Review Article

Neurodevelopmental Disorders and Environmental Toxicants: Epigenetics as an Underlying Mechanism

Table 1

Summary of recent reviews and cohort epidemiological studies on environmental toxicants and neurodevelopment.

AuthorsYearToxicantsType and subjectAssessmentsFindings

Maternal smoking
Kakbrenner et al. [133]2012Prenatal maternal smokingCase-cohort study of 633,989
children from parts of 11
U.S states
ASD was based on surveillance
program of the Autism and
Developmental Disabilities
Monitoring Network
Maternal smoking may not associate
with ASD but may differ by ASD
subgroup
Tran et al. [151]2013Maternal smoking during
pregnancy
Finnish cohort study including
4019 ASD cases and 16,123
controls
Medical registryMaternal smoking during the
whole pregnancy was associated
with an increased risk for pervasive
developmental disorder (OR = 1.2,
95%CI: 1.0–1.5)
Zhu et al. [131]2014Paternal smoking and
nicotine replacement use
in pregnancy
84,803 Danish singletons, 50,870
children participated in the
7-year follow-up
Self-report; also observed for
nicotine substitutes; ADHD
was based on medical diagnosis
and questionnaires
Children born to smoking or nicotine
replacement usage mother and
nonsmoking father have higher risk
for ADHD compared to children born
to smoking father and nonsmoking
mother (adjusted hazard ratio
HR = 1.63, 95%CI: 1. 36–1.94 and 2.28,
95%CI: 1.48–3.51 compared to 1.29,
95%CI: 1.14–1.47, resp.); children born to
stop smoking mother and smoking father
also increased risk of ADHD (HR = 1.70,
95%CI: 1.38–2.10; both maternal and
paternal smoking during pregnancy
associated with an elevated risk for
ADHD, maternal smoking have more
important effect
Melchior et al. [129]2015Maternal tobacco smoking
in pregnancy
1113 families in France since
pregnancy in 2003–2005 until
the child’s 5th birthday
Self-report; data collection
at pregnancy, birth, 4, 8, 12, 24,
and 36 months, and 5 years
Maternal smoking predicted high
symptoms of hyperactivity or
inattention OR = 1.95, 95%CI: 1.13–3.38
(in the 1st trimester); OR = 2.11, 95%CI:
1.36–3.27; (throughout pregnancy);
maternal smoking throughout
pregnancy have elevated level of
hyperactivity or inattention OR = 2.20,
95%CI: 1.21–4.00; the dose of smoking showed a trend to associate with
children’s levels of hyperactivity or
inattention OR = 1.49, 95%CI: 0.52–4.21
and 1.64, 95%CI: 0.53–4.64 for less than
and equal to or higher than 10 cigarettes/
day, respectively
Tang et al. [134]2015Maternal smoking during
pregnancy
Meta-analysis of 6 cohort and 9 case-control studiesNo association between maternal smoking
during pregnancy and ASD (pooled
OR = 1.02, 95%CI: 0.93–1.13)
Joelsson et al. [130]2016Prenatal smoking exposureFinnish cohort study of
10,409 ADHD cases and
40,141 controls
Self-reportMaternal smoking increased the odds for
ADHD compared to entire samples when
adjusted for confounder (OR = 1.73,
95%CI: 1.62–1.84); maternal smoking
only in the first trimester or after the first
trimester increased odds for ADHD,
although smoking only in the first trimester
had a lower risk (OR = 1.24, 95%CI: 1.03–1.50
in only the first trimester compared to
OR = 1.79, 95%CI: 1.68–1.82 in group
smoking after first trimester)
Browne et al. [132]2016Prenatal maternal smokingWomen early in pregnancy
from 1996–2002, follow-up
to when the child was 15
year old
Self-report and psychiatric
diagnoses
Heavy maternal smoking (>10 cigarettes/day)
increased risk for Tourette syndrome and
chronic tic disorders; heavy maternal
smoking also increased risk for Tourette
syndrome comorbid with ADHD

