Abstract
The aim of this study is to investigate whether in addition to established early risk factors other, less studied pre-, peri-, and postnatal influences, like gestational hypertension or neonatal respiratory disorders and infections, may increase a child’s risk of developing attention-deficit/hyperactivity disorders (ADHD). In the IDEFICS study more than 18,000 children, aged 2–11.9 years, underwent extensive medical examinations supplemented by parental questionnaires on pregnancy and early childhood. The present analyses are restricted to children whose parents also completed a supplementary medical questionnaire (n = 15,577), including the question whether or not the child was ever diagnosed with ADHD. Multilevel multivariable logistic regression was used to assess the association between early life influences and the risk of ADHD. Our study confirms the well-known association between maternal smoking during pregnancy and a child’s risk of ADHD. In addition, our study showed that children born to mothers younger than 20 years old were 3–4 times more likely to develop ADHD as compared to children born to mothers aged 25 years and older. Moreover, we found that children whose mothers suffered from pregnancy-induced hypertension had an approximately twofold risk of ADHD (OR 1.95; 95% CI 1.09–3.48). This also holds true for infections during the first 4 weeks after birth (OR 2.06; 95% CI 1.05–4.04). In addition, although not statistically significant, we observed a noticeable elevated risk estimate for neonatal respiratory disorders (OR 1.76; 95% CI 0.91–3.41). Hence, we recommend that these less often studied pre-, peri, and postnatal influences should get more attention when considering early indicators or predictors for ADHD in children. However, special study designs such as genetically sensitive designs may be needed to derive causal conclusions.
Similar content being viewed by others
References
Harpin VA (2005) The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 90(Suppl 1):i2–7
Matza LS, Paramore C, Prasad M (2005) A review of the economic burden of ADHD. Cost Eff Resour Alloc 3:5
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948
Polanczyk G, Rohde LA (2007) Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Curr Opin Psychiatry 20:386–392
Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P (2005) Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 57:1313–1323
Scahill L, Schwab-Stone M, Merikangas KR, Leckman JF, Zhang H, Kasl S (1999) Psychosocial and clinical correlates of ADHD in a community sample of school-age children. J Am Acad Child Adolesc Psychiatry 38:976–984
Edwards MC, Schulz EG, Long N (1995) The role of the family in the assessment of attention deficit hyperactivity disorder. Clin Psychol Rev 15:375–394
Banerjee TD, Middleton F, Faraone SV (2007) Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr 96:1269–1274
Langley K, Holmans PA, van den Bree MB, Thapar A (2007) Effects of low birth weight, maternal smoking in pregnancy and social class on the phenotypic manifestation of attention deficit hyperactivity disorder and associated antisocial behaviour: investigation in a clinical sample. BMC Psychiatry 7:26
Obel C, Linnet KM, Henriksen TB, Rodriguez A, Jarvelin MR, Kotimaa A, Moilanen I, Ebeling H, Bilenberg N, Taanila A, Ye G, Olsen J (2009) Smoking during pregnancy and hyperactivity-inattention in the offspring—comparing results from three Nordic cohorts. Int J Epidemiol 38:698–705
Zhu JL, Olsen J, Liew Z, Li J, Niclasen J, Obel C (2014) Parental smoking during pregnancy and ADHD in children: the Danish national birth cohort. Pediatrics 134:e382–388
Biederman J, Martelon M, Woodworth KY, Spencer TJ, Faraone SV (2014) Is maternal smoking during pregnancy a risk factor for cigarette smoking in offspring? a longitudinal controlled study of ADHD children grown up. J Atten Disord. doi:10.1177/1087054714557357
Han JY, Kwon HJ, Ha M, Paik KC, Lim MH, Gyu Lee S, Yoo SJ, Kim EJ (2015) The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: a large population-based study. Psychiatry Res 225:164–168
Sagiv SK, Epstein JN, Bellinger DC, Korrick SA (2013) Pre- and postnatal risk factors for ADHD in a nonclinical pediatric population. J Atten Disord 17:47–57
Melchior M, Hersi R, van der Waerden J, Larroque B, Saurel-Cubizolles MJ, Chollet A, Galera C (2015) Maternal tobacco smoking in pregnancy and children’s socio-emotional development at age 5: the EDEN mother-child birth cohort study. Eur Psychiatry 30:562–568
