OBJECTIVES:Exposure to air pollutants is well established as being associated with the development and exacerbation of asthma. However, relatively few studies have examined the relationship between fine particulate matter (PM2.5) exposure and the risk of urticaria and allergic rhinitis (AR). Therefore, this study aimed to investigate the associations between long-term PM2.5 exposure and the risks of urticaria and AR. METHODS:We analyzed data from the Korean National Health Insurance Service-National Sample Cohort spanning 2002 to 2019. The cohort included individuals enrolled from birth and followed until the onset of urticaria or AR. Annual PM2.5 exposure was estimated using validated machine learning-based prediction models with high spatial resolution across mainland Korea. At the initial healthcare visit, urticaria and AR were identified based on primary diagnostic codes from the 10th revision of the International Classification of Diseases. Cox proportional hazards models with time-varying exposures and confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risks associated with a 5 μg/m3 increase in annual PM2.5 concentration. RESULTS:During follow-up, 364,227 individuals aged 0-18 years at enrollment were included, among whom 151,508 developed urticaria and 258,041 developed AR. The mean PM2.5 concentration at baseline was 29.6 μg/m3 (standard deviation, 3.1). The HR per 5 μg/m3 increase in annual PM2.5 concentration was 1.02 (95% CI, 1.01 to 1.03) for urticaria and 1.06 (95% CI, 1.05 to 1.07) for AR. CONCLUSIONS:In this nationwide cohort, long-term exposure to PM2.5 was associated with the incidence of urticaria and AR. These findings provide important evidence for strategies aimed at preventing urticaria and AR in children.

Allergic conjunctivitis (AC) is a common ocular condition that impacts children’s quality of life. While ozone (O₃) and particulate matter (PM10) are known risk factors, their long-term effects on childhood AC remain unclear. We investigated the association between long-term childhood exposure to O₃ and PM10 and the risk of developing allergic conjunctivitis. By investigating the National Health Insurance Service–National Sample Cohort, we focused on individuals aged 0–18 years at enrollment. From 2002 to 2019, we defined the onset of mild AC as the first hospital visit with a diagnostic code of H10.1. Severe AC was defined as either the addition of steroid and cyclosporine eye drop prescriptions to a case of mild AC, or as a primary diagnostic code of H16.25. We assigned annual average exposure of both PM10 and O3 to 226 inland districts in South Korea using a machine learning-based ensemble prediction model. We applied a Cox regression model with time-varying exposures and covariates. In this study, we identified 364,227 individuals aged 0–18 at enrollment, among whom 137,491 experienced mild AC and 83,815 experienced severe AC during the study period. For each 5-unit increase in annual PM10 and O3 concentrations, the hazard ratios (HR) for mild AC were 1.02 (95

Kawasaki Disease (KD) is an acute pediatric vasculitis with unclear etiology, though environmental triggers have been proposed. This scoping review synthesized epidemiological evidence on outdoor environmental exposures and KD incidence. A systematic search up to December 2024 identified 32 eligible studies. KD incidence is highest in East Asia, particularly Japan, South Korea, and Taiwan, where most research has been concentrated. Meteorological variables and air pollutants were most studied. Approximately half of the studies on meteorological variables found associations with KD, with some suggesting the role of temperatures or wind-driven transport of airborne agents. Air pollution studies showed inconsistent short-term effects, but more consistent links with long-term or prenatal particulate matter exposure. Studies on airborne biological agents, though fewer, showed consistent positive findings. These results suggest a multifactorial etiology. However, heterogeneity in methods limits comparability. Little is known about chemical substances in soil, water, or other outdoor sources, which may also affect immune pathways relevant to KD. Standardized, multinational research is needed to clarify environmental contributions and guide prevention in high-risk regions.

