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Familial confounding of the association between maternal smoking during pregnancy and ADHD in offspring
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, United States.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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2014 (English)In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 55, no 1, p. 61-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal Smoking During Pregnancy (SDP) has consistently been associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring, but recent studies indicate that this association might be due to unmeasured familial confounding.

METHODS: A total of 813,030 individuals born in Sweden between 1992 and 2000 were included in this nationwide population-based cohort study. Data on maternal SDP and ADHD diagnosis were obtained from national registers and patients were followed up from the age of 3 to the end of 2009. Hazard Ratios (HRs) were estimated using stratified Cox regression models. Cousin and sibling data were used to control for unmeasured familial confounding.

RESULTS: At the population level maternal SDP predicted ADHD in offspring (HR(ModerateSDP) = 1.89; HR(HighSDP)= 2.50). This estimate gradually attenuated toward the null when adjusting for measured confounders (HR(ModerateSDP)= 1.62; HR(HighSDP)= 2.04), unmeasured confounders shared within the extended family (i.e., cousin comparison) (HR(ModerateSDP)= 1.45; HR(HighSDP)= 1.69), and unmeasured confounders within the nuclear family (i.e., sibling comparison) (HR(ModerateSDP)= 0.88; HR(HighSDP)= 0.84).

CONCLUSIONS: Our results suggest that the association between maternal SDP and offspring ADHD are due to unmeasured familial confounding.

Place, publisher, year, edition, pages
Blackwell Publishing, 2014. Vol. 55, no 1, p. 61-8
Keywords [en]
Maternal smoking during pregnancy, attention-deficit/hyperactivity disorder, confounding, sibling comparisons
National Category
Medical and Health Sciences Psychology Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-66286DOI: 10.1111/jcpp.12124ISI: 000328246400009PubMedID: 25359172Scopus ID: 2-s2.0-84890806112OAI: oai:DiVA.org:oru-66286DiVA, id: diva2:1194436
Funder
Stockholm County Council, K1426-2011The Karolinska Institutet's Research Foundation, K1426-2011Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council, 2010-3184, 2011-2492
Note

Funding Agency:

National Institute of Child Health and Human Development, NICHD, HD061817

Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-06-26Bibliographically approved

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Larsson, Henrik

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