Perinatal Risk Factors for ADHD Confirmed

In ADHD, ADHD Adult, Psychiatry, School Psychology on Monday, 24 September 2012 at 16:06

important info!

Perinatal Risk Factors for ADHD Confirmed

Megan Brooks

September 13, 2012 — The combination of maternal gestational diabetes mellitus (GDM) and low socioeconomic status (SES) is a strong risk factor for childhood attention-deficit/hyperactivity disorder (ADHD), a study from Germany confirms.

Perinatal health problems, maternal smoking during pregnancy, and atopic eczema also raise the risk for ADHD, whereas fully breastfeeding appears to protect against ADHD, regardless of the duration of breastfeeding, the study showed.

“Modification of these environmental risk factors by evidence-based prevention programs may help to decrease the burden of ADHD,” write coinvestigators Jochen Schmitt, MD, MPH, of Technical University Dresden, and Marcel Romanos, MD, from the University Hospital of Würzburg, in Germany.

The study was published online September 10 in Archives of Pediatrics and Adolescent Medicine.

It follows a study published in the same journal earlier this year by Yoko Nomura, PhD, MPH, from the Department of Psychology, Queens College, City University of New York, and colleagues. That study, which included 212 preschool-age children, linked maternal GDM and low SES, especially in combination, to a heightened risk for childhood ADHD.

Nationwide Study

These latest findings from Dr. Schmitt and Dr. Romanos replicate this finding in a large nationwide representative sample of 3- to 17-year-olds who participated in the German Health Interview and Examination Survey for Children and Adolescents (n = 13,488).

The outcome of interest was childhood ADHD, and the primary exposures of interest were self-reported physician-diagnosed GDM (absent or present) and SES, classified as low, medium, or high on the basis of parental education, professional qualification, professional status, and family income.

The authors also considered age, sex, and a broad set of environmental exposures in the prenatal and perinatal period and in infancy as competing risk factors in multivariate analysis.

A total of 660 children (4.9%) had ADHD; the prevalence of GDM and low SES was 2.3% (n = 280) and 25.5% (n = 3420), respectively, the authors report.

Both maternal GDM and low SES were significantly related to ADHD. In multivariate regression modeling (based on 11,222 observations without any missing data), GDM and low SES were independent risk factors for childhood ADHD. The same was true for perinatal health problems, maternal smoking during pregnancy, and atopic eczema, whereas breastfeeding was protective.

Table: Risk for ADHD With Outcomes of Interest

Characteristic/Exposure aOR (95% CI)
Maternal GDM 1.91 (1.21 – 3.01)
Low SES 2.04 (1.56 – 2.68)
Smoking 1.48 (1.19 – 1.84)
Perinatal health problems 1.69 (1.40 – 2.03)
Atopic eczema 1.62 (1.30 – 2.02)
Breastfeeding 0.83 (0.69 – 0.996)

aOR = adjusted odds ratio; CI = confidence interval

The investigators note that their findings confirm those of Dr. Nomura and colleagues by showing an association between low SES, maternal GDM, and ADHD “and their additive interaction as risk factors for ADHD in a large population-based sample.”

The researchers say their study also extends previous research by showing that fully breastfeeding may have protective effects on childhood ADHD.

Fetus a “Captive Audience”

Dr. Nomura told Medscape Medical News that “being able to duplicate our findings in a different sample and a much larger sample is important.”

“I’m not sure if most doctors know that GDM is a risk factor for ADHD; biological and environmental risk factors for ADHD is a fairly new scientific field,” she added.

“ADHD is a highly hereditary illness, but it’s not only hereditary; we are beginning to gather information about environmental or biological causes and beginning to focus on perinatal risk factors for ADHD,” said Dr. Nomura.

“The fetus is a captive audience,” she noted, “and it seems like in utero exposure to a variety of things like excessive insulin, smoking, plastic materials, food dyes, toxic chemicals may cause epigenetic changes in brain development that may show up later in life.”

Arch Pediatr Adolesc Med. Published online September 10, 2012. Abstract



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