The modifying role of maternal adverse psychological status on the association between prenatal exposure to per- and polyfluoroalkyl substances and infant atopic dermatitis: A nested case-control study

Atopic dermatitis (AD) is a common childhood allergic disease associated with substantial health and economic burdens. Although prenatal exposure to per- and polyfluoroalkyl substances (PFAS) has been linked to adverse child health outcomes, its association with AD and the potential modifying role of maternal adverse psychological status (MAPS) remain unclear. Based on the China National Birth Cohort, we quantified 759 maternal serum PFAS concentrations during the first trimester and evaluated MAPS (including stress, depression, and anxiety) across all three trimesters. AD in infants at 6 months of age was diagnosed according to the UK Working Party diagnostic criteria. The associations of individual PFAS exposure with AD were estimated using multivariable logistic regression, whereas the joint effects of PFAS mixtures were assessed using quantile g-computation. Interaction terms and stratified analyses were performed based on MAPS group (positive vs. negative). After adjusting for potential confounders, prenatal PFAS exposure was associated with an increased risk of AD in 6-month-old infants. Moreover, when MAPS was positive overall, or specifically for anxiety, depression, or stress, prenatal PFAS exposure was associated with a further elevated risk of infant AD at 6 months. These findings underscore the need for further research into childhood health determinants and for public health policies that reduce prenatal exposure to PFAS pollutants and maternal psychological distress, thereby potentially alleviating AD risk in future generations. • PFAS exposure and psychological distress challenge pregnant women in Shanghai. • Prenatal PFAS exposure increases atopic dermatitis risk in 6-month-old infants. • Maternal psychological distress may modify PFAS-atopic dermatitis association.