Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis
Abstract
CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Exploring the risk factors for ADHD is helpful in preventing ADHD. OBJECTIVE: To explore the association between maternal smoking during pregnancy and the occurrence of ADHD in offspring. DATA SOURCES: PubMed, Embase, and Cochrane Library were searched from inception to May 2017 for studies. STUDY SELECTION: Cohort or case-control studies in which the association between maternal smoking and ADHD in offspring were investigated were eligible if they included odds ratios (ORs), hazard ratios, or risk ratios and 95% confidence intervals (CIs). DATA EXTRACTION: Two investigators independently extracted data on definition of exposure and outcome, number of cases and total sample population, and potential confounders adjusted. Any dose-relationship data for smoking and ADHD risk were also extracted. RESULTS: Fifteen cohort studies and 5 case-control studies with 50 044 cases and 2 998 059 participants were included. Smoking during pregnancy increased the risk of offspring ADHD (OR: 1.60; 95% CI: 1.45–1.76). The risk of ADHD was greater for children whose mothers were heavy smokers (OR: 1.75; 95% CI: 1.51–2.02) than for those mothers were light smokers (OR: 1.54; 95% CI: 1.40–1.70). LIMITATIONS: The limitations of our study included different assessment tools of ADHD and a lack of objective biological measures for maternal smoking. CONCLUSIONS: With our meta-analysis, we provide evidence for an association between maternal smoking and offspring ADHD but do not solve the causality issues concerning potential confounding by other risk factors. More high-quality studies are needed to establish whether the association with smoking is causal.
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Smoking during pregnancy increased risk of offspring ADHD (OR 1.60; 95% CI 1.45-1.76).
“Lastly, a meta-analysis of cohort and case-control studies (n = 50,044 cases, 2,998,059 total) found that smoking during pregnancy increased the risk of offspring ADHD (OR: 1.60; 95% CI:1.45–1.76)”
From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [71]
Risk of ADHD was greater in children whose mothers smoked 10 or more cigarettes per day (OR 1.75; 95% CI 1.51-2.02) than for mothers who smoked fewer than 10 cigarettes per day (OR 1.54; 95% CI 1.40-1.70).
“and that the risk of ADHD was greater in children whose mothers who smoked more than 10 or more cigarettes per day (OR: 1.75; 95% CI: 1.51–2.02) than for mothers that smoked fewer than 10 cigarettes per day (OR: 1.54; 95% CI: 1.40–1.70)”
From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [71]
Results for maternal smoking and ADHD were robust to adjustment for publication bias.
“There was non-significant indication of publication bias, and results were robust even when adjusting for this.”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [57]
Maternal smoking significantly heightens risk of ADHD in offspring (OR=1.35, 95% CI 1.2-1.52).
“Pooled analyses of ORs adjusted for a range of confounding maternal factors (e.g., mother's age, education and socio-demographic status) and offspring variables (i.e., child's gender and gestational age) showed that maternal smoking significantly heightened the risk of ADHD (OR=1.35, 95% CI: 1.2-1.52, I²=59.5%).”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [57]
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“35 Three meta-analyses with over twenty studies covering more than three million persons have found prenatal exposure to maternal smoking associated with a greater than 50 % increase in incidence of ADHD (Huang et al., 2018a) (Dong et al., 2018; Nilsen and Tulve, 2020).”
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Self-citation
- Authors
- Huang, L., Wang, Y., Zhang, L., Zheng, Z., Zhu, T., Qu, Y., & Mu, D.
- Affiliations
- Sichuan University (CN)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2018-01-01
- Volume
- 141
- Issue
- 1
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2781226500
- Cited by
- 179
- References
- 58
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 28 · 2023: 24 · 2022: 22 · 2021: 28 · 2020: 23 · 2019: 19 · 2018: 6 · 2013: 2
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (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 › Physiology › Smoking Behavior and Cessation
- Keywords
- maternal smoking, prenatal tobacco exposure, attention deficit hyperactivity disorder, neurodevelopmental disorders
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Female, Humans, Male, Pregnancy, Prenatal Exposure Delayed Effects, Prognosis, Smoking, United States, Incidence, Proportional Hazards Models, Case-Control Studies, Age Distribution, Sex Distribution, Risk Assessment, Maternal Exposure
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