Froehlich Tanya E, Lanphear Bruce P, Auinger Peggy, Hornung Richard, Epstein Jeffery N, Braun Joe, Kahn Robert S
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
Pediatrics. 2009 Dec;124(6):e1054-63. doi: 10.1542/peds.2009-0738. Epub 2009 Nov 23.
The study objective was to determine the independent and joint associations of prenatal tobacco and childhood lead exposures with attention-deficit/hyperactivity disorder (ADHD), as defined by current diagnostic criteria, in a national sample of US children.
Data are from the 2001-2004 National Health and Nutrition Examination Survey, a cross-sectional, nationally representative sample of the US population. Participants were 8 to 15 years of age (N = 2588). Prenatal tobacco exposure was measured by report of maternal cigarette use during pregnancy. Lead exposure was assessed by using current blood lead levels. The Diagnostic Interview Schedule for Children was used to ascertain the presence of ADHD in the past year, on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
A total of 8.7% (95% confidence interval [CI]: 7.3%-10.1%) of children met criteria for ADHD. Prenatal tobacco exposure (adjusted odds ratio [aOR]: 2.4 [95% CI: 1.5-3.7]) and higher current blood lead concentrations (aOR for third versus first tertile: 2.3 [95% CI: 1.5-3.8]) were independently associated with ADHD. Compared with children with neither exposure, children with both exposures (prenatal tobacco exposure and third-tertile lead levels) had an even greater risk of ADHD (aOR: 8.1 [95% CI: 3.5-18.7]) than would be expected if the independent risks were multiplied (tobacco-lead exposure interaction term, P < .001).
Prenatal tobacco and childhood lead exposures are associated with ADHD in US children, especially among those with both exposures. Reduction of these common toxicant exposures may be an important avenue for ADHD prevention.
本研究旨在确定美国儿童全国样本中，产前烟草暴露和儿童期铅暴露与注意力缺陷多动障碍（ADHD，按现行诊断标准定义）之间的独立关联和联合关联。
数据来自2001 - 2004年全国健康与营养检查调查，这是一个具有全国代表性的美国人口横断面样本。参与者年龄在8至15岁之间（N = 2588）。产前烟草暴露通过孕期母亲吸烟报告来衡量。铅暴露通过当前血铅水平进行评估。儿童诊断访谈表用于根据《精神疾病诊断与统计手册》第四版标准确定过去一年中ADHD的存在情况。
共有8.7%（95%置信区间[CI]：7.3% - 10.1%）的儿童符合ADHD标准。产前烟草暴露（调整优势比[aOR]：2.4 [95% CI：1.5 - 3.7]）和当前较高的血铅浓度（第三分位数与第一分位数相比的aOR：2.3 [95% CI：1.5 - 3.8]）与ADHD独立相关。与既无暴露的儿童相比，同时有两种暴露（产前烟草暴露和第三分位数铅水平）的儿童患ADHD的风险比独立风险相乘时预期的风险更高（aOR：8.1 [95% CI：3.5 - 18.7]）（烟草 - 铅暴露交互项，P < .001）。
产前烟草暴露和儿童期铅暴露与美国儿童的ADHD相关，尤其是在同时有这两种暴露的儿童中。减少这些常见毒物暴露可能是预防ADHD的重要途径。