BPA and phthalates
Braun et al. [135]2011Gestational and childhood
BPA exposure
244 mothers and their
3-year-old children
Spot urine samples; mother:
twice during 16 and 26 weeks
of gestation, and within 24 h
after birth; child: 1, 2, and 3
years of age
Gestational BPA concentration were
associated with higher anxiety,
hyperactivity, and depression scale
score; especially greater among girls
at 3 years of age
Pepera et al. [137]2012Prenatal BPA exposure198 African-American and
Dominican mother and
children pairs
Spot urine sample for mother
during pregnancy and for child
between 3 and 4 years old
In boys, high BPA concentration had
higher scores on emotionally reactive
and aggressive behavior (OR = 1.62,
95%CI: 1.12–2.32 and 1.29, 95%CI:
1.09–1.53, resp.); in girls, high BPA
concentration had lower scores on
emotionally reactive and aggressive
behavior (OR = 0.74, 95%CI: 0.51–1.07
and 0.82, 95%CI: 0.70–0.97, resp.)
Evans et al. [136]2014Prenatal BPA exposure153 mother-child pairs (children
were 6 to 10 years old)
Maternal urine spot sample in
the mean 26.6 weeks of gestation
Higher prenatal BPA concentration
increased scores in some behaviors
including ADHD or conduct disorders;
the effect of BPA was worse in boys
than in girls
Roen et al. [138]2015Prenatal BPA exposure250 mothers and childrenSpot urine sample for mother in
the third trimester and for child
between 3 and 5 years old
In boys, high BPA concentration were
associated with higher behavioral
symptom scores; when in girls, high BPA
concentration were associated with lower
behavioral symptom scores
Casas et al. [139]2015Prenatal BPA exposure438 mother-child pairs
(children followed up
to 7 years old)
Spot urine samples in
the 1st and 3rd trimesters
Prenatal PBA exposure was associated
with increasing inattention symptoms
in boys when decreasing inattention
symptoms in girls
Polanska et al. [140]2014Prenatal and postnatal phthalate
exposure
165 children in the Polish
Mother and Child Cohort study
Phthalate levels in the urinePrenatal phthalate exposure inversely
correlated with child psychomotor
development such as cognitive, language,
and motor abilities
Ejaredar et al. [152]2015Prenatal exposure to phthalatesSystematic review of 11 articlesPrenatal exposure to phthalates is
associated with adverse cognitive and
behavioral outcomes in children from
0 to 12 years old, including lower IQ, and
problems with attention, hyperactivity,
and poorer social communication
Lien et al. [141]2015Prenatal phthalate exposure122 mother-child pairs in
Taiwan Maternal and Infant Cohort study
Mother: urine samples
in the 3rd trimester; child:
urine samples at 8-9 years of age
Higher concentration of DBP and DEHP
in maternal urine samples were
associated with externalizing disorders
Minatoya et al. [142]2016Prenatal phthalate exposure224 participants (infants at
6 and 18 months of age)
Maternal blood MEHP
concentration at 23–35
weeks of gestation
Prenatal DEHP exposure showed no
changes in infant thyroid hormone level
and had no adverse effects on infant
neurodevelopment

POPs
Strom et al. [143]2014Maternal exposure to PCBs
and POPs
876 mother-child pairs in
Danish cohort study
Maternal serum at 3rd
trimester
No relationship between POPs and child
neurodevelopment
Neugebauer et al. [146]2015Prenatal and postnatal exposure to
polychlorinated dibenzo-p-dioxins
and furans (PCDD/Fs), PCB,
and lead
117 childrenMaternal blood at 32 weeks of
gestation and 1st week of
breastfeeding
Prenatal exposure to PCDD/F and PCB
significantly associated with attention
performance in healthy children, whereas
ADHD-related behavior remained unchanged
Kiriklaki et al. [144]2016Prenatal exposure to POPs689 mother-child pairs in a
Greece cohort study
Maternal serum in 2nd
trimester of gestation
Prenatal exposure to POPs may be
related to reduce cognitive but not to
child behavioral difficulties
Oulhote et al. [145]2016Prenatal and postnatal exposure
to POPs
656 children in Faroese cohortMaternal serum at week
32 of gestation; child
serum at age 5 and 7
Prenatal exposure to POPs had no
association with behavioral difficulties
in child; however, high serum PFAS
concentration at ages 5 and 7 was
related to behavioral problems
Goudarzi et al. [147]2016Prenatal exposure to PFOS
and PFOA
428 mother-infant pairsMaternal serum PFOS and PFOA
concentrations
Prenatal PFOA exposure had negative
effects on female infants at 6 months of
age but not at 18 months of age.
Prenatal PFOS exposure was not
associated with neurodevelopmental
scores

Heavy metals
Rodríguez-Barranco
et al. [148]
2013Arsenic, cadmium, and manganese exposureMeta-analysisIncrease of arsenic and manganese
concentrations were associated with
lower IQ, and exposure to manganese
increases the risk of ADHD
Liu et al. [149]2014Postnatal lead exposure1341 childrenLead: blood concentration
at 3, 4, and 5 years of age
Higher blood lead concentration is
associated with increase DSM-IV
pervasive developmental problems
Rodrigues et al. [150]2016Postnatal lead exposure, prenatal and postnatal arsenic and
manganese exposure
524 children in BangladeshLead: blood concentration;
arsenic and manganese: water
concentration
There are relationships between higher
blood lead concentration and water
arsenic or manganese concentration
with decrease cognitive scores