Bisphenol A Exposure and Behavioral Outcomes in Children: A Systematic Review and Meta-Analysis of Evidence Limited to the BASC Assessment Tool

Abstract

Background: The growing concern about exposure to endocrine disrupting chemicals (EDCs), and their effects on human health, especially the possible neurobehavioral effects in children, makes a review of the scientific evidence on the subject important. The study conducts a systematic review and applies meta-analysis to determine whether there is a relationship between bisphenol exposure and behavioral development in children, as measured by the Behavioral Assessment System for Children (BASC). Methods: In June and July 2024, Scopus, Web of Science, and Medline with PubMed were the databases used to search for studies within the scope of this study. A total of 562 articles were found, of which 59 were analyzed; finally, 13 studies met the inclusion criteria for systematic review and 7 for the meta-analysis. The scales measured in the different studies have been aggression, attention, hyperactivity, depression, anxiety and somatization; behavioral indices (behavioral symptom index, externalizing and internalizing behaviors) were also analyzed. Results: Most of the studies found no significant associations and no consistency in the results obtained. The heterogeneity in the design of the studies made it impossible to generate conclusive results in the application of meta-analysis. Discussion: There is a sex-based differentiation in the behavioral effects associated with bisphenol exposure, as bisphenols affect boys and girls differently, potentially through mechanisms involving estrogen receptors, among other biological pathways. Conclusions: Our study highlights the need to improve and homogenize the design and results of epidemiological studies to extract data effectively. More results are needed to be able to draw conclusions.