Background: Maternal nutritional requirements change with each trimester, making it crucial to provide appropriate vitamin supplementation tailored to each stage. In this study, we investigated the trimester-specific patterns of various vitamin supplements in pregnant women. Methods: In this multicenter cross-sectional study, we analyzed a total of 816 singleton pregnant women who visited hospitals for prenatal care from April 2023 to December 2023. Participants were grouped by trimester, with 140 in the first trimester, 365 in the second, and 311 in the third trimester. A stratified analysis by trimester was performed using multiple linear regression and logistic regression models to examine trimester-specific differences in vitamin supplement intake. A one-way analysis of variance was conducted to compare the total vitamin supplement intake across trimesters. Results: Among the 816 pregnant women, 98.16% (801/816) reported taking at least one supplement, with the mean number of supplements increasing from 2.92 ± 1.27 in the first trimester to 4.04 ± 1.63 in the second and 4.37 ± 1.52 in the third trimester. Notably, iron supplementation increased significantly across trimesters. Stratification analysis revealed that maternal age significantly influenced calcium intake (p-value for interaction = 0.03), with women aged ≥35 years exhibiting higher intake in the third trimester. However, parity and body mass index (BMI) did not show significant interactions with any supplement type. Vitamin D and folic acid intake remained consistently high across trimesters, indicating widespread awareness of their importance. These findings suggest that supplementation practices vary based on pregnancy stage and maternal characteristics. Conclusions: Our study examined the patterns of vitamin supplement intake among pregnant women in Republic of Korea across trimesters. We anticipate that this research will serve as a foundational study, providing valuable insights for future investigations into trimester-specific supplement use among pregnant women.

BACKGROUND:Bisphenol A (BPA) is a type of endocrine-disrupting chemical utilized in the production of plastics like epoxy resins and polycarbonate polymers. BPA exhibits weak estrogenic and potent anti-androgenic effects, and prior research has linked it to disturbances in thyroid function. This study aims to assess the potential association between early childhood exposure to urinary bisphenol A and thyroid hormone levels in pubertal children from Korea. METHODS:Participants were drawn from the Ewha Birth and Growth Cohort Study, encompassing individuals who visited Ewha Women's Mokdong Hospital between 2001 and 2005. The concentration of urinary BPA was repeatedly measured for each subject at ages 3-5 years and 7-9 years. Serum levels of free triiothyronine (T3), free thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured at ages 10-12 years in a subgroup of 128 out of 164 subjects who had undergone repeated BPA concentration measurements. We utilized the SAS program to analyze possible links between childhood exposure to BPA and thyroid hormone function in adolescence. Additionally, we explored how exposure to BPA during two specific periods influenced changes in thyroid hormone levels. RESULTS:The study observed that urinary BPA levels at ages 3-5 years were not notably linked to thyroid hormone levels in adolescents aged 10-12 years. However, BPA levels at ages 7-9 years were significantly associated with free T3 levels in girls aged 10-12 years. Conversely, exposure to BPA did not result in significant differences in thyroid hormone levels among boys. The study did not find statistically significant connections between levels of urinary BPA and the other thyroid hormones, specifically TSH and free T4. There was a significant decrease in the concentration of free T3 in girls with higher BPA concentrations. CONCLUSIONS:BPA exposure in childhood affects thyroid function in adolescent girls. This relationship may contribute to an increased prevalence of thyroid disorders in adolescents due to environmental influences.

This study explores the causal role of multiple correlated risk factors in coronary heart disease (CHD) and ischemic stroke, using Mendelian randomization (MR) analyses with GWAS summary data from both prevalent and incident stroke cases. Thirteen candidate risk factors were considered, including age at menarche, adiposity, lipid fractions, blood pressure, and smoking. Univariable MR identified seven exposures significantly associated with CHD risk, including BMI, blood pressure, LDL, triglycerides, type-II diabetes, and smoking. Notably, HDL showed a protective effect (OR = 0.77, 95% CI: 0.72–0.83), while type-II diabetes was positively associated with CHD (OR = 1.10, 95% CI: 1.05–1.16). For ischemic stroke subtypes, diastolic and systolic blood pressure showed consistent effects across both small vessel and large artery stroke (e.g., DBP OR = 2.27, 95% CI: 1.77–2.89 for small vessel stroke), and HDL again demonstrated protective effects. Multivariable MR (MVMR) further confirmed these associations, though estimates were attenuated. In summary, both univariable and MVMR analyses identified robust associations of lipid fractions and blood pressure with cardiovascular outcomes, highlighting their importance in CHD and ischemic stroke risk across multiple stroke subtypes.

