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Air pollution exposure during pregnancy and symptoms of attention deficit and hyperactivity disorder in children in Europe
Forns, J., Sunyer, J., Garcia-esteban, R., Porta, D., Ghassabian, A., Giorgis-allemand, L., Gong, T., Gehring, U., Sørensen, M., Standl, M., Sugiri, D., Almqvist, C., Andiarena, A., Badaloní, C., Beelen, R., Berdel, D., Cesaroni, G., Charles, M., Eriksen, K. T., ... Guxens, M. (2018). Air pollution exposure during pregnancy and symptoms of attention deficit and hyperactivity disorder in children in Europe. Epidemiology, 29(5), 618-626. https://doi.org/10.1097/EDE.0000000000000874
BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.
METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.
RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.
CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.