Cited by 9Prenatal Substance Exposure EffectsSmoking Behavior and CessationAttention Deficit Hyperactivity Disorder

The DOI matches its Crossref record; 73 of the 73 references it cites were found in a registry or an index; 1 of the 49 sources its claims cite were checked for support.

Maternal smoking cessation in the first trimester still poses an increased risk of attention-deficit/hyperactivity disorder and learning disability in offspring

Open access
Li, Qiu, Cai, Xiaotang, Zhou, Hui, Ma, Dan, Li, Na·2024·Frontiers in Public Health

Abstract

Background: Studies have found maternal smoking during pregnancy was linked to attention-deficit/hyperactivity disorder (ADHD) risk. It is unclear if maternal smoking cessation during pregnancy lowers ADHD and learning disability (LD) risk in offspring. This study aimed to explore the associations between maternal smoking cessation during pregnancy and ADHD and LD risk in offspring. Methods: Data from the National Health and Nutrition Examination Survey 1999–2004 (8,068 participants) were used. Logistic regression was used to analyze the associations between maternal smoking and smoking cessation during pregnancy and ADHD and LD risk in offspring. Results: Compared to non-smokers’ offspring, maternal smoking during pregnancy increased the risk of ADHD (odds ratios [OR] = 2.07, 95% confidence interval [CI]: 1.67–2.56) and LD (OR = 1.93, 95% CI: 1.61–2.31) in offspring, even if mothers quit smoking later (OR ADHD = 1.91, 95%CI ADHD: 1.38–2.65, OR LD = 1.65, 95%CI LD: 1.24–2.19). Further analysis of the timing of initiation of smoking cessation during pregnancy revealed that, compared to non-smokers’ offspring, maternal quitting smoking in the first trimester still posed an increased risk of ADHD (OR = 1.72, 95% CI: 1.41–2.61) and LD (OR = 1.52, 95% CI: 1.06–2.17) in offspring. Maternal quitting smoking in the second or third trimester also had a significantly increased risk of ADHD (OR = 2.13, 95% CI: 1.26–3.61) and LD (OR = 1.82, 95% CI: 1.16–2.87) in offspring. Furthermore, maternal smoking but never quitting during pregnancy had the highest risk of ADHD (OR = 2.17, 95% CI: 1.69–2.79) and LD (OR = 2.10, 95% CI: 1.70–2.58) in offspring. Interestingly, a trend toward a gradual increase in the risk-adjusted OR for ADHD and LD risk was observed among the three groups: maternal quitting smoking in the first trimester, maternal quitting smoking in the second or third trimester, and maternal smoking but never quitting. Conclusion: Maternal smoking cessation in the first trimester still poses an increased risk of ADHD and LD in offspring. Furthermore, it seems that the later the mothers quit smoking during pregnancy, the higher the risk of ADHD and LD in their offspring. Therefore, early intervention of maternal smoking in preconception and prenatal care is vital for offspring neurodevelopment.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In NHANES 1999–2004, maternal smoking during pregnancy was associated with higher odds of ADHD and learning disability (LD) in offspring, and quitting later in pregnancy did not eliminate the elevated risk. Even quitting in the first trimester was associated with increased odds of ADHD and LD compared with offspring of non-smokers.

Key findings

  • Compared with non-smokers’ offspring, maternal smoking during pregnancy increased the risk of ADHD (OR = 2.07, 95% CI: 1.67–2.56) and LD (OR = 1.93, 95% CI: 1.61–2.31).
  • Mothers who smoked but quit later still had offspring with increased ADHD (OR = 1.91, 95% CI: 1.38–2.65) and LD (OR = 1.65, 95% CI: 1.24–2.19) risk.
  • Quitting in the first trimester was still associated with ADHD (OR = 1.72, 95% CI: 1.41–2.61) and LD (OR = 1.52, 95% CI: 1.06–2.17); quitting in the second or third trimester was associated with ADHD (OR = 2.13, 95% CI: 1.26–3.61) and LD (OR = 1.82, 95% CI: 1.16–2.87).
  • Smoking but never quitting had the highest reported risk of ADHD (OR = 2.17, 95% CI: 1.69–2.79) and LD (OR = 2.10, 95% CI: 1.70–2.58), with a trend toward gradually increasing adjusted ORs across first-trimester quitters, second/third-trimester quitters, and never-quitters.

Methods

  • Used publicly available National Health and Nutrition Examination Survey (NHANES) 1999–2004 data; from 31,126 participants, the final analytic sample was 8,068 children (8,052 with ADHD data; 8,056 with LD data).
  • Maternal smoking and cessation timing were based on parental/guardian interview responses; ADHD and LD outcomes were based on parent/guardian reports of doctor or school/health professional diagnosis.
  • Logistic regression estimated associations using a crude model and adjusted models; Model II adjusted for age, gender, race, poverty income ratio, birth weight, and NHANES cycle, with sensitivity analysis excluding participants missing PIR data.

