Prenatal Organophosphate Exposure Not Linked to Autism-Related Traits: JAMA

A new study published in the Journal of American Medical Association showed that in a prospective cohort analysis of the Environmental Influences on Child Health Outcomes (ECHO) cohort, prenatal organophosphate pesticide (OP) exposure was not linked to autism-related features in childhood.

Prenatal exposure to OPs, which are known neurotoxicants, is common in the US population and is mostly caused by food. There is still conflicting evidence connecting prenatal OP exposure to autism spectrum disorder (ASD) and features associated with autism. Thus, this study investigated the relationship between prenatal OP exposure and childhood autism-related features, as well as to evaluate potential variations in the relationship by child sex and mother diet.

Mother-child couples from 20 research sites in the ECHO cohort provided harmonized data for this pooled prospective cohort study. Autism-related outcomes in children aged 2 to 19 were evaluated over the recruitment period, which ran from January 1997 to December 2019. Urine levels of 3,5,6-trichloro-2-pyridinol (TCPy) and the total of 6 dialkyl phosphate (βDAP) metabolites are used to assess prenatal OP exposure.

Using the Social Responsiveness Scale (SRS), parents identified characteristics associated with autism in their children. After controlling for mother sociodemographic and behavioral variables, correlations between biomarkers and SRS T scores overall and by child sex were estimated using multivariable linear, quantile, and logistic regression models. This study explored impact modification by maternal diet quality in exploratory analyzes and subsequently accounted for dietary parameters in other models.

The SRS was given at a mean (SD) age of 6.4 (3.87) years, 1665 children (49.9%) were female, and the mean (SD) maternal age of the 3339 mother-child pairs analyzed was 31 (6) years.

Inverse correlations between prenatal TCPy or ΨDAP levels and SRS scores were suggested by crude or minimally adjusted models; however, these correlations diminished and lost statistical significance following full adjustment (β per doubling of TCPy concentration [ng/mL] = −0.13; 95% CI, −0.57 to 0.31; β per doubling of ΣDAP [nmol/L] = −0.42; 95% CI, −1.03 to 0.19).

The findings held true for many sensitivity analyses, sex-stratified models, secondary analyses employing quantile and logistic regressions, and after dietary confounding adjustments. There was no proof that the quality of the diet affected the results. Overall, organophosphate pesticide exposure during pregnancy has not been linked to juvenile autism-related characteristics, according to a large prospective ECHO cohort research. 

Reference:

Cavalier, H. M., Volk, H. E., Kivumbi, A., Liu, M., Lyall, K., Afanasyeva, Y., Chen, Y., Wang, Y., Kannan, K., Li, Z., Sherris, A. R., Croen, L. A., Schmidt, R. J., Bennett, D. H., Ames, J. L., Breton, C. V., Bakian, A. V., Bastain, T. M., Alkhouri, N. B., … ECHO Cohort Consortium. (2026). Prenatal organophosphate exposure and autism-related traits in children. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2026.3785