Water fluoridation is a population health intervention used in Canada and the United States to control tooth decay. The safety of administering fluoride via public drinking water is uncertain. Recent human studies suggest that exposure to fluoride in drinking water may alter thyroid function, increase blood lead levels, lower IQ, and increase the risk of developing ADHD. Still, many of the human studies included groups who were exposed to higher levels of fluoride and they often lacked a comparison group or sensitive measures of behavior or learning. Given widespread exposure to fluoridated water, the US National Research Council concluded in a 2007 report that rigorous epidemiological research is urgently needed to address the controversy about the safety of this public health intervention.
The aim of this study is to determine if prenatal and childhood exposure to fluoride impacts learning abilities and behavioral problems in young Canadian children, with particular emphasis on vulnerable populations. The present proposal will build upon an exceptional national pregnancy cohort study: ?Maternal-Infant Research on Environmental Chemicals? (MIREC). The MIREC cohort is ideally suited to address the research objectives because the requisite information (urine during pregnancy and child outcomes) was collected in a large sample that varied as a function of municipal water fluoridation. Fluoride concentrations will be measured using stored urine samples obtained from a sample of 1960 pregnant women living in ten large Canadian cities ? half of which add fluoride to municipal water. Out of 1207 participants who were approached, standardized questionnaires assessing behavioral outcomes are available for 898 children (74% of sample) living in select cities across Canada. In addition, standardized cognitive assessments, or IQ scores, are available for 610 of the children in the birth cohort. The study will also examine whether neurodevelopmental outcomes differ among children who ingested infant formula using fluoridated versus non-fluoridated water. Finally, we will examine whether serial urinary fluoride concentrations in pregnant women are higher in women who live in communities that fluoridate their municipal drinking water. The results of this study will inform public health officials and decision makers about ?real-time? fluoride levels of pregnant women living in fluoridated and non-fluoridated communities. It will also provide important information about whether fluoride exposure adversely impacts children?s behaviors or learning abilities. This information will direclty impact decision making concerning the safety of water fluoridation among vulnerable populations and is therefore an area of high

Public Health Relevance

Because of the unique vulnerability of the developing brain, the potential for adverse neurodevelopmental outcomes as a consequence of prenatal and early postnatal fluoride exposure is of high public health relevance. The proposed study will significantly enhance the quality of data testing for adverse impact of water fluoridation to help guide policy and practice decisions. If safety concerns are identified, the public health intervention can be refined to minimize risk for adverse health outcomes, particularly among population sub-groups that tend to bear a greater environmental health burden, including biologically vulnerable populations, such as formula-fed infants and low-income communities.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Exploratory/Developmental Grants (R21)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
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Gray, Kimberly A
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York University
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M3 1-P3