Kovess V, Keyes KM, Hamilton A, Pez O, Bitfoi A, Koc C, Goelitz D, Kuijpers R, Lesinskiene S, Mihova Z, Otten R, Fermanian C, Pilowsky DJ, Susser E (2015) Maternal smoking and offspring inattention and hyperactivity: results from a cross-national European survey. Eur Child Adolesc Psychiatry 24:919–929
Button TM, Maughan B, McGuffin P (2007) The relationship of maternal smoking to psychological problems in the offspring. Early Hum Dev 83:727–732
Palmer RH, Bidwell LC, Heath AC, Brick LA, Madden PA, Knopik VS (2016) Effects of maternal smoking during pregnancy on offspring externalizing problems: contextual effects in a sample of female twins. Behav Genet 46:403–415
Bidwell LC, Palmer RH, Brick L, Madden PA, Heath AC, Knopik VS (2016) A propensity scoring approach to characterizing the effects of maternal smoking during pregnancy on offspring’s initial responses to cigarettes and alcohol. Behav Genet 46:416–430
Boutwell BB, Beaver KM (2010) Maternal cigarette smoking during pregnancy and offspring externalizing behavioral problems: a propensity score matching analysis. Int J Environ Res Public Health 7:146–163
D’Onofrio BM, Class QA, Rickert ME, Larsson H, Langstrom N, Lichtenstein P (2013) Preterm birth and mortality and morbidity: a population-based quasi-experimental study. JAMA Psychiatry 70:1231–1240
Pettersson E, Sjolander A, Almqvist C, Anckarsater H, D’Onofrio BM, Lichtenstein P, Larsson H (2015) Birth weight as an independent predictor of ADHD symptoms: a within-twin pair analysis. J Child Psychol Psychiatry 56:453–459
Hultman CM, Torrang A, Tuvblad C, Cnattingius S, Larsson JO, Lichtenstein P (2007) Birth weight and attention-deficit/hyperactivity symptoms in childhood and early adolescence: a prospective Swedish twin study. J Am Acad Child Adolesc Psychiatry 46:370–377
Mann JR, McDermott S (2011) Are maternal genitourinary infection and pre-eclampsia associated with ADHD in school-aged children? J Atten Disord 15:667–673
Thapar A, Cooper M, Eyre O, Langley K (2013) What have we learnt about the causes of ADHD? J Child Psychol Psychiatry 54:3–16
Pasker-de Jong PC, Zielhuis GA, van Gelder MM, Pellegrino A, Gabreels FJ, Eskes TK (2010) Antihypertensive treatment during pregnancy and functional development at primary school age in a historical cohort study. BJOG 117:1080–1086
Pringsheim T, Sandor P, Lang A, Shah P, O’Connor P (2009) Prenatal and perinatal morbidity in children with Tourette syndrome and attention-deficit hyperactivity disorder. J Dev Behav Pediatr 30:115–121
Rand KM, Austin NC, Inder TE, Bora S, Woodward LJ (2016) Neonatal infection and later neurodevelopmental risk in the very preterm infant. J Pediatr 170:97–104
Ahrens W, Bammann K, Siani A, Buchecker K, De Henauw S, Iacoviello L, Hebestreit A, Krogh V, Lissner L, Marild S, Molnar D, Moreno LA, Pitsiladis YP, Reisch L, Tornaritis M, Veidebaum T, Pigeot I, Consortium I (2011) The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int J Obesity 35(Suppl 1):S3–15
Russell G, Ford T, Rosenberg R, Kelly S (2014) The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. J Child Psychol Psychiatry 55:436–445
UNESCO (2012) International standard classification of education ISCED 2011. In: UNESCO Institute for Statistics Montreal, Canada
Cole TJ, Lobstein T (2012) Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 7:284–294. doi:10.1111/j.2047-6310.2012.00064.x
Skogli EW, Teicher MH, Andersen PN, Hovik KT, Oie M (2013) ADHD in girls and boys—gender differences in co-existing symptoms and executive function measures. BMC Psychiatry 13:298
Barkley RA (2006) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. The Guilford Press, New York City
Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56:345–365
Rucklidge JJ (2010) Gender differences in attention-deficit/hyperactivity disorder. Psychiatr Clin N Am 33:357–373
Langley K, Rice F, van den Bree MB, Thapar A (2005) Maternal smoking during pregnancy as an environmental risk factor for attention deficit hyperactivity disorder behaviour. A review. Minerva Pediatr 57:359–371
Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I, Thomsen PH, Olsen J, Jarvelin MR (2003) Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry 160:1028–1040
Roza SJ, Verhulst FC, Jaddoe VW, Steegers EA, Mackenbach JP, Hofman A, Tiemeier H (2009) Maternal smoking during pregnancy and child behaviour problems: the Generation R Study. Int J Epidemiol 38:680–689
Knopik VS (2009) Maternal smoking during pregnancy and child outcomes: real or spurious effect? Dev Neuropsychol 34:1–36
