Table 1.

Bisphenol A exposure and neurodevelopmental outcomes.

Reference	Study Design	Location	Sample Size	Age	Exposure Levels/Specimen	Test Tool	Main Findings
Casas et al. [21]	Longitudinal	Spain	438	1, 4, 7 y	2.6 μg/g Cr (GM)/1st and 3rd trimester maternal urine	BSID-I MSCA DSM-IV CPRS SDQ	Prenatal exposure does not affect cognitive development up to age 4 years. Associations are observed with psychomotor development (β= −4.28, 95% confidence interval (CI): −8.15, −0.41) and ADHD-related symptoms (IRR(Incidence rate ratio) = 1.72; 95% CI: 1.08, 2.73) at early ages, but these do not appear to persist until later ages.
Roen et al. [22]	Longitudinal	US	250	7–9 y	1.9 μg/L (GM)/3rd trimester maternal urine 3.2 μg/L (GM)/child urine	CBCL	High prenatal concentration was associated with increased internalizing (β = 0.41) and externalizing (β = 0.40) composite scores and with their corresponding individual syndrome scales (boys). High postnatal concentration was associated with increased behaviors on both internalizing (β = 0.30) and externalizing (β = 0.33) composite scores and individual sub scores (girls).
Perera et al. [23]	Longitudinal	US	241	10–12 y	1.93 μg/L (GM)/3rd trimester maternal urine 5.28 μg/L (GM)/child urine	RCMAS CDRS	Prenatal exposure was associated with more symptoms of anxiety and depression (β = 2.83) (boys).
Lim et al. [24]	Longitudinal	Korea	304	4 y	2.0 μg/g Cr (mean)/mid-pregnancy urine 4.9 μg/g Cr (mean)/child urine	K-SCQ	Pre and postnatal exposure were associated with increase in social impairment (β = 58.4%; 95% CI: 6.5, 135.8, β = 11.8%; 95% CI: 0.6, 24.3, respectively) (girls).
Braun et al. [25]	Longitudinal	US	346	1–8 y	2.0 μg/g Cr (median)/maternal urine at 16 and 26 weeks	BASC-2 BSID-II WPPSI-III WISC-IV	Prenatal exposure was associated with more externalizing behaviors (β = 5.9; 95% CI: 1.1, 11) (girls).
Lin et al. [26]	Longitudinal	Taiwan	208 (2 y) 148 (7 y)	2 y 7 y	3.2–3.3 ng/mL (median)/cord blood	CDIIT WICS-IV	Prenatal exposure had adverse effects on full-scale IQ and verbal comprehension index (boys). Prenatal exposure had adverse effects on full-scale IQ, perceptual reasoning index, and working memory index (girls).
Stacy et al. [27]	Longitudinal	US	228	8 y	2.1 ng/mL (median)/maternal urine1.6 ng/mL (median)/child urine	BASC-2 WISC-IV BRIEF	Prenatal exposure was associated with more externalizing behaviors (β = 6.2, 95% CI: 0.8, 11.6) (girls). Concurrent exposure was associated with more externalizing behaviors (β = 3.9, 95% CI: 0.6, 7.2) (boys).
Minatoya et al. [28]	Longitudinal	Japan	285	6 m 18 m 3.5 y	0.051 ng/mL (median)/cord blood	BSID-II K-ABC CBCL	No association between prenatal exposure and child mental or psychomotor ability but was positively associated with development problems score (β = 2.60, 95% CI: 0.15, 5.06).
Braun et al. [29]	Longitudinal	Canada	812	3 y	0.8 ng/mL (median)/maternal urine at 12.1 weeks	WPPSI-III BRIEF-P BASC-2 SRS-2	Prenatal exposure was associated with poorer working memory and more internalizing and somatizing behaviors (β = 0.5; 95% CI: −0.1, 1.1, β = 0.6; 95% CI: 0.0, 1.2, respectively) (boys). Prenatal exposure was associated with poorer SRS-2 scores (β = 0.3; 95% CI: 0, 0.7).
Braun et al. [30]	Longitudinal	US	198	8 y	2.0 μg/g Cr (median)/maternal urine at 16 and 26 weeks	VMWM	Prenatal exposure was not associated with VMWM performance.
Minatoya et al. [31]	Longitudinal	Japan	458	5 y	0.062 ng/mL (median)/1st trimester maternal serum	SDQ	No significant association of prenatal exposure.
Pan et al. [32]	Longitudinal	China	368 (12 m) 296 (24 m)	12 m 24 m	1.05 μg/g Cr (median)/maternal urine at delivery	DQ	Prenatal exposure was adversely associated with the adaptive domain DQs (boys and girls) (β = −1.43; 95% CI: −2.30, −0.56), and the social domain DQs (girls) at 12 mo, as well as with the language domain (girls) at 24 mo (β = −1.69; 95% CI: −3.23, −0.15).
