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Familial confounding of the association between maternal smoking during pregnancy and ADHD in offspring.
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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
2014. Vol. 55, no 1, p. 61-8
Keywords [en]
Maternal smoking during pregnancy, attention-deficit/hyperactivity disorder, confounding, sibling comparisons
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-400506DOI: 10.1111/jcpp.12124PubMedID: 25359172OAI: oai:DiVA.org:uu-400506DiVA, id: diva2:1381478
Available from: 2019-12-21 Created: 2019-12-21 Last updated: 2020-02-04Bibliographically approved

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