A Cohort Study Of Maternal Bisphenol A Exposure And Pregnancy-related Anxiety Induced Executive Function Impairment In Preschoolers

ObjectivesTo describe the distribution of bisphenol A?BPA?exposure during pregnancy,pregnancy-related anxiety,executive dysfunction in preschoolers.And to explore the association between BPA exposure during pregnancy,pregnancy-related anxiety,their combined exposure and executive function abnormalities in preschoolers,so as to provide evidence-based evidence for women's and children's health care.MethodMembers of the Ma'anshan Birth Cohort,a sub-cohort of the China-Anhui Birth Cohort Study?C-ABCS?,were selected as the study subjects.During the prenatal examination,the self-compiled Maternal Health Record Form and the Pregnancy-related Anxiety Questionnaire were used to collect general demographic information,environmental exposure,mental health status and so on.The venous blood was collected at the time of inclusion,the serum was separated and stored in the-80?refrigerator.The content of free BPA in the serum was determined by high-performance liquid chromatography-tandem mass spectrometry?HPLC-MS/MS?.A total of 5 084 pregnant women were included in this study,spontaneous abortion?n=92?,twins?n=66?,induced labor and stillbirth?n=55?,lost to follow-up?n=202?were excluded during the follow-up.Finally,the remained 4 669 cases were single live births.From April 2014 to June 2015,preschool children were followed up in kindergartens in Ma'anshan city.The Preschool Children's Health Record Form and the Behavior Rating Inventory of Executive Function-Preschool version?BRIEF-P?were used to collect preschool children's general demographic information and executive function.From December 2012 to January 2014,the research team tested the serum BPA determination of 2 452 pregnant women in the C-ABCS,of which the number of pregnant women with BPA measurement in this cohort was 1 783.Of the 1 783pregnant children,12 cases of missing executive function were excluded.Finally,a total of 1 771 mother-child pairs were included.P₂₅and P₇₅of urine BPA concentration were used as two cut-off points and divided into three groups.The distribution of serum BPA exposure in pregnant women with different characteristics and the influencing factors of executive dysfunction in preschool children were compared by?².Univariate and multivariate logistic regression were used to analyze the correlation between maternal BPA exposure,pregnancy-related anxiety,their combined exposure and preschoolers'executive function,respectively.ResultsIn this study,the BPA serum samples of pregnant women were mainly collected in the early pregnancy,accounting for 57.3%?1 014/1 771?.According to the classification criteria,the inhibitory self-control index?ISCI?anomaly detection rate is 5.5%?97/1771?,flexibility index?FI?anomaly detection rate is 2.8%?50/1 771?,emergent metacognition index?EMI?anomaly detection rate is 16.3%?289/1 771?,and global executive composite?GEC?anomaly detection rate is 9.3%?164/1 771?.Multivariate logistic regression analysis showed that maternal BPA exposure during pregnancy,pregnancy-related anxiety and both combined exposures were associated with preschoolers'executive function.Stratified by sex,the group with high maternal BPA exposure during pregnancy was a risk factor for ISCI in girls?OR=3.554,95%CI:1.126-11.213?.It is also a risk factor for EMI in girls?OR=1.847,95%CI:1.039-3.282?.Compared with normal pregnant women,mothers who have pregnancy-related anxiety,their children have executive functions of ISCI,EMI,and GEC abnormalities that are 1.892?OR=1.892,95%CI:1.241-2.886?,1.645?OR=1.645,95%CI:1.261-2.147?,and 1.850?OR=1.850,95%CI:1.326-2.580?times than the normal group,respectively.Compared with the low exposure without anxiety group,the middle exposure with anxiety group and the high exposure with anxiety group had an increased risk of abnormal ISCI?OR=2.635,95%CI:1.169-5.938,OR=3.433,95%CI:1.441-8.180?.For FI,the risk of abnormality in the high exposure with anxiety group is 3.507 times higher than that in low exposure without anxiety group?OR=3.507,95%CI:1.122-10.962?.Compared with the low exposure without anxiety group,the risk of abnormal EMI increased in the high exposure without anxiety group,low exposure with anxiety group,medium exposure with anxiety group and high exposure with anxiety group?OR=1.676,95%CI:1.058-2.656,OR=2.011,95%CI:1.185-3.414,OR=1.725,95%CI:1.077-2.763,OR=1.913,95%CI:1.118-3.275?.In the GEC dimension,the risk of abnormalities in the low exposure with anxiety group and the middle exposure with anxiety group was 1.957 and 1.999 times higher than the low exposure without anxiety group?OR=1.957,95%CI:1.002-3.823,OR=1.999,95%CI:1.113-3.592?.After gender stratification,there was still a correlation between girls'executive function and combined exposure,and no statistical correlation was found in boys.ConclusionMaternal BPA exposure during pregnancy can increase the risk of abnormal executive function in girls and pregnancy-related anxiety is associated with abnormal executive function in preschoolers.And their combined exposure showed an increased risk of executive dysfunction in children,especially in girls.