Maternal Lifestyle Factors in Pregnancy Risk of Attention Deficit Hyperactivity Disorder and Associated Behaviors: Review of the Current Evidence
Abstract
OBJECTIVE: The purpose of this review was to examine the literature assessing the relationship between prenatal exposure to nicotine, alcohol, caffeine, and psychosocial stress during pregnancy to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in childhood. METHOD: PubMed, MEDLINE, EMBASE, and PsycINFO were searched systematically. Studies using DSM diagnostic criteria and other validated diagnostic or screening instruments for ADHD and those examining ADHD symptoms were included. A narrative approach was used because the studies differed too much in methods and data sources to permit a quantitative meta-analysis. RESULTS: Twenty-four studies on nicotine (tobacco smoking), nine on alcohol, one on caffeine, and five on psychosocial stress were identified. All were published between 1973 and 2002. In spite of inconsistencies, the studies on nicotine indicated a greater risk of ADHD-related disorders among children whose mothers smoked during pregnancy. Contradictory findings were reported in the alcohol studies, and no conclusion could be reached on the basis of the caffeine study. Results from studies on psychological stress during pregnancy were inconsistent but indicated a possible modest contribution to ADHD symptoms in the offspring. Many studies suffered from methodological shortcomings, such as recall bias, crude or inaccurate exposure assessments, low statistical power, and lack of or insufficient control of confounders. A general lack of information on familial psychopathology also limited the interpretations. CONCLUSIONS: Exposure to tobacco smoke in utero is suspected to be associated with ADHD and ADHD symptoms in children. Other maternal lifestyle factors during pregnancy may also be associated with these disorders. Further studies are needed to reach conclusions.
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For low amounts of alcohol (8-28 g per occasion), several studies have found that there is no increased risk of behavioural and/or developmental deficits in children.
“For low amounts of alcohol (8–28 g per occasion), several studies have found that there is no increased risk of behavioural and/or developmental deficits in children 69, 71, 72, 73.”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [72]
One of the persistent consequences of gestational tobacco exposure in human children is an elevated risk for developing ADHD.
“One of the persistent consequences of gestational tobacco exposure in human children is an elevated risk for developing ADHD [7, 52–54].”
From Impaired auditory discrimination learning following perinatal nicotine exposure or β2 nicotinic acetylcholine receptor subunit deletion (2012) · cites this paper as [54]
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- Authors
- Linnet, K. M., Dalsgaard, S., Obel, C., Wisborg, K., Henriksen, T. B., Rodriguez, A., Kotimaa, A., Moilanen, I., Thomsen, P. H., Olsen, J., & Jarvelin, M.-R.
- Affiliations
- Aarhus University Hospital (DK)
- Venue
- American Journal of Psychiatry
- Published
- 2003-06-01
- Volume
- 160
- Issue
- 6
- Pages
- 1028-1040
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2125347442
- Cited by
- 778
- References
- 96
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 10 · 2023: 14 · 2022: 20 · 2021: 24 · 2020: 19 · 2019: 21 · 2018: 22 · 2017: 37 · 2016: 36 · 2015: 52 · 2014: 39 · 2013: 43 · 2012: 69
- FWCI
- 16.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- attention deficit hyperactivity disorder, prenatal exposure, maternal smoking, prenatal alcohol exposure, prenatal caffeine exposure, maternal lifestyle factors, child behavior problems
- MeSH terms
- Adolescent, Adult, Alcohol Drinking, Attention Deficit Disorder with Hyperactivity, Caffeine, Child, Child, Preschool, Coffee, Female, Humans, Life Style, Male, Nicotine, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Risk Factors, Smoking, Stress, Psychological, United States
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