BACKGROUND:Global Burden of Disease (GBD) studies have proposed integrated exposure-response models primarily based on North American and European data, which may not be directly applicable to the Asia-Pacific region. Through a systematic review and meta-analysis, we aimed to explore the association between long-term exposure to ambient particulate matter (PM) and mortality in the Asia-Pacific states. METHODS:We searched 3 databases (PubMed [n = 8,326], Embase [n = 4,709], and Cochrane Library [n = 357]) between 1st January 1990 and 31st July 2023. Our search focused on studies examining the associations between long-term exposure to PM with an aerodynamic diameter < 2.5 μm (PM2.5) and 10 μm (PM₁₀) and all-cause (or non-accidental) and cause-specific mortality, including cardiovascular disease (CVD), ischemic heart disease (IHD), stroke, acute lower respiratory infection, chronic obstructive pulmonary disease, and lung cancer deaths in the Asia-Pacific states. We conducted a meta-analysis to pool the estimates in the studies. RESULTS:We identified 71 articles investigating the association between long-term exposure to PM and all-cause and cause-specific mortality. For a 10 μg/m³ increase in PM2.5, the pooled relative risk (RR) with 95% confidence intervals (CI) for all-cause mortality was 1.11 (95% CI, 1.05-1.17), 1.13 (95% CI, 1.06-1.21) for CVD, 1.13 (95% CI, 1.02-1.25) for IHD, 1.12 (95% CI, 1.02-1.24) for stroke, and 1.12 (95% CI, 1.08-1.16) for lung cancer. For a 10 μg/m³ increase in PM₁₀, the pooled RR for all-cause mortality was 1.12 (95% CI, 1.00-1.24) and 1.33 (95% CI, 1.28-1.38) for IHD. CONCLUSION:Our analysis revealed positive associations between long-term exposure to PM and all-cause and cause-specific mortality for CVD, IHD, stroke, and lung cancer in the Asia-Pacific states. TRIAL REGISTRATION:PROSPERO Identifier: CRD42023441916.

Background: Particulate air pollution and residential greenness are associated with sleep quality in the general population; however, their influence on maternal sleep quality during pregnancy has not been assessed. Objective: This cross-sectional study investigated the individual and interactive effects of exposure to particulate matter (PM) air pollution and residential greenness on sleep quality in pregnant women. Methods: Pregnant women (n = 4933) enrolled in the Korean Children's Environmental Health Study with sleep quality information and residential address were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The average concentrations of PM (PM2.5 and PM10) during pregnancy were estimated through land use regression, and residential greenness in a 1000 m buffer area around participants' residences was estimated using the Normalized Difference Vegetation Index (NDVI1000-m). Modified Poisson regression models were used to estimate the associations between PM and NDVI and poor sleep quality (PSQI >5) after controlling for a range of covariates. A four-way mediation analysis was conducted to examine the mediating effects of PM. Results: After adjusting for confounders, each 10 μg/m3 increase in PM2.5 and PM10 exposure was associated with a higher risk of poor sleep quality (relative risk [RR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11; and RR: 1.09; 95% CI: 1.06, 1.13, respectively), and each 0.1-unit increase in NDVI1000-m was associated with a lower risk of poor sleep quality (RR: 0.97; 95% CI: 0.95, 0.99). Mediation analysis showed that PM mediated approximately 37%–56% of the association between residential greenness and poor sleep quality. Conclusions: This study identified a positive association between residential greenness and sleep quality. Furthermore, these associations are mediated by a reduction in exposure to particulate air pollution and highlight the link between green areas, air pollution control, and human health.

OBJECTIVES:Although previous epidemiological studies have reported the effects of fetal exposure to phthalates and phenols on birth outcomes, evidence is still limited. The objective of this study was to investigate whether prenatal exposure to endocrine-disrupting chemicals [EDCs; phthalates and bisphenol A (BPA)] is associated with birth outcomes and whether there are sex-specific effects. METHODS:We used data from the Korean CHildren's ENvironmental health Study (Ko-CHENS) cohort. Exposure to phthalates and BPA was measured by urine tests, and the information on outcomes and confounders was obtained from delivery records, biomarker assessment, and a self-reported questionnaire. We performed multivariate logistic regression to estimate the association between exposure to individual phthalates and bisphenol A and birth outcomes. Additionally, to evaluate the effects of EDC mixture exposure, we performed weighted quantile sum regression analysis. Subgroup analysis stratified by maternal age and sex at birth was performed to examine potential differences in associations. RESULTS:This study included 2,176 mother-child pairs from the Ko-CHENS. We observed a significant association between the risk of PTB and exposure to BPA during early pregnancy and mono-carboxyoctyl phthalate (MCOP) during late pregnancy, with odds ratios of 1.23 (95% CI: 1.01, 1.49) and 1.29 (95% CI: 1.03, 1.62), respectively. Additionally, there was a significant association between exposure to MCOP during early pregnancy and the risk of LBW (OR: 1.39, 95% CI: 1.03, 1.89). For male infants in particular, exposure to MCOP during early pregnancy was associated with the risk of LBW (OR: 2.44, 95% CI: 1.43, 4.15), and exposure to MCOP during late pregnancy was associated with the risk of PTB (OR 1.45, 95% CI: 1.05, 2.02). CONCLUSIONS:This study suggests a potential association between exposure to BPA during early pregnancy and PTB, while exposure to MCOP during late pregnancy was associated with increased PTB risk in male infants.

