Abstract
BackgroundPrenatal smoking exposure has been associated with attention-deficit/hyperactivity disorder (ADHD). ADHD is commonly associated with a wide spectrum of psychiatric comorbidity. The association between smoking and neuropsychiatric comorbidity of ADHD has remained understudied. The aim of this study is to examine the association between prenatal exposure to maternal smoking and offspring ADHD, and test whether the smoking-ADHD associations are stronger when ADHD is accompanied by other lifetime neuropsychiatric comorbidities.MethodsThe study is based on a nested case-control design and includes all Finnish singletons born between 1991 and 2005 and diagnosed with ADHD by 2011 (n = 10,132), matched with four controls (n = 38,811) on date of birth, sex and residence in Finland.ResultsThe risk for ADHD with or without comorbidity was significantly increased among offspring exposed to maternal smoking on adjusting for potential confounders (OR = 1.75, CI 95 % = 1.65–1.86). Compared to the only ADHD cases, subjects with comorbid conduct disorder or oppositional defiant disorder had a significantly stronger association with smoking exposure (OR = 1.80, CI 95 % = 1.55–2.11).ConclusionsPrenatal smoking represents an important risk factor for the ADHD comorbid with CD/ODD. Further research on the association between prenatal smoking exposure and neuropsychiatric comorbidity of ADHD is needed considering the increased risk among these subjects of an overall poor health outcome as compared to only ADHD. In particular, studies utilizing biomarkers or including subjects with neuropsychiatric conditions with and without comorbid ADHD are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1007-2) contains supplementary material, which is available to authorized users.
Highlights
Prenatal smoking exposure has been associated with attention-deficit/hyperactivity disorder (ADHD)
Among the potential covariates, maternal and paternal psychiatric history, maternal substance abuse history, maternal and paternal age at birth, maternal socioeconomic status, weight for gestational age, number of previous births and gestational age were associated with both maternal smoking during pregnancy among the controls and ADHD and were included as covariates in the analyses (Tables 1 and 2)
The odds for ADHD in the entire sample was significantly increased among subjects exposed to maternal smoking during pregnancy when adjusted for confounders
Summary
Prenatal smoking exposure has been associated with attention-deficit/hyperactivity disorder (ADHD). Among ADHD cases, comorbid diagnosis of autism spectrum disorders (ASD) are found in 10–33 % [4, 5], conduct disorder (CD) in 16–18 % [6, 7], learning and coordination disorders in 15–46 % [4, 6, 7] and mental retardation in 4–8 % [4, 6]. Both genetic and environmental risk factors contribute to the development of ADHD [8]. Maternal smoking during pregnancy has been associated with increased offspring risk for several psychiatric conditions, such as pervasive developmental disorders [16], conduct disorders [17] and depression [18]
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