IJE Advance Access originally published online on February 2, 2008
International Journal of Epidemiology 2009 38(3):698-705; doi:10.1093/ije/dym290
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Smoking during pregnancy and hyperactivity-inattention in the offspring—comparing results from three Nordic cohorts
1 The Perinatal Epidemiology Research Unit, Department of Obstetrics and Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark.
2 The Department of General Medicine, Institute of Public Health, Aarhus University, Denmark.
3 Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark.
4 Department of Psychology, Uppsala University, Sweden
5 Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
6 Department of Public Health Science and General Practice, University of Oulu, Finland.
7 Department of Epidemiology and Public Health, Imperial College Faculty of Medicine, London, UK.
8 Clinic of Child Psychiatry, University and University Hospital of Oulu, Finland.
9 Department of Child and Department of Adolescence Psychiatry, University of Southern Denmark, Odense, Denmark.
10 Department of Epidemiology, Institute of Public Health, Aarhus University, Denmark.
11 UCLA School of Public Health, Department of Epidemiology, Los Angeles, USA.
* Corresponding author. The Perinatal Epidemiology Research Unit, Department of Obstetrics and Department of Pediatrics, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark. E-mail: co{at}soci.au.dk; co{at}alm.au.dk
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Abstract |
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Background Prenatal exposure to smoking has been associated with Attention Deficit Hyperactivity Disorder (ADHD) in a number of epidemiological studies. However, mothers with the ADHD phenotype may ‘treat’ their problem by smoking and therefore be more likely to smoke even in a society where smoking is not acceptable. This will cause genetic confounding if ADHD has a heritable component, especially in populations with low prevalence rates of smoking since this reason for smoking is expected to be proportionally more frequent in a population with few ‘normal’ smokers. We compared the association in cohorts with different smoking frequencies.
Methods A total of 20 936 women with singleton pregnancies were identified within three population-based pregnancy cohorts in Northern Finland (1985–1986) and in Denmark (1984–1987 and 1989–1991). We collected self-reported data on their pre-pregnancy and pregnancy smoking habits and followed the children to school age where teachers and parents rated hyperactivity and inattention symptoms.
Results Children, whose mothers smoked during pregnancy, had an increased prevalence of a high hyperactivity-inattention score compared with children of nonsmokers in each of the cohorts after adjustment for confounders but we found no statistical significant difference between the associations across the cohorts.
Conclusion The estimated association was not strongest in the population with the fewest smokers which does not support the hypothesis that the association is entirely due to genetic confounding.
Keywords smoking, confounding, prenatal, child behaviour, ADHD
Accepted 28 November 2007
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