Background: Maternal diet quality during pregnancy may significantly influence fetal growth and birth weight. Objectives: This study aimed to assess the dietary quality of pregnant women in Korea and investigate its association with the risk of delivering a small-for-gestational-age (SGA) infant. Methods: A total of 1158 pregnant women and their newborns were recruited from the Mothers and Children's Environmental Health (MOCEH) 2006-2010 cohort. Maternal dietary intake during gestational weeks 12-28 was assessed using a validated food frequency questionnaire. The nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and Korean Healthy Eating Index (KHEI) were employed to evaluate dietary quality. Birth outcomes were obtained from hospital records, and logistic regression analyses were performed to examine associations between maternal dietary quality and SGA risk. Results: Higher KHEI scores were significantly associated with increased nutrient intake, with the exception of fat, and demonstrated a positive association with the NAR of 15 nutrients. After adjusting for covariates, women in the highest KHEI quartile exhibited a significantly lower risk of SGA birth than those in the lowest quartile (adjusted odds ratio: 0.448; 95% confidence interval: 0.201-0.997; P-for-trend = 0.031). Conclusions: Enhanced maternal diet quality, as measured using the KHEI, is associated with improved nutrient intake and a reduced risk of SGA births among Korean pregnant women. These findings underscore the need for public health strategies that promote high-quality diets during pregnancy to improve birth outcomes.

Prenatal exposure to climate factors, air pollution, and green space has been linked to respiratory diseases in infants. However, the role of the combined effects of exposure to these factors on respiratory ailments remains unclear. Here we investigate the association of combined exposure to traffic-related air pollution (TRAP), climate factors, and green space during the prenatal period with respiratory diseases in infants. We enrolled 454 participants from the ongoing prospective birth cohort known as the Mothers and Children's Environmental Health study. Data on infant respiratory diseases were collected from parents or guardians. Average exposure values of TRAP, climate factors, and green spaces for the study population were calculated based on geocoded residential addresses. Multiple logistic regression and quantile-based g-calculation models were utilized to examine the association of exposure to environmental factors and green space with respiratory diseases. The combined exposure to climate factors and TRAP during the first trimester of pregnancy was associated with an increased risk of respiratory diseases in infants. High levels of particulate matter with a diameter less than 2.5 μm (PM2.5) and temperature increased the risk of respiratory diseases (adjusted odds ratio (AOR): 1.615, 95% confidence interval (CI): 1.001, 2.658). Additionally, the risk of respiratory diseases from exposure to air pollution and temperature was associated with lower tertiles of residential green spaces. The AOR was 1.064 (95% CI: 1.001, 1.133) per 1 µg/m3 increase in PM2.5, 1.057 (95% CI: 1.001, 1.116) per 1 ppb increase in NO2, and 1.108 (95% CI: 1.001, 1.176) per 1 ℃ increase in temperature. Incorporating green space into the analysis of joint exposure to climate factors and air pollution reduced the risk of respiratory disease. This study proposes that combined exposures to climate factors, TRAP, and green spaces during pregnancy are associated with infant respiratory diseases. Fewer residential green spaces could enhance the association of climate factors and air pollution with respiratory diseases.

