Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA.
Gryphon Scientific, Takoma Park, MD, USA.
Prev Sci. 2024 May;25(Suppl 2):203-224. doi: 10.1007/s11121-022-01359-3. Epub 2022 Mar 18.
Previous studies have shown mixed results on the relationship between prenatal, birth, and postnatal ("pregnancy-related") risk factors and attention-deficit/hyperactivity disorder (ADHD). We conducted meta-analyses to identify potentially modifiable pregnancy-related factors associated with ADHD. A comprehensive search of PubMed, Web of Science, and EMBASE in 2014, followed by an updated search in January 2021, identified 69 articles published in English on pregnancy-related risk factors and ADHD for inclusion. Risk factors were included in the meta-analysis if at least three effect sizes with clear pregnancy-related risk factor exposure were identified. Pooled effect sizes were calculated for ADHD overall, ADHD diagnosis, inattention, and hyperactivity/impulsivity. Odds ratios (OR) were calculated for dichotomous measures and correlation coefficients (CC) for continuous measures. Prenatal factors (pre-pregnancy weight, preeclampsia, pregnancy complications, elevated testosterone exposure), and postnatal factors (Apgar score, neonatal illness, no breastfeeding) were positively associated with ADHD overall; the findings for ADHD diagnosis were similar with the exception that there were too few effect sizes available to examine pre-pregnancy weight and lack of breastfeeding. Prenatal testosterone was significantly associated with inattention and hyperactivity/impulsivity. Effect sizes were generally small (range 1.1-1.6 ORs, -0.16-0.11 CCs). Risk factors occurring at the time of birth (perinatal asphyxia, labor complications, mode of delivery) were not significantly associated with ADHD. A better understanding of factors that are consistently associated with ADHD may inform future prevention strategies. The findings reported here suggest that prenatal and postnatal factors may serve as potential targets for preventing or mitigating the symptoms of ADHD.
先前的研究表明，产前、出生和产后（“妊娠相关”）风险因素与注意缺陷多动障碍（ADHD）之间的关系存在混杂结果。我们进行了荟萃分析，以确定与 ADHD 相关的潜在可改变的妊娠相关因素。2014 年全面检索了 PubMed、Web of Science 和 EMBASE，并于 2021 年 1 月进行了更新检索，确定了 69 篇发表在英语杂志上的关于妊娠相关风险因素和 ADHD 的文章纳入分析。如果至少有三个明确的妊娠相关风险因素暴露的效应大小，则将风险因素纳入荟萃分析。对 ADHD 整体、ADHD 诊断、注意力不集中和多动/冲动进行了汇总效应大小计算。对二分类指标计算比值比（OR），对连续指标计算相关系数（CC）。产前因素（孕前体重、子痫前期、妊娠并发症、睾酮暴露升高）和产后因素（阿普加评分、新生儿疾病、非母乳喂养）与 ADHD 整体呈正相关；ADHD 诊断的结果相似，只是可用的效应大小太少，无法检查孕前体重和缺乏母乳喂养。产前睾酮与注意力不集中和多动/冲动显著相关。效应大小通常较小（范围 1.1-1.6 OR，-0.16-0.11 CC）。出生时发生的风险因素（围产期窒息、分娩并发症、分娩方式）与 ADHD 无显著相关性。更好地了解与 ADHD 一致相关的因素可能为未来的预防策略提供信息。这里报告的发现表明，产前和产后因素可能成为预防或减轻 ADHD 症状的潜在目标。
