Prenatal lead exposure and childhood executive function and behavioral difficulties in project viva

Victoria Fruh, Sheryl L. Rifas-Shiman, Chitra Amarasiriwardena, Andres Cardenas, David C. Bellinger, Lauren A. Wise, Roberta F. White, Robert O. Wright, Emily Oken, Birgit Claus Henn

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: Lead is an established neurotoxicant and early life exposure to lead is associated with detrimental impacts on IQ and several neurobehavioral domains. Less is known, however, about effects of prenatal lead exposure below 5 μg/dL on executive function and on social, emotional and self-regulatory behaviors in childhood. Objectives: To examine the association between prenatal lead exposure and childhood executive function and social, emotional and self-regulatory behaviors. Methods: We included 1006 mother-child pairs from the Project Viva prospective pre-birth cohort. We measured prenatal maternal lead in second-trimester erythrocytes. In mid-childhood (median 7.7 years), parents and teachers rated executive function related behaviors using the Behavior Rating Inventory of Executive Function (BRIEF) and behavioral difficulties using the Strengths and Difficulties Questionnaire (SDQ). We used multivariable linear regression models adjusted for maternal, paternal, and child characteristics and metal co-exposures. Results: Mean maternal erythrocyte lead concentration was 1.2 μg/dL (interquartile range [IQR] 0.8–1.5 μg /dL), equivalent to approximately 0.4 μg/dL in whole blood. In adjusted models, associations with parent and teacher-rated scales were largely null, although effect estimates were consistently positive, suggesting worse scores with increasing lead levels. For an IQR increase in lead, BRIEF Global Executive Composite (GEC) was 0.73 (95% CI: -0.06, 1.52) points higher for parent-rated scores and 0.42 (95% CI: -0.39, 1.23) points higher for teacher-rated scores. Associations were strongest for parent-rated BRIEF plan/organize (β = 0.85; 95% CI: 0.12, 1.59) and shift (β = 0.88; 95% CI: 0.01, 1.75) subscales, as well as the SDQ emotional problems subscale (β = 0.18; 95% CI: 0.03, 0.33). Discussion: In this cohort with lead levels commonly experienced by U.S. women, there were few statistically significant associations with childhood executive function and behavior. However, there was a trend of worse neurobehavioral scores with increasing prenatal lead concentrations, in particular for childhood emotional problems and capacity to plan/organize and shift. Our results highlight the importance of continuing efforts to eliminate lead exposure in the general population.

Original languageEnglish
Pages (from-to)105-115
Number of pages11
StatePublished - Dec 2019


  • Childhood
  • Environmental epidemiology
  • Lead
  • Neurobehavior
  • Prenatal exposure


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