Jensen et al. [33]	Longitudinal	Denmark	535 (MB-CDI) 658 (CBCL)	21 m 2–7 y	1.2 ng/mL (median)/3rd trimester maternal urine	MB-CDI CBCL	Prenatal exposure adversely associated with vocabulary score (boys). BPA exposure in the highest tertile had OR = 3.70; 95% CI: 1.34–10.21.
Jiang et al. [34]	Longitudinal	China	456	2 y	1.13 μg/L (median, average)/1st, 2nd, 3rd trimester maternal urine	BSID-I	Increase in BPA concentrations was related to lower MDI scores only in the 2nd trimester (β = −2.87, 95 % CI: −4.98, −0.75).
Guo et al. [35]	Longitudinal	China	326	7 y	2.78 μg/L (GM)/Maternal urine	C-WISC	Prenatal exposure was significantly negatively associated with FIQ (β = −1.18, 95% CI: −2.21, −0.15).
England-Mason et al. [36]	Longitudinal	Canada	312	2 and 4 y	1.64 μg/g Cr (GM)/3rd trimester maternal urine 1.11 μg/g Cr (GM)/postpartum maternal urine	BRIEF-P	Higher concentrations of maternal BPA at 3-month postpartum were associated with increasing difficulties in inhibitory self-control and emergent metacognition from age 2 to 4 (girls).
Freire et al. [37]	Longitudinal	Spain	191	4–5 y	1.30 ng/g (median)/placenta	MSCA	Prenatal exposure was associated with greater ORs of scoring lower in the verbal (OR = 2.78, 95% CI: 1.00–5.81) and gross motor (OR = 1.75, 95% CI: 1.06–9.29).
Perez-Lobato et al. [38]	Cross-sectional	Spain	300	9–11 y	4.76 μg/L (median)/child urine	CBCL/6-18	Concurrent exposure was associated with worse behavioral scores. Children with the highest BPA had more somatic complaints (β = 2.35; 95% CI: 0.25, 4.46) and social (β = 1.71; 95% CI: 0.19, 3.22) and thought problems (β = 2.58; 95% CI: 0.66, 4.51).
Arbuckle et al. [39]	Cross-sectional	Canada	1080	6–11 y	1.31 μg/L (GM)/child urine	SDQ	Concurrent exposure was not associated with SDQ score but was associated with taking psychotropic medications (OR = 1.59; 95% CI: 1.05–2.40).
Tewar et al. [40]	Cross-sectional	US	460	8–15 y	3.9μg/L(median)/child urine	ADHD diagnosis	Concurrent exposure was associated with ADHD and the association was stronger in boys (OR = 10.9; 95% CI: 1.4–86.0).
Li et al. [41]	Case-control	China	215 (case) 253 (control)	6–12 y	Case 4.63 μg/g Cr Control 1.71 μg/g Cr (mean)/child urine	ADHD diagnosis	Concurrent exposure may be related to ADHD. (OR = 4.58; 95% CI: 2.84–7.37 boys, OR = 2.83; 95% CI: 1.17–6.84 girls).
Stein et al. [42]	Case-control	US	46 (ASD) 52 (control)	10 y (mean)	Case 11.18 ng/mL Control 6.58 ng/mL (median)/child urine	ASD diagnosis	Concurrent exposure was associated with ASD. Total BPA was 3 times greater with the ASD group (p < 0.001).
Rahbar et al. [43]	Case-control	US	30 (ASD) 10 (control)	2–8 y	Case 1.33 µg/g Cr Control 0.93 µg/g Cr (mean)/child urine	ASD diagnosis	Controls had lower bisphenol A levels.
Tsai et al. [44]	Case-control	Taiwan	130 (ADHD) 68 (control)	6–12 y	Not provided.	ADHD diagnosis	No significant difference of urinary BPA levels between case and control groups.

ASD Autism Spectrum Disorder, ADHD Attention Deficit Hyperactivity Disorder, CBCL Child Behavior CheckList, SDQ Strengths and Difficulties Questionnaire, BSID Bayley Scales of Infant Development, MSCA McCarthy Scales of Children’s Abilities, DSM Diagnostic and Statistical Manual of Mental Disorders, CPRS Conner’s Parent Rating Scales, RCMAS Revised Children’s Manifest Anxiety Scale, CDRS Children’s Depression Rating Scale, K-SCQ Korean version of the Social Communication Questionnaire, BASC Behavior Assessment System for Children, WPPSI Wechsler Preschool and Primary Scales of Intelligence, WISC Wechsler Intelligence Scale for Children, CDIIT Comprehensive Developmental Inventory for Infants and Toddlers, BRIEF Behavior Rating Inventory of Executive Function, K-ABC Kaufman Assessment Battery for Children, BRIEF-P Behavior Rating Inventory of Executive Function–Preschool, SRS Social Responsiveness Scale, VMWM Virtual Morris Water Maze, DQ developmental quotient, and MB-CDI MacArthur-Bates Communicative Development Inventories.