epidemiology articles 2
Association Between Smoking During Pregnancy and ADHD
Group #1: Hazel Ortiz, Coral Oros, Dillon Razo, Coral Trujillo
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Research Question & Hypothesis
Research Question: Is smoking cigarettes during pregnancy a potential cause of offspring ADHD?
Hypothesis: Smoking cigarettes during pregnancy causes ADHD in offspring.
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Flow chart
Searched term: Smoking
ADHD
N=947
Searched term:
Smoking during pregnancy
N=23,796
Searched term:
effect of smoking during pregnancy
N=14,126
Searched term:
smoking during pregnancy ADHD
N=331
Searched term:
maternal smoking during pregnancy ADHD
N=263
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Attention-deficit/hyperactivity disorder, prenatal exposures, cigarette smoke
Smoking, Pregnancy, Child ADHD
Attention deficit disorder with hyperactivity, maternal exposure, paternal exposure, causality, confounding factors, smoking, pregnancy
Key words
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Criteria Checklist
| Author (Year) | Research Question and Hypotheses | Study Design | Subjects | Response Rate | Length of follow-up | Exposure | Outcome | Confounding | Statistical Analysis | Results | Rigor Score |
| Langley (2012) | Does smoking cigarettes during pregnancy cause ADHD in offspring? Smoking during pregnancy does cause ADHD in offspring | Longitudinal study | Women with due dates (1991-1992) Avon Study of parents and children (n=13,988) | N=8324 of study from initial n=13,988 | 7 years (18-36 weeks of gestation) | Maternal smoking habits from week 18-36 | Upon reaching age 7, children were put under DAWBA for ADHD diagnosis | Childs sex, ethnicity, multiple birth, low birthweight, maternal alcohol use, social class | Maternal smoking habits were associated with ADHD in offspring (β=0.25, 95% confidence interval CI:0.18,0.32) | Exposed vs unexposed (5.99 v 4.52), ADHD symptoms (4.79 SD=6.71),correlation (0.39), no exposure mean=4.31 SD=6.29) | 70% |
| Gustavson (2017) | Is smoking cigarettes during pregnancy a potential cause of offspring ADHD? There is no association between maternal smoking and offspring ADHD | Cohort study | Pregnant women recruited from Norway (1999-2008) | N=95,00 (maternal) N=75,00 (paternal) N=110,000 initial to N=104,846 (children) | 2008-2014 (5 years) individual assessments | Maternal smoking habits, paternal smoking habits, second hand maternal smoke exposure | 6 question assessment for ADHD in children regarding common symptoms on a scale of (not true:1 –very often true: 3) | Childs sex, ethnicity, living situation, paternal education, birth weight of children | Maternal and paternal age, education, maternal and paternal BMI pre-pregnancy, during pregnancy, post-pregnancy, birth year, geographical residential region. BMI and children's sex was excluded from covariates and data analysis | 2035 (2%) of 104,846 children diagnosed with ADHD, 51% boys, 43.7% women, smoking prevalence 8.5% maternal, 24.6% paternal, 3334 maternal reports of secondhand smoke exposure | 63% |
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Materials and Methods
Langley (2012)
DAWBA assessment for ADHD (age 7)
Maternal smoking habits categorized
Covariates: sex, ethnicity, multiple births, alcohol use, social class
Gustavson (2017)
Ultrasound examinations (17 weeks)
Questionnaire containing common ADHD symptoms (1-3 scale)
Maternal + paternal smoking habits
Covariates: child's sex, ethnicity, living situation, maternal + paternal education, weight
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Summaries of the Quality Criteria
Summary #1: Maternal and Paternal Smoking during Pregnancy and Risk of ADHD Symptoms in Offspring.
Research questions were clearly defined, and the study subjects were well comprehended. Response rate was fully well covered however the author did not indicate the portion of characters who failed to participate in the research. The author clearly defines the exposures and outcomes; the author only showed residual confounders of the diseases. Determining the rigor score, this article got a score of 83% which means it is rigorous.
Summary #2: Smoking in Pregnancy and Child ADHD
Though the author did well in other sections the research was not rigorous due to the article not effectively showing the research questions as it left out the author's alternative hypothesis. In addition, during the selection of the study, the author failed to indicate the criteria specified with sufficient details. The response rate was effectively looked on by the author however in handling withdrawals only follow-up methods were clearly defined. The use of blinding in preventing bias introduction was not looked into by the author. In confounders, the author only identifies factors related to the disease and exposure. Overall, this article scored 63% which means it is not rigorous.
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Findings and Statistical Information
ADHD diagnosis
- ADHD was diagnosed in 7.3% of the children.
Smoking prevalence
-The smoking prevalence was 8.5% for mothers
Paternal Smoking
-Paternal (0.18) smoking in pregnancy cause ADHD
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Group Decision
Our research question, "Is smoking cigarettes during pregnancy a potential cause of offspring ADHD?“
Studies show an association between maternal smoking and child ADHD
Studies included confounding factors and not causal factors
Overall, Yes smoking during pregnancy is a potential cause of offspring in ADHD.
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Some studies check the association between prenatal or maternal smoking during pregnancy and the risk of developing ADHD in offspring. Some other studies reveal that there are confounding factors such as genetics that are also associated with developing attention-deficit/hyperactivity disorder. Only one or two studies said that there is a lesser role of maternal smoking in causing ADHD, and the major role is played by confounding factors. In our opinion, the occurrence of ADHD symptoms in the offspring is due to maternal smoking during pregnancy, but sometimes some confounding factors also contribute to increasing the risk.
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References
Coral Tru:
https://pubmed.ncbi.nlm.nih.gov/35213510/ (only use for the table & flowchart)
https://pubmed.ncbi.nlm.nih.gov/28138005/ <--- (focus on for presentation)
https://pubmed.ncbi.nlm.nih.gov/22791738/ <--- (focus on for presentation)
Hazel Ortiz:
https://acamh-onlinelibrary-wiley-com.mimas.calstatela.edu/doi/full/10.1111/jcpp.12124
https://onlinelibrary-wiley-com.mimas.calstatela.edu/doi/full/10.1002/ajmg.b.32421
Coral Oros
https://pubmed.ncbi.nlm.nih.gov/25049343/
https://pubmed.ncbi.nlm.nih.gov/25416463/
https://pubmed.ncbi.nlm.nih.gov/26379720/
Dillon Razo
https://www.nature.com/articles/tp201212
https://academic.oup.com/ntr/article-abstract/15/1/149/1104903?redirectedFrom=fulltext&login=false
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