Obel C, Zhu JL, Olsen J, Breining S, Li J, Gronborg TK, Gissler M, Rutter M (2016) The risk of attention deficit hyperactivity disorder in children exposed to maternal smoking during pregnancy—a re-examination using a sibling design. J Child Psychol Psychiatry 57:532–537
Thapar A, Rice F, Hay D, Boivin J, Langley K, van den Bree M, Rutter M, Harold G (2009) Prenatal smoking might not cause attention-deficit/hyperactivity disorder: evidence from a novel design. Biol Psychiatry 66:722–727
Chudal R, Joelsson P, Gyllenberg D, Lehti V, Leivonen S, Hinkka-Yli-Salomaki S, Gissler M, Sourander A (2015) Parental age and the risk of attention-deficit/hyperactivity disorder: a nationwide, population-based cohort study. J Am Acad Child Adolesc Psychiatry 54(487–494):e481
Silva D, Colvin L, Hagemann E, Bower C (2014) Environmental risk factors by gender associated with attention-deficit/hyperactivity disorder. Pediatrics 133:e14–22
Chang Z, Lichtenstein P, D’Onofrio BM, Almqvist C, Kuja-Halkola R, Sjolander A, Larsson H (2014) Maternal age at childbirth and risk for ADHD in offspring: a population-based cohort study. Int J Epidemiol 43:1815–1824
Mersky JP, Reynolds AJ (2007) Child maltreatment and violent delinquency: disentangling main effects and subgroup effects. Child Maltreat 12:246–258
Xie H, Cairns BD, Cairns RB (2001) Predicting teen motherhood and teen fatherhood: individual characteristics and peer affiliations. Soc Dev 10:488–511
Russell AE, Ford T, Russell G (2015) Socioeconomic associations with ADHD: findings from a mediation analysis. PLoS ONE 10:e0128248
Coyne CA, Långström N, Rickert ME, Lichtenstein P, D’Onofrio BM (2013) Maternal age at first birth and offspring criminality: using the children-of-twins design to test causal hypotheses. Dev Psychopathol 25:17–35
Allen VM, Joseph K, Murphy KE, Magee LA, Ohlsson A (2004) The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study. BMC Pregnancy Childbirth 4:17
Groom KM, North RA, Poppe KK, Sadler L, McCowan LM (2007) The association between customised small for gestational age infants and pre-eclampsia or gestational hypertension varies with gestation at delivery. BJOG 114:478–484
Silva D, Colvin L, Hagemann E, Stanley F, Bower C (2014) Children diagnosed with attention deficit disorder and their hospitalisations: population data linkage study. Eur Child Adolesc Psychiatry 23:1043–1050
Silk TJ, Vance A, Rinehart N, Bradshaw JL, Cunnington R (2009) White-matter abnormalities in attention deficit hyperactivity disorder: a diffusion tensor imaging study. Hum Brain Mapp 30:2757–2765
Inder TE, Wells SJ, Mogridge NB, Spencer C, Volpe JJ (2003) Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. J Pediatr 143:171–179
Chau V, Brant R, Poskitt KJ, Tam EW, Synnes A, Miller SP (2012) Postnatal infection is associated with widespread abnormalities of brain development in premature newborns. Pediatr Res 71:274–279
Reich W, Todd RD, Joyner CA, Neuman RJ, Heath AC (2003) Reliability and stability of mothers’ reports about their pregnancies with twins. Twin Res 6:85–88
Tomeo CA, Rich-Edwards JW, Michels KB, Berkey CS, Hunter DJ, Frazier AL, Willett WC, Buka SL (1999) Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology 10:774–777
Heath AC, Knopik VS, Madden PA, Neuman RJ, Lynskey MJ, Slutske WS, Jacob T, Martin NG (2003) Accuracy of mothers’ retrospective reports of smoking during pregnancy: comparison with twin sister informant ratings. Twin Res 6:297–301
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S (1994) The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 84:1086–1093
Acknowledgements
This work was done as part of the IDEFICS study (http://www.idefics.eu). We gratefully acknowledge the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD) and the grant support from EU for IDEFICS study. We thank the children and their parents for their participation in the IDEFICS study. Finally, we would also like to thank the anonymous reviewers for their helpful comments and suggestions, which we have addressed in the revised manuscript.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Pohlabeln, H., Rach, S., De Henauw, S. et al. Further evidence for the role of pregnancy-induced hypertension and other early life influences in the development of ADHD: results from the IDEFICS study. Eur Child Adolesc Psychiatry 26, 957–967 (2017). https://doi.org/10.1007/s00787-017-0966-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-017-0966-2