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. 2023 Oct:86:119-125.e4.
doi: 10.1016/j.annepidem.2023.08.007. Epub 2023 Aug 28.

Preterm or early term birth and risk of attention-deficit/hyperactivity disorder: a national cohort and co-sibling study

Casey Crump  1 , Jan Sundquist  2 , Kristina Sundquist  2
Affiliations

Preterm or early term birth and risk of attention-deficit/hyperactivity disorder: a national cohort and co-sibling study

Casey Crump et al. Ann Epidemiol. 2023 Oct.

Abstract

Purpose: To examine risks of attention-deficit/hyperactivity disorder (ADHD) in preterm and early term birth survivors, and potential sex-specific differences.

Methods: A national cohort study was conducted of all 4061,795 singletons born in Sweden in 1973-2013 who survived infancy, followed up for ADHD identified from nationwide diagnoses and medications through 2018. Poisson regression was used to compute prevalence ratios (PRs), adjusting for sociodemographic and perinatal factors. Co-sibling analyses assessed for confounding by unmeasured shared familial (genetic or environmental) factors.

Results: ADHD prevalences by gestational age at birth were 12.1% for extremely preterm (22-27 weeks), 7.0% for moderately preterm (28-33 weeks), 5.7% for late preterm (34-36 weeks), 6.1% for all preterm (<37 weeks), 5.2% for early term (37-38 weeks), and 4.5% for full-term (39-41 weeks). Adjusted PRs comparing extremely preterm, all preterm, or early term versus full-term, respectively, were 2.35 (95% CI, 2.15-2.57), 1.28 (1.25-1.31), and 1.12 (1.10-1.13) among males, and 2.46 (2.17-2.78), 1.24 (1.20-1.28), and 1.08 (1.06-1.10) among females (P < .001 for each). These associations were virtually unchanged after controlling for shared familial factors. Both spontaneous and medically indicated preterm birth were associated with ADHD (adjusted PRs, 1.21; 95% CI, 1.18-1.24; and 1.39; 1.34-1.43, respectively).

Conclusions: In this large cohort, preterm and early term birth were associated with increased risks of ADHD in males and females, independently of covariates and shared familial factors.

Keywords: Attention deficit disorder; Attention deficit-hyperactivity disorder; Gestational age; Prematurity; Preterm birth.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Casey Crump reports financial support was provided by National Heart Lung and Blood Institute. Kristina Sundquist reports financial support was provided by National Heart Lung and Blood Institute.

Figures

Figure 1.
Figure 1.
Prevalence ratios for ADHD by gestational age at birth compared with full-term birth in males (Fig. 1A) and females (Fig. 1B), 1973–2018, Sweden (dotted lines represent 95% confidence intervals for adjusted analyses).
See this image and copyright information in PMC

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