Prenatal Fluoride Exposure Shows No Overall Link to Childhood Behavioral Problems: JAMA

A new study published in the Journal of American Medical Association showed that prenatal exposure to fluoride in public drinking water did not significantly correlate with internalizing or externalizing emotional and behavioral issues in children.

While high levels of fluoride exposure during the prenatal period have been linked to socioemotional issues in children, less is known about possible correlations at lower levels of fluoride exposure, especially in the United States. Thus, the purpose of this study was to investigate the relationship between children's socioemotional issues in a pooled US pediatric consortium and prenatal exposure to fluoride levels in public drinking water.

The Environmental Influences on Child Health Outcomes (ECHO) Cohort, which was conducted at 20 prenatal pediatric cohort sites in 34 US states, provided observational pregnancy cohort data for children ages 1.5 to 17 years from January 1, 2005, to December 31, 2019. Between December 2024 and December 2025, statistical analysis was carried out. Pregnancy-related home addresses were used to determine area-level, time-weighted mean fluoride concentrations in public water.

There were 5520 children in the cohort (mean [SD] age, 5.8 [3.0] years; 2849 males [51.6%]). Prenatal time-weighted water fluoride levels ranged from <1.4-3272.5 µg/L, with a mean (SD) of 407.9 (361.0) µg/L. T scores per 500 for the adjusted mean difference in behavioral and emotional problems.

For internalizing difficulties, the 0-μg/L greater exposure to prenatal public water fluoride was −0.15 (95% CI, −0.85 to 0.56) and for externalizing problems, it was 0.06 (95% CI, −0.44 to 0.55), consistently demonstrating no relationships at the continuous level.

However, only when employing change point models for externalizing difficulties (adjusted mean difference, 1.59 [95% CI, 0.72-2.47] per 500.0-µg/L rise over the inflection point) and for certain subgroups were some favorable relationships found.

Overall, there were no correlations found in this study between children's internalizing and externalizing issue T scores and prenatal fluoride exposure by public water fluoride. These results demonstrate that children's emotional and behavioral issues were not linked to prenatal water fluoride levels close to or below the current USPHS limit (700.0 µg/L). Only after employing change point models for externalizing issues and some subgroups were some positive correlations found at higher levels.

Reference:

Hernandez, A., Nigra, A. E., Simon, K. R., Bloomquist, T. R., Rajeev, T., Margolis, A., Kress, A. M., Burjak, M., Shuffrey, L. C., Akbaryan, A., Xu, X., Liu, C., Eick, S., Wang, Z., Aschner, J. L., Shin, H.-M., Karagas, M., Fry, R. C., Sanchez, T., … Environmental Influences on Child Health Outcomes (ECHO) Cohort Consortium. (2026). Prenatal water fluoride exposure and children’s behavioral problems. JAMA Network Open, 9(9), e2629389. https://doi.org/10.1001/jamanetworkopen.2026.29389