Nonspecific DAP metabo-lites (nanomoles per liter) were summed and transformed to the log10 scale. We created “pregnancy” DEs, DMs, and total DAP values by averaging the two log-transformed pregnancy measures. The two pregnancy total DAP measurements were correlated (r = 0.14, p = 0.005) and did not significantly differ (paired t-test = −0.28, p = 0.78). For 29 women, only one DAP measurement was available. Prenatal and postnatal DAP measures were uncorre-lated, so we placed both exposures into a single model for each outcome. Coefficients were similar to those in models containing either prenatal or postnatal exposures alone. Because a large proportion of women had nonde-tectable levels of MDA and TCPy, we categorized levels into three groups for each metabolite: < LOD for both pregnancy measurements, and for those with at least one detectable level, subdivided below and above the median of the average pregnancy level.
To assess the relationship between metabo-lite levels and Bayley performance, we constructed separate multiple regression models for MDI and PDI at each of the three time points: 6, 12, and 24 months. We evaluated MDI and PDI continuously using linear regression. We included the same covariates in all Bayley models. Covariates were selected for these analyses if they were related to conditions of testing [i.e., psychometrician (n = 4), location (office or RV), exact age at assessment]; related to neurodevelopment in the literature and associated (p < 0.10) with most outcomes [i.e. sex, breast-feeding duration (months), HOME score (continuous), and household income]; or consistently related to neurodevel-opment in the literature even if not in our data [i.e., parity and maternal PPVT (continuous)]. We classified household income as above or below poverty by comparing total household income to the federal poverty threshold for a household of that size (U.S. Census Bureau 2000 ). In addition to the variables we included, we examined the potential confounding effects of several other variables suggested by the literature (i.e., maternal age, education, depressive symptoms, active/passive smoking exposure during pregnancy, regular alcohol use during pregnancy, marital status, father’s presence in home, housing density, maternal work status, ≥ 15 hours out-of-home childcare/week), but they did not markedly alter the observed associations. For simplicity, the same set of covariates was used for CBCL models with three exceptions: maternal depression, found to be important (p < 0.10), was added, and psychometrician and assessment location were dropped, because scores were based on maternal report. Covariates in final models were categorized as noted inTable 1 , unless otherwise specified above. To preserve the size of the analytic population, each missing covariate value was imputed by randomly selecting a value from participants with non-missing values. Maternal depression had the largest percentage of values requiring imputation (5%). Of remaining covariates, between 0% and 1.8% of values were imputed.
In secondary analyses, we controlled for some factors potentially on the causal pathway (birth weight, gestational age, abnormal reflexes) and re-ran models excluding low birth weight and preterm infants. We also considered whether controlling for other suspected neuro-toxicants (i.e., PCBs, lead, and DDT) and other high-level exposures in our population (i.e., β-hexachlorocyclohexane and hexa-chlorobenzene) (Fenster et al. 2006 (link)) altered our results for DAPs in the subsample with both DAPs and the other chemical. Furthermore, we examined interactions between child DAPs and child sex and, because we previously observed an association with maternal DDT and 24-month MDI (Eskenazi et al. 2006 (link)), between maternal DAPs and DDT. Finally, we re-ran models using log-transformed creatinine-adjusted metabolites for comparative purposes.
In addition, we performed longitudinal data analyses [generalized estimating equations (GEE)] of the relationship between DAPs and Bayley scores, which produced similar findings. These GEE models included indicators for age at assessment and interaction terms for most independent variables and age. We obtained a minor increase in precision when the effects of some potential confounders were assumed constant over time. In addition, assuming a single effect of DAPs over time also produced small increases in precision of the relevant regression coefficient estimators, but again the gains were slight. Thus, we only present the results from the cross-sectional analyses for ease of understanding.
To assess the relationship between metabo-lite levels and Bayley performance, we constructed separate multiple regression models for MDI and PDI at each of the three time points: 6, 12, and 24 months. We evaluated MDI and PDI continuously using linear regression. We included the same covariates in all Bayley models. Covariates were selected for these analyses if they were related to conditions of testing [i.e., psychometrician (n = 4), location (office or RV), exact age at assessment]; related to neurodevelopment in the literature and associated (p < 0.10) with most outcomes [i.e. sex, breast-feeding duration (months), HOME score (continuous), and household income]; or consistently related to neurodevel-opment in the literature even if not in our data [i.e., parity and maternal PPVT (continuous)]. We classified household income as above or below poverty by comparing total household income to the federal poverty threshold for a household of that size (U.S. Census Bureau 2000 ). In addition to the variables we included, we examined the potential confounding effects of several other variables suggested by the literature (i.e., maternal age, education, depressive symptoms, active/passive smoking exposure during pregnancy, regular alcohol use during pregnancy, marital status, father’s presence in home, housing density, maternal work status, ≥ 15 hours out-of-home childcare/week), but they did not markedly alter the observed associations. For simplicity, the same set of covariates was used for CBCL models with three exceptions: maternal depression, found to be important (p < 0.10), was added, and psychometrician and assessment location were dropped, because scores were based on maternal report. Covariates in final models were categorized as noted in
In secondary analyses, we controlled for some factors potentially on the causal pathway (birth weight, gestational age, abnormal reflexes) and re-ran models excluding low birth weight and preterm infants. We also considered whether controlling for other suspected neuro-toxicants (i.e., PCBs, lead, and DDT) and other high-level exposures in our population (i.e., β-hexachlorocyclohexane and hexa-chlorobenzene) (Fenster et al. 2006 (link)) altered our results for DAPs in the subsample with both DAPs and the other chemical. Furthermore, we examined interactions between child DAPs and child sex and, because we previously observed an association with maternal DDT and 24-month MDI (Eskenazi et al. 2006 (link)), between maternal DAPs and DDT. Finally, we re-ran models using log-transformed creatinine-adjusted metabolites for comparative purposes.
In addition, we performed longitudinal data analyses [generalized estimating equations (GEE)] of the relationship between DAPs and Bayley scores, which produced similar findings. These GEE models included indicators for age at assessment and interaction terms for most independent variables and age. We obtained a minor increase in precision when the effects of some potential confounders were assumed constant over time. In addition, assuming a single effect of DAPs over time also produced small increases in precision of the relevant regression coefficient estimators, but again the gains were slight. Thus, we only present the results from the cross-sectional analyses for ease of understanding.
Full text: Click here