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. 2022 May 1;33(3):431-440.
doi: 10.1097/EDE.0000000000001467.

Smoking During Pregnancy and Risk of Attention-deficit/Hyperactivity Disorder in the Third Generation

Gyeyoon Yim  1 , Andrea Roberts  1 , Alberto Ascherio  2   3   4 , David Wypij  5   6   7 , Marianthi-Anna Kioumourtzoglou  8 , And Marc G Weisskopf  1   2
Affiliations

Smoking During Pregnancy and Risk of Attention-deficit/Hyperactivity Disorder in the Third Generation

Gyeyoon Yim et al. Epidemiology. .

Abstract

Background: Animal experiments indicate that environmental factors, such as cigarette smoke, can have multigenerational effects through the germline. However, there are little data on multigenerational effects of smoking in humans. We examined the associations between grandmothers' smoking while pregnant and risk of attention-deficit/hyperactivity disorder (ADHD) in her grandchildren.

Methods: Our study population included 53,653 Nurses' Health Study II (NHS-II) participants (generation 1 [G1]), their mothers (generation 0 [G0]), and their 120,467 live-born children (generation 2 [G2]). In secondary analyses, we used data from 23,844 mothers of the nurses who were participants in the Nurses' Mothers' Cohort Study (NMCS), a substudy of NHS-II.

Results: The prevalence of G0 smoking during the pregnancy with the G1 nurse was 25%. ADHD was diagnosed in 9,049 (7.5%) of the grandchildren (G2). Grand-maternal smoking during pregnancy was associated with increased odds of ADHD among the grandchildren (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.1, 1.2), independent of G1 smoking during pregnancy. In the Nurses' Mothers' Cohort Study, odds of ADHD increased with increasing cigarettes smoked per day by the grandmother (1-14 cigarettes: aOR = 1.1; 95% CI = 1.0, 1.2; 15+: aOR = 1.2; 95% CI = 1.0, 1.3), compared with nonsmoking grandmothers.

Conclusions: Grandmother smoking during pregnancy is associated with an increased risk of ADHD among the grandchildren.

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Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:
Directed acyclic graph (DAG) of possible mediator-outcome confounding by other variables (L) in the association between grandmother (G0) smoking during pregnancy and risk of ADHD among the grandchildren (G2).
Figure 2:
Figure 2:
Odds ratios (OR) and 95% Confidence Intervals (CI) for ADHD in third generation (G2) by grandparents’ (G0) smoking during pregnancy among the 23,844 grandmothers in the Nurses’ Mothers’ Cohort Study. The symbols and lines are ORs and 95% Cis, respectively. The Adjusted Model controls for grandmother (G0) race, G0 education, grandfather (G0) occupation, grandparents’ (G0) home ownership at G1 birth, G0 pre-pregnancy body mass index, G0 alcohol use during pregnancy, and maternal (G1) year of birth and its squared term.
Figure 3:
Figure 3:
Odds ratios (OR) and 95% Confidence Intervals (CI) for ADHD in third generation (G2) by grandmothers’ (G0) number of cigarettes smoked during pregnancy among the 23,844 grandmothers in the Nurses’ Mothers’ Cohort Study. The symbols and lines are ORs and 95% Cis, respectively. The Adjusted Model controls for grandmother (G0) race, G0 education, grandfather (G0) occupation, grandparents’ (G0) home ownership at G1 birth, G0 pre-pregnancy body mass index, G0 alcohol use during pregnancy, and maternal (G1) year of birth and its squared term.
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References

    1. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 2015;135(4):e994–1001. - PubMed
    1. Davidovitch M, Koren G, Fund N, Shrem M, Porath A. Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade. BMC Pediatr 2017;17(1):218. - PMC - PubMed
    1. Sciberras E, Mulraney M, Silva D, Coghill D. Prenatal Risk Factors and the Etiology of ADHD-Review of Existing Evidence. Curr Psychiatry Rep 2017;19(1):1. - PubMed
    1. American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, 2013.
    1. He Y, Chen J, Zhu LH, Hua LL, Ke FF. Maternal Smoking During Pregnancy and ADHD: Results From a Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Atten Disord 2017:1087054717696766. - PubMed