Associations of cord blood concentrations of perfluoroalkyl substances with autistic traits in Singaporean children: The growing up in Singapore towards healthy outcomes study

Michael Mascari¹, Nathan Cohen², Meizhen Yao³, Jonathan Huang⁴, Jamil Lane⁵, Katherine W Reeves⁶, Raji Balasubramanian⁷, Zhenhua Liu⁸, Nasser Laouali⁹, Lourdes Mary Daniel¹⁰, Chia-Yang Chen¹¹, Chong Yap Seng¹², Chan Shiao-Yng¹³, Michelle Z L Kee¹⁴, Damaskini Valvi¹⁵, Youssef Oulhote¹⁶

Affiliations

¹ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: mtmascari@gmail.com.
² Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: nathan.cohen@mssm.edu.
³ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: meizhen.yao@mssm.edu.
⁴ Thompson School of Social Work and Public Health, Office of Public Health Studies, University of Hawaii at Manoa, 2430 Campus Road, Honolulu, HI, 96822, USA. Electronic address: huangjy@hawaii.edu.
⁵ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: jamil.lane@mssm.edu.
⁶ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: kwreeves@umass.edu.
⁷ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: rbalasub@schoolph.umass.edu.
⁸ Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: zliu@nutrition.umass.edu.
⁹ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: alaoualimaha@umass.edu.
¹⁰ Department of Child Development, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899. Electronic address: mary.daniel@singhealth.com.sg.
¹¹ Institute of Food Safety and Health, College of Public Health, National Taiwan University, No. 17, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan. Electronic address: dbms@ntu.edu.tw.
¹² Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597. Electronic address: obgcys@nus.edu.sg.
¹³ Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597; Institute for Human Development and Potential (IHDP), Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore. Electronic address: obgchan@nus.edu.sg.
¹⁴ Institute for Human Development and Potential (IHDP), Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore; Brain-Body Initiative, Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore. Electronic address: michelle_kee@sics.a-star.edu.sg.
¹⁵ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: dania.valvi@mssm.edu.
¹⁶ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: youssef.oulhote@mssm.edu.

PMID: 39733956
PMCID: PMC11758275 (available on 2026-02-01)
DOI: 10.1016/j.chemosphere.2024.144040

Associations of cord blood concentrations of perfluoroalkyl substances with autistic traits in Singaporean children: The growing up in Singapore towards healthy outcomes study

Michael Mascari et al. Chemosphere. 2025 Feb.

. 2025 Feb:371:144040.

doi: 10.1016/j.chemosphere.2024.144040. Epub 2025 Jan 8.

Authors

Affiliations

¹ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: mtmascari@gmail.com.
² Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: nathan.cohen@mssm.edu.
³ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: meizhen.yao@mssm.edu.
⁴ Thompson School of Social Work and Public Health, Office of Public Health Studies, University of Hawaii at Manoa, 2430 Campus Road, Honolulu, HI, 96822, USA. Electronic address: huangjy@hawaii.edu.
⁵ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: jamil.lane@mssm.edu.
⁶ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: kwreeves@umass.edu.
⁷ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: rbalasub@schoolph.umass.edu.
⁸ Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: zliu@nutrition.umass.edu.
⁹ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. Electronic address: alaoualimaha@umass.edu.
¹⁰ Department of Child Development, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899. Electronic address: mary.daniel@singhealth.com.sg.
¹¹ Institute of Food Safety and Health, College of Public Health, National Taiwan University, No. 17, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan. Electronic address: dbms@ntu.edu.tw.
¹² Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597. Electronic address: obgcys@nus.edu.sg.
¹³ Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597; Institute for Human Development and Potential (IHDP), Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore. Electronic address: obgchan@nus.edu.sg.
¹⁴ Institute for Human Development and Potential (IHDP), Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore; Brain-Body Initiative, Agency for Science, Technology, and Research (A∗STAR), 1, #20-10 Fusionopolis Wy, Connexis, North Tower, 138632, Singapore. Electronic address: michelle_kee@sics.a-star.edu.sg.
¹⁵ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: dania.valvi@mssm.edu.
¹⁶ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. Electronic address: youssef.oulhote@mssm.edu.

PMID: 39733956
PMCID: PMC11758275 (available on 2026-02-01)
DOI: 10.1016/j.chemosphere.2024.144040

Abstract

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social deficits and repetitive behaviors. Environmental pollutants may contribute to the etiology of ASD, but studies of perfluoroalkyl substances (PFAS) have shown conflicting results.

Objectives: We assessed associations between cord blood concentrations of PFAS with autistic traits at age seven years in a Singaporean birth cohort.

Methods: We measured cord blood concentrations of eight PFAS in a sample of 430 mother-child pairs from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort. We assessed autistic traits using the Social Responsiveness Scale Second Edition (SRS-2) and its sub-scores, in which higher scores indicate more autistic traits. We estimated covariate-adjusted associations between the PFAS and SRS-2 scores using Bayesian weighted quantile sum (BWQS) regression models for the PFAS mixtures and multivariable regressions for single PFAS. We additionally evaluated effect modification by biological sex.

Results: We observed a positive association between the PFAS mixture and SRS-2 cognition sub-scores (β per SD increase = 1.25 points, 95% CI -0.03, 2.40). Perfluorononanoic acid (PFNA) was the strongest contributor to the mixture effect. In single PFAS models, exposure to PFNA was associated with a higher SRS-2 total score (β = 0.93 points, 95% CI 0.29, 1.58), cognition sub-score (β = 1.26 points, 95% CI 0.55, 1.97), communication sub-score (β = 0.88 points, 95% CI 0.20, 1.56), and restrictive and repetitive behaviors sub-score (β = 0.93 points, 95% CI 0.23, 1.63). We also observed evidence of effect modification by sex for perfluoroundecanoic acid (PFUnDA) for the total score (p-effect modification [EM] = 0.03), cognition sub-score (p-EM = 0.03), and communication sub-score (p-EM = 0.04), with negative associations seen in females and null associations in males.

Discussion: Cord blood PFAS concentrations were positively associated with autistic traits measured by SRS-2.

Keywords: Autism; Perfluoroalkyl substances; Singapore; Social responsiveness scale second edition.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

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Associations of cord blood concentrations of perfluoroalkyl substances with autistic traits in Singaporean children: The growing up in Singapore towards healthy outcomes study

Affiliations

Associations of cord blood concentrations of perfluoroalkyl substances with autistic traits in Singaporean children: The growing up in Singapore towards healthy outcomes study

Authors

Affiliations

Abstract

Conflict of interest statement

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