  • Childhood BPA exposure was not associated with significant changes in BASC-2 and BRIEF-P scores overall or for girls or boys.
  • Results were not affected by adjustment for maternal IQ, parity, or duration of breast-feeding; analysis of 215 women and 154 children with all 3 urine samples; or exclusion of 32 women and 13 children with dilute or concentrated urine.
  • Study limitations included low statistical power for interactions between sex and BPA exposure and variable generalizability of findings.

Clinical Implications

  • Gestational BPA exposure appears to be associated with more anxiety, hyperactivity, and depressive behavior and poorer emotional control and inhibition in the offspring at age 3 years, particularly in girls.
  • Childhood BPA exposure is not linked with behavioral or emotional measures at age 3 years overall for girls or boys.

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