Limitations

  • Stated: the authors could not adjust for other risk factors such as gene–environment correlations or maternal health problems, so causality could not be established.
  • Stated: tobacco exposure was heterogeneous, and NHANES lacked maternal smoking frequency, so heavy smoking may not be fully captured.
  • Stated: smoking and cessation variables were self-reported, risking subjective bias; evident from the design, the study is cross-sectional/observational with parent-reported ADHD and LD outcomes and no objective biomarkers, leaving potential residual confounding.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpubh.2024.1386137

Cites

73 of 73 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Eligible participants and those included in the analysis of the associations between maternal smoking history and the risk of ADHD and LD in offspring in the U.S. population. ADHD, attention-deficit/hyperactivity disorder; LD, learning disability; NHANES, National Health and Nutrition Examination Survey.
Figure 1 Eligible participants and those included in the analysis of the associations between maternal smoking history and the risk of ADHD and LD in offspring in the U.S. population. ADHD, attention-deficit/hyperactivity disorder; LD, learning disability; NHANES, National Health and Nutrition Examination Survey.CC BY · PubMed Central
Figure 2 Associations between the timing of maternal initiation of smoking cessation during pregnancy and the risk of ADHD and LD in offspring. (A) ADHD; (B) LD; binary logistic regression by adjusting for age, gender, race, PIR, birthweight, and NHANES cycle was used in the analysis. The reference was non-smokers. ADHD, attention-deficit/hyperactivity disorder; LD, learning disability; PIR, poverty income ratio; NHANES, National Health and Nutrition Examination Survey; OR, Odds Ratio; CI, confidence interval.
Figure 2 Associations between the timing of maternal initiation of smoking cessation during pregnancy and the risk of ADHD and LD in offspring. (A) ADHD; (B) LD; binary logistic regression by adjusting for age, gender, race, PIR, birthweight, and NHANES cycle was used in the analysis. The reference was non-smokers. ADHD, attention-deficit/hyperactivity disorder; LD, learning disability; PIR, poverty income ratio; NHANES, National Health and Nutrition Examination Survey; OR, Odds Ratio; CI, confidence interval.CC BY · PubMed Central

Verification

Claims the paper makes

16 Own result · 14 Not checked yet · 12 No full text of the sources · 10 Own method · 10 Own interpretation · 1 Supported so far · 1 Check pending

Verify all 22 references — free account

Show all 40 claims

  • It may state two separate claims as one. 7
  • Probably not a substantial claim. 22
24 of 24
  • The paper relies on this without support.

    Parental or guardian reports of ADHD and LD are valid measures of these outcomes.

    “To assess the neurodevelopmental outcomes, including ADHD and LD, the parents/guardian were asked, “Has a doctor or health professional ever told you/SP that you/s/he/SP had attention deficit disorder?” and “Has a representative from a school or a health professional ever told you/SP that s/he/SP had a learning disability?””
  • The paper relies on this without support.

    Parental or guardian reports of maternal smoking and smoking cessation timing are accurate.

    “This information was based on parental or guardian responses to the NHANES interview question.”
  • The paper relies on this without support.

    The measured covariates (age, gender, race, PIR, birth weight, NHANES cycle) adequately control for confounding of the association between maternal smoking and ADHD/LD.

    “Some covariables were assessed as potential confounders, including age, gender, race, poverty income ratio (PIR), birth weight, and NHANES cycle.”
    “Model II: adjusted for all underlying covariates including age, gender, race, PIR, birthweight, and NHANES cycle.”
  • The paper relies on this without support.

    The observed associations between maternal smoking/cessation and ADHD/LD are not due to unmeasured genetic or environmental confounding.

    “Even though some studies suggest that this association is explained by unmeasured genetic or environmental confounding (37, 38)”
  • The paper relies on this without support.

    The critical period of embryo development is early in pregnancy, and this period is particularly sensitive to external factors.

    “One possible explanation is that the critical period of embryo development is early in pregnancy, a period that is particularly sensitive to external factors.”
  • The paper relies on this without support.

    Accumulated toxins in the body can pass through the bloodstream into the placenta and affect the embryo’s brain development.

    “these can pass through the bloodstream into the placenta, affecting the embryo’s brain development.”
6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

1 of 1

Citations

Cites

Show all 73 references

Research works printed but not linked: 1

  1. Arlington, 2013, American Psychiatric Association: diagnostic and statistical manual of mental disorders

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Metadata

Authors
Li, Q., Cai, X., Zhou, H., Ma, D., & Li, N.
Affiliations
Sichuan University (CN)
Corresponding author
Li, Na
Venue
Frontiers in Public Health
Published
2024-07-16
Volume
12
Pages
1386137-1386137
ISSN
2296-2565 (ISSN-L)
OpenAlex
W4400696047
Cited by
9
References
73
Citations by year
2026: 5 · 2025: 4
FWCI
4.23
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Chengdu Science and Technology Bureau
  • Health Commission of Sichuan Province
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Keywords
maternal smoking cessation, prenatal tobacco exposure, attention deficit hyperactivity disorder, learning disabilities, offspring neurodevelopment, first trimester, smoking during pregnancy, prenatal care
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Learning Disabilities, Male, Mothers, Nutrition Surveys, Pregnancy, Pregnancy Trimester, First, Prenatal Exposure Delayed Effects, Risk Factors, Smoking, Smoking Cessation

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