Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 462-467 (doi:10.1542/peds.2004-2054)
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Smoking During Pregnancy and the Risk for Hyperkinetic Disorder in Offspring

Karen Markussen Linnet, MD, PhD*,{ddagger}, Kirsten Wisborg, MD, DMSc*, Carsten Obel, MD, PhD*, Niels Jørgen Secher, MD*,§, Per Hove Thomsen, MD, DMSc{ddagger}, Esben Agerbo, MSc|| and Tine Brink Henriksen, MD, PhD*

* Perinatal Epidemiological Research Unit, Department of Obstetrics and Pediatrics, Aarhus University Hospital, Aarhus, Denmark
{ddagger} Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Skejby, Denmark
§ Department of Obstetrics and Gynaecology, Hvidovre Hospital, Copenhagen, Denmark
|| National Center for Register-Based Research, Aarhus University, Aarhus, Denmark

Objective. Maternal smoking during pregnancy may increase the risk for behavioral disorders. The aim of this study was to investigate the association between smoking during pregnancy and hyperkinetic and attention-deficit/hyperactivity disorder in the offspring in a large population-based study.

Methods. This study was designed as a nested case-control study. Data were obtained from Danish longitudinal registers and included 170 children with hyperkinetic disorder and 3765 population-based control subjects, who were matched by age, gender, and date of birth. Potential confounders, including newborn characteristics, socioeconomic status, and family history of psychiatric illnesses, were evaluated by conditional logistic regression analyses.

Results. Women who smoked during pregnancy had a 3-fold increased risk for having offspring with hyperkinetic disorder compared with nonsmokers. Socioeconomic factors and history of mental disorder in the parents or siblings seemed to confound the result to some extent (adjusted relative risk: 1.9; 95% confidence interval: 1.3–2.8). Adjustment for parental age or exclusion of children with low birth weight (<2500 g), preterm delivery (<37 weeks completed gestation), and Apgar scores <7 at 5 minutes revealed no changes in the results. Also, excluding children with conduct disorders or comorbid disorders revealed no change in the results.

Conclusions. Our results showed an increased risk for hyperkinetic disorder in children of mothers who smoked during pregnancy. This could not be explained by newborn characteristics, parental socioeconomic status, family history of psychiatric hospitalizations or contact as outpatients, conduct disorders, or comorbidity.

Key Words: smoking • pregnancy • intrauterine • hyperkinetic disorder • attention-deficit/hyperactivity disorder

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • ICD-10, International Classification of Diseases, Tenth Revision • IDA, Integrated Database for Labour Market Research • RR, relative risk • CI, confidence interval

Accepted Nov 22, 2004.




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