Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
J Child Psychol Psychiatry. 2019 Jun;60(6):665-675. doi: 10.1111/jcpp.12990. Epub 2018 Oct 27.
Prenatal exposure to maternal adverse life events has been associated with offspring ADHD, but the role of familial confounding is unclear. We aimed to clarify if adverse life events during pregnancy are related to ADHD symptoms in offspring, taking shared familial factors into account.
Data were collected on 34,751 children (including 6,427 siblings) participating in the population-based Norwegian Mother and Child Cohort Study. During pregnancy, mothers reported whether they had experienced specific life events. We assessed ADHD symptoms in five-year-old children with the Conners' Parent Rating Scale-Revised: short form. We modeled the associations between life events and mean ADHD scores with ordinary linear regression in the full cohort, and with fixed-effect linear regression in sibling comparisons to adjust for familial confounding.
Children exposed to adverse life events had higher ADHD scores at age 5, with the strongest effect observed for financial problems (mean differences 0.10 [95% CI: 0.09, 0.11] in adjusted model), and the weakest for having lost someone close (0.02 [95% CI 0.01, 0.04] in adjusted model). Comparing exposure-discordant siblings resulted in attenuated estimates that were no longer statistically significant (e.g. mean difference for financial problems -0.03 [95% CI -0.07, 0.02]). ADHD scores increased if the mother had experienced the event as painful or difficult, and with the number of events, whereas sibling-comparison analyses resulted in estimates attenuated toward the null.
These results suggest that the association between adverse life events during pregnancy and offspring ADHD symptoms is largely explained by familial factors.
母亲在孕期经历的不良生活事件与后代 ADHD 有关，但家族性混杂因素的作用尚不清楚。我们旨在明确在考虑到共享家族因素的情况下，孕期不良生活事件是否与后代的 ADHD 症状有关。
数据来自于参与基于人群的挪威母亲和儿童队列研究的 34751 名儿童（包括 6427 对兄弟姐妹）。在孕期，母亲报告她们是否经历过特定的生活事件。我们使用康纳父母评定量表修订版：短式评估五岁儿童的 ADHD 症状。我们在全队列中使用普通线性回归模型来评估生活事件与平均 ADHD 评分之间的关联，在兄弟姐妹比较中使用固定效应线性回归模型来调整家族性混杂因素。
暴露于不良生活事件的儿童在五岁时的 ADHD 评分较高，其中经济问题的影响最大（调整模型中的平均差异为 0.10[95%CI：0.09，0.11]），失去亲近的人影响最小（调整模型中的平均差异为 0.02[95%CI 0.01，0.04]）。比较暴露不一致的兄弟姐妹导致估计值减弱且不再具有统计学意义（例如，经济问题的平均差异为-0.03[95%CI-0.07，0.02]）。如果母亲将事件视为痛苦或困难，以及经历的事件数量增加，ADHD 评分会升高，而兄弟姐妹比较分析的结果则向零值方向减弱。
这些结果表明，孕期不良生活事件与后代 ADHD 症状之间的关联主要由家族因素解释。
