Pediatrics 2014 Jan 01;133(1)e14-22, D Silva, L Colvin, E Hagemann, C Bower
Research · January 31, 2014
TAKE-HOME MESSAGE
- This population-based study from Australia evaluated characteristics of mothers, pregnancy, and newborns related to both risk and protection in attention-deficit/hyperactivity disorder (ADHD). ADHD diagnosis and use of stimulant medication was associated with mothers being young and single, smoking during pregnancy, threat of preterm labor, preeclampsia, maternal urinary tract infection, and induced labor. In a partially adjusted model, factors related to ADHD were lower gestational age and low birth weight in boys. In the fully adjusted model, early-term birth remained significant.
- Low birth weight, post-term pregnancy, low Apgar score, and fetal distress were not associated with ADHD, a contrary finding to those of previous studies. Oxytocin augmentation during labor may be protective, but only for girls.
ABSTRACT
BACKGROUND
Early environmental risk factors associated with attention-deficit/hyperactivity disorder (ADHD) have been increasingly suggested. Our study investigates the maternal, pregnancy, and newborn risk factors by gender for children prescribed stimulant medication for treatment of ADHD in Western Australia.
METHODS
This is a population-based, record linkage case-control study. The records of all non-Aboriginal children and adolescents born in Western Australia and aged
RESULTS
Mothers of children with ADHD were significantly more likely to be younger, be single, have smoked in pregnancy, have labor induced, and experience threatened preterm labor, preeclampsia, urinary tract infection in pregnancy, or early term delivery irrespective of the gender of the child, compared with the control group. In the fully adjusted model, a novel finding was of a possible protective effect of oxytocin augmentation in girls. Low birth weight, postterm pregnancy, small for gestational age infant, fetal distress, and low Apgar scores were not identified as risk factors.
CONCLUSIONS
Smoking in pregnancy, maternal urinary tract infection, being induced, and experiencing threatened preterm labor increase the risk of ADHD, with little gender difference, although oxytocin augmentation of labor appears protective for girls. Early term deliveries marginally increased the risk of ADHD. Studies designed to disentangle possible mechanisms, confounders, or moderators of these risk factors are warranted.