Grand Rounds

Could Smoking During Pregnancy Increase Risk for ADHD in Offspring?

BACKGROUND AND PURPOSE:

The cause of Attention-deficit/hyperactivity disorder (ADHD) is not well known but involves a combination of both genetics and environment
Environmental exposures include exposure to alcohol, cigarette smoking, lead and other nutritional factors
Huang et al. (Pediatrics, 2017) examined the association between maternal smoking during pregnancy and ADHD rates in offspring

Data was collected from Fifteen cohort studies and 5 case-control studies with a total 50,044 cases and 2,998,059 participants
In 3 cohort studies, sibling analysis was used to control for shared genetic and social confounding
Only one study adjusted for paternal smoking and therefore that particular subgroup analysis could not be performed
Smoking during pregnancy increased the risk of ADHD in offspring
- Odds Ratio (OR): 1.60; 95% CI: 1.45–1.76
When comparing heavy smokers to light smokers the risk of ADHD was increased in offspring
- Heavy smokers OR 1.75; 95% CI: 1.51–2.02
- Light smokers OR 1.54; 95% CI: 1.40–1.70

Authors recognize that a limitation of this study was the use of different ADHD assessment tools and lack of objective biological measures for maternal smoking
Maternal smoking during pregnancy is associated with a 60% increased odds of ADHD
The authors suggest that more high-quality studies are needed

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