Outdoor air pollution pregnancy exposures are associated with behavioral problems in China’s preschoolers
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There are mounting evidences indicated that maternal exposure to outdoor air pollutants in pregnancy affects children’s neural development, but the researches on children’s behavioral difficulties are seldom. We explored the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and the prevalence of behavioral difficulties among 657 preschool children aged 3–4 from three kindergartens in Wuhan, China. This is a cross-sectional study. Children’s behavioral difficulties were assessed by the Strengths and Difficulties Questionnaire (SDQ) (reported by parents). Maternal exposure to outdoor air pollutants during pregnancy were estimated based on the daily average measured concentration levels from ground monitoring stations. Potential confounding factors including children-related, maternal, and socio-economic status (SES) were adjusted in the study. We calculated the prevalence of each type of behavioral difficulties and used binary logistic regression method to estimate the crude odds ratio (cOR), adjusted odds ratio (aOR), and corresponding 95% confidence intervals (95% CIs) for 1 μg/m3 increase in each air pollutant during every exposure window in single- and two-pollutant models. The prevalence of participants’ total behavioral difficulties was 9.6%. In single-pollutant models, during full gestation, positive associations were observed between exposure to NO2 (aOR = 1.204, 95% CI 1.042, 1.392), particle matter (PM)10 (aOR = 1.070, 95% CI 1.018, 1.125), PM2.5 (aOR = 1.095, 95% CI 1.021, 1.176) and total difficulties, exposure to PM10 (aOR = 1.040, 95% CI 1.001, 1.081), PM2.5 (aOR = 1.053, 95% CI 1.000, 1.109) and prosocial behavior, respectively. In the first trimester, exposure to SO2 (aOR = 1.047, 95% CI 1.009, 1.086), NO2 (aOR = 1.039, 95% CI 1.013, 1.066), PM10 (aOR = 1.013, 95% CI 1.004, 1.023), and PM2.5 (aOR = 1.016, 95% CI 1.004, 1.028) were all positively associated with total difficulties. The associations between second and third trimesters’ exposure to all pollutants and outcomes were not statistically significant. However, in the two-pollutant models, second trimester exposure to PM2.5 (aOR = 1.078, 95%CI 1.023, 1.137) was positively associated with total behavioral difficulties after adjusting for PM10. Exposure to outdoor air pollutants SO2, NO2, PM10, and PM2.5 during pregnancy may be associated with behavioral difficulties, especially in the first trimester.
KeywordsAir pollution Behavioral difficulties Pregnancy China
We gratefully thank all the children, their parents/guardians for their enthusiastic participation, and all the staff of kindergartens for their cooperation. The three kindergartens were Qingqing kindergarten, No.1 kindergarten of Qingshan District, and No.2 kindergarten of Hubei Provincial direct organ, respectively.
This study was funded by the Natural Science Fund of Hubei Province (grant number 2018CFB634).
Compliance with ethical standards
This study was conducted within an agreement of Wuhan University. All the parents recruited in the study signed informed consent letters before the survey.
Conflicts of interest
The authors declare that they have no conflict of interest.
- Belfort MB, Rifas-Shiman SL, Kleinman KP, Bellinger DC, Harris MH, Taveras EM, Gillman MW, Oken E (2016) Infant breastfeeding duration and mid-childhood executive function, behavior, and social-emotional development. J Dev Behav Pediatr 37:43–52. https://doi.org/10.1097/dbp.0000000000000237 CrossRefGoogle Scholar
- Blasko I, Stampfer-Kountchev M, Robatscher P, Veerhuis R, Eikelenboom P, Grubeck-Loebenstein B (2004) How chronic inflammation can affect the brain and support the development of Alzheimer’s disease in old age: the role of microglia and astrocytes. Aging Cell 3:169–176. https://doi.org/10.1111/j.1474-9728.2004.00101.x CrossRefGoogle Scholar
- Calderon-Garciduenas L et al (2008) Long-term air pollution exposure is associated with neuroinflammation, an altered innate immune response, disruption of the blood-brain barrier, ultrafine particulate deposition, and accumulation of amyloid beta-42 and alpha-synuclein in children and young adults. Toxicol Pathol 36:289–310. https://doi.org/10.1177/0192623307313011 CrossRefGoogle Scholar
- Calderon-Garciduenas L et al (2018) Hallmarks of Alzheimer disease are evolving relentlessly in Metropolitan Mexico City infants, children and young adults. APOE4 carriers have higher suicide risk and higher odds of reaching NFT stage V at </=40 years of age. Environ Res 164:475–487. https://doi.org/10.1016/j.envres.2018.03.023 CrossRefGoogle Scholar