Ambient air pollution is a serious public health issue that may influence reproductive health, including fertility and menopause onset in women worldwide. Thus, understanding the risk factors associated with early menopause is crucial to inform women about potential health risks and guide public health interventions. We collected data from KHANES (The Korea National Health and Nutrition Examination Survey) at the Korean Center for Disease Control and Prevention, Ministry of Health and Welfare between 2010 and 2020. These data were linked with summary pollution data from AiMS-CREATE (AI-Machine Learning and Statistics Collaborative Research Ensemble for Air Pollution, Temperature, and All Types of Environmental Exposures) from 2002 to 2020. These summary data encapsulate the monthly average air pollution predictions for 226 si-gun-gu (cities, counties, and districts) in Korea. A total of 8506 participants who had experienced menopause (early menopause: 40–44 years, N = 341; normal menopause: ≥ 45 years, N = 8165) between 2002 and 2020 were included in the analysis. We employed survey logistic regression analyses to determine the associations between ambient air pollution and menopause after adjusting for covariates. An association was observed between particulate matter 2.5 (PM2.5) and early menopause (adjusted survey logistic regression (aOR): 1.26, 95

BACKGROUND:Epidemiology studies have reported inconsistent associations of humidity with heat-related health outcomes, despite strong plausibility of such physiological associations. In this regard, there has been a heated debate on which humidity metric to use in epidemiological research. OBJECTIVES:This study aimed to compare the role of two common humidity metrics, relative and absolute humidity, in heat-related mortality in summer using a nationwide mortality dataset. METHODS:We applied a case time-series design for summer (June-September) mortality across the entire 229 districts of South Korea from 2011 to 2019. The temperature was fitted using a distributed lag nonlinear model (DLNM) with 10 lag days. A linear interaction between the cross-basis of temperature and humidity was included in each model to examine the different patterns of association between heat and mortality by humidity level (low and high humidity defined by fifth and 95th percentile of each humidity distribution). RESULTS:A total of 780,102 deaths were recorded in the summer from 2011 to 2019 in South Korea. The association between extreme heat (temperature approximately above the 99th percentile of the temperature distribution) and mortality was modified more by absolute humidity than by relative humidity, although the effect modification of both humidity indicators was not statistically significant. The relative risks at the 99.Ninth percentile temperature in comparison with the minimum mortality temperature were 1.21 [95% confidence interval (CI): 1.11, 1.31] and 1.22 (95% CI: 1.03, 1.44) for low and high relative humidity, respectively, and 1.11 (95% CI: 0.89, 1.37) and 1.25 (95% CI: 1.15, 1.34) for low and high absolute humidity, respectively. DISCUSSION:Our findings provide epidemiological evidence on the role of relative and absolute humidity in heat-related mortality and suggest that absolute humidity may be a more appropriate metric than relative humidity when assessing health impact. https://doi.org/10.1289/EHP15827.

Background Air pollution, particularly particulate matter, has been linked to various health issues, including respiratory infections in children. This study investigates the impact of long-term PM2.5 exposure on acute otitis media (AOM), sinusitis, pharyngitis, and tonsillitis in a large Korean cohort. While children are known to be more vulnerable due to anatomical factors, the relationship between prolonged PM2.5 exposure and these infections has been insufficiently explored in large populations. Methods We aimed to examine the association of long-term exposure to PM2.5 with the first hospital visit of four infectious diseases - acute otitis media, sinusitis, pharyngitis, and tonsillitis - using a population-based cohort from National Health Insurance Service-National Sample Cohort data from 2002 to 2019. To ensure a minimum follow-up period of five years, individuals who enrolled in 2016 or later were excluded. A time-varying Cox model was applied to adjust for age, sex, income status, residential areas and district-level socioeconomic indicators. Annually updated residential addresses and related PM2.5 concentrations based on mean annual predictions from a machine learning-based ensemble prediction model were assigned. Results Our study included 364,227 people aged 0-18 years at enrollment and total of onset of each disease was 196,762 with acute otitis media, 253,248 with sinusitis, 275,160 with pharyngitis, and 315,367 with tonsillitis. Estimated hazard ratios (HR) per 5 mu g/m(3) increase in PM2.5 were noticeably associated with acute otitis media (HR = 1.06; 95% confidence interval [CI]: 1.05-1.08), sinusitis (HR = 1.01; 95% CI: 1.01-1.02), pharyngitis (HR = 1.02; 95% CI: 1.01-1.03), and tonsillitis (HR = 1.05; 95% CI: 1.05-1.06). Conclusions This study demonstrates a significant link between long-term PM2.5 exposure and increased risks of AOM, sinusitis, pharyngitis, and tonsillitis, especially in younger individuals. Highlighting the effects of prolonged exposure, it emphasizes the importance of public health strategies to protect vulnerable populations and provides insights for policies addressing air pollution-related health risks.