- Forns J, Dadvand P, Foraster M, Alvarez-Pedrerol M, Rivas I, López-Vicente M, Suades-Gonzalez E, Garcia-Esteban R, Esnaola M, Cirach M, Grellier J, Basagaña X, Querol X, Guxens M, Nieuwenhuijsen MJ, Sunyer J (2016) Traffic-related air pollution, noise at school, and behavioral problems in Barcelona schoolchildren: a cross-sectional study. Environ Health Perspect 124:529–535. https://doi.org/10.1289/ehp.1409449 CrossRefGoogle Scholar
- Gao X, Shi W, Zhai Y, He L, Shi X (2013) Results of the parent-rated Strengths and Difficulties Questionnaire in 22,108 primary school students from 8 provinces of China. Shanghai Arch Psychiatry 25:364–374. https://doi.org/10.3969/j.issn.1002-0829.2013.06.005 Google Scholar
- Gehring U, Wijga AH, Brauer M, Fischer P, de Jongste JC, Kerkhof M, Oldenwening M, Smit HA, Brunekreef B (2010) Traffic-related air pollution and the development of asthma and allergies during the first 8 years of life. Am J Respir Crit Care Med 181:596–603. https://doi.org/10.1164/rccm.200906-0858OC CrossRefGoogle Scholar
- Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry Allied Discip 38:581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x CrossRefGoogle Scholar
- Harris MH, Gold DR, Rifas-Shiman SL, Melly SJ, Zanobetti A, Coull BA, Schwartz JD, Gryparis A, Kloog I, Koutrakis P, Bellinger DC, Belfort MB, Webster TF, White RF, Sagiv SK, Oken E (2016) Prenatal and childhood traffic-related air pollution exposure and childhood executive function and behavior. Neurotoxicol Teratol 57:60–70. https://doi.org/10.1016/j.ntt.2016.06.008 CrossRefGoogle Scholar
- Huang GW, Hong WU, Liu ZY, Qi-Yun DU, HUANG-Qun, Fang JQ (2012a) Investigation on emotion and behavior problems among children aged 3 to 6 years old. Chin J Child Health Care 20(7):595–597 (in Chinese) Google Scholar
- Huang Y, Yan Q, Li Y, Liu J, Yao H, Yan Y (2012b) Strengths and Difficulties Questionnaire in 737 primary and middle school students aged 6–17 in Changsha. J Cent South Univ (Med Sci) 37:860–864. https://doi.org/10.3969/j.issn.1672-7347.2012.08.018 Google Scholar
- Mohammadi MR, Salmanian M, Ghanizadeh A, Alavi A, Malek A, Fathzadeh H, Moharreri F, Hebrani P, Arman S, Khoshhal Dastjerdi J, Motavallian A (2014) Psychological problems of Iranian children and adolescents: parent report form of Strengths and Difficulties Questionnaire. J Ment Health 23:287–291. https://doi.org/10.3109/09638237.2014.924049 CrossRefGoogle Scholar
- Murray J, Burgess S, Zuccolo L, Hickman M, Gray R, Lewis SJ (2016) Moderate alcohol drinking in pregnancy increases risk for children’s persistent conduct problems: causal effects in a Mendelian randomisation study. J Child Psychol Psychiatry 57:575–584. https://doi.org/10.1111/jcpp.12486 CrossRefGoogle Scholar
- Pihlakoski L, Sourander A, Aromaa M, Rautava P, Helenius H, Sillanpaa M (2006) The continuity of psychopathology from early childhood to preadolescence—a prospective cohort study of 3-12-year-old children. Eur Child Adolesc Psychiatry 15:409–417. https://doi.org/10.1007/s00787-006-0548-1 CrossRefGoogle Scholar
- Rodriguez A, Olsen J, Kotimaa AJ, Kaakinen M, Moilanen I, Henriksen TB, Linnet KM, Miettunen J, Obel C, Taanila A, Ebeling H, Järvelin MR (2009) Is prenatal alcohol exposure related to inattention and hyperactivity symptoms in children? Disentangling the effects of social adversity. J Child Psychol Psychiatry 50:1073–1083. https://doi.org/10.1111/j.1469-7610.2009.02071.x CrossRefGoogle Scholar
- van den Hooven EH, Pierik FH, de Kluizenaar Y, Willemsen SP, Hofman A, van Ratingen SW, Zandveld PYJ, Mackenbach JP, Steegers EAP, Miedema HME, Jaddoe VWV (2012) Air pollution exposure during pregnancy, ultrasound measures of fetal growth, and adverse birth outcomes: a prospective cohort study. Environ Health Perspect 120:150–156. https://doi.org/10.1289/ehp.1003316 CrossRefGoogle Scholar
- WHO (2013) Atlas: child and adolescent mental health resources: global concerns: implications for the future. World Health OrganizationGoogle Scholar
- Yang Y (2016) Rating scales for children’s developmental behavior and mental health. China (in Chinese) Google Scholar
- Yao S, Zhang C, Zhu X, Jing X, McWhinnie CM, Abela JRZ (2009) Measuring adolescent psychopathology: psychometric properties of the self-report strengths and difficulties questionnaire in a sample of Chinese adolescents. J Adolesc Health 45:55–62. https://doi.org/10.1016/j.jadohealth.2008.11.006 CrossRefGoogle Scholar
- Zeng R, Zhang L-L, Luo J-Y, Gong W-J, Du Q-Y, Wu H (2009) Study on emotional, behavioral problems and related determinants among stranded children aged 4 to 7 years in the rural areas of China. Chin J Epidemiol 30:706–709Google Scholar