Heavy metal concentration in pregnant women affects neurocognitive and behavioral development of their infants and children. The majority of existing research focusing on pregnant women's heavy metal concentration has considered individual environmental factor. In this study, we aim to comprehensively consider lifestyle, food, and environmental factors to determine the most influential factor affecting heavy metal concentration in pregnant women. The Ko-CHENS (Korean CHildren health and ENvironmental Study) is a nationwide prospective birth cohort study in South Korea enrolling pregnant women from 2015 to 2020. A total of 5458 eligible pregnant women were included in this study, and 897 variables were included in questionnaire comprising: maternal general information, indoor and living environment, dietary habits, health behavior, exposure to chemicals. Lead, cadmium and mercury concentration on blood were measured in early, late pregnancy and in cord blood at birth. Variables that might be related to heavy metal concentrations were included in machine learning models. Random forest and XGBoost machine learning models were conducted for predictions. Both models had similar but better performance than multiple linear regression. Kimchi (β = 1.55), seaweed (β = 0.40), fatty fish (β = 1.55), intakes respectively affected lead, cadmium, and mercury exposure through early, late pregnancy and cord blood.

Objectives: Interest in the association between particulate air pollution and appendicitis risk has been increasing in recent years, and previous studies have suggested a link between particulate matter <= 10 mu m in diameter (PM10) 10 ) and appendicitis. However, robust evidence is currently lacking. This study explored the association between short-term PM10 10 exposure and appendicitis using data from Ewha Womans University Mokdong Hospital, Seoul, Korea, between January 1, 2001 and December 31, 2018. Methods: We employed a time-stratified case-crossover design using data from 6,526 appendicitis patients taken from the hospital's electronic medical records system. We analyzed the data using a conditional logistic regression model adjusted for daily mean temperature and relative humidity. The effect size of PM10 10 was estimated in terms of each 10 mu m/m3 3 increase in PM10 10 concentration. Sex, season, and age group were analyzed as subgroups. Results: Appendicitis patients had been exposed to higher levels of PM10 10 concentrations 3 days (OR 1.045, 95% CI: 1.007-1.084) and 7 days (OR, 1.053; 95% CI, 1.005-1.103) before hospital admission. The case-crossover analysis stratified by sex, age, and season showed that the male sex, being aged under 10, and the cold season were associated with a significantly stronger association between appendicitis and PM10 10 concentrations. Conclusion: Our study found that PM10 10 concentrations were associated with appendicitis in boys aged under 10. The cold season was also a risk factor. Further research with a larger sample size and with other pollutants is required to clarify the association between PM10 10 and appendicitis.

Background Allergic diseases (ADs) have been increasingly reported in infants and children over the last decade. Diet, especially the inclusion of fish intake, may help to lower the risk of ADs. However, fish also, can bioaccumulate environmental contaminants such as mercury. Hence, our study aims to determine what effects the type and frequency of fish intake have on ADs in six-month-old infants, independently and jointly with mercury exposure. Methods This study is part of the prospective birth cohort: Mothers and Children’s Environmental Health (MOCEH) study in South Korea. Data was collected on prenatal fish intake, prenatal mercury concentration and ADs for infants aged six months for 590 eligible mother-infant pairs. Logistic regression analysis was conducted to evaluate the risk of prenatal fish intake and mercury concentration on ADs in infants. Finally, interaction between fish intake and mercury concentration affecting ADs in infants was evaluated. Hazard ratios of prenatal fish intake on ADs in 6 month old infants were calculated by prenatal mercury exposure. Results Logistic regression analysis showed that white fish (OR: 0.53; 95% CI 0.30–0.94; P < 0.05) intake frequency, once a week significantly decreased the risk of ADs in infants. Stratification analysis showed that consuming white fish once a week significantly reduced the hazard of ADs (HR: 0.44; 95% CI 0.21–0.92; P < 0.05) in infants in the high-mercury (≥ 50th percentile) exposure group. Conclusion The result indicates that prenatal white fish intake at least once a week reduces the risk of ADs in infants, especially in the group with high prenatal mercury exposure.