School of Psychological Science, University of Bristol, Bristol, UK.
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Addiction. 2022 Oct;117(10):2602-2613. doi: 10.1111/add.15858. Epub 2022 Apr 6.
Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this relationship is causal. We conducted a systematic review to determine: (1) if the literature supports a causal role of maternal prenatal substance use on offspring externalizing disorders diagnosis and (2) whether these associations differ across externalizing disorders.
We searched Web of Science, Embase, PsycINFO and Medline databases. Risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS), and where possible meta-analysis was conducted for studies classed as low risk of bias. We included studies of any design that examined prenatal smoking, alcohol or caffeine use. Studies in non-English language, fetal alcohol syndrome and comorbid autism spectrum disorders were excluded. Participants in the included studies were mothers and their offspring. Measurements included prenatal smoking, alcohol or caffeine use as an exposure, and diagnosis of attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring as an outcome.
We included 63 studies, 46 of which investigated smoking and ADHD. All studies were narratively synthesized, and seven studies on smoking and ADHD were meta-analysed. The largest meta-analysis based on genetically sensitive design included 1 011 546 participants and did not find evidence for an association [odds ratio (OR) = 0.90, 95% confidence interval (CI) = 0.83-1.11; OR = 1.04, 95% CI = 0.79-1.36). Studies on alcohol exposure in all the outcomes reported inconsistent findings and no strong conclusions on causality can be made. Studies on caffeine exposure were mainly limited to ADHD and these studies do not support a causal effect.
There appears to be no clear evidence to support a causal relationship between maternal prenatal smoking and offspring attention-deficit hyperactivity disorder. Findings with alcohol and caffeine exposures and conduct disorder and oppositional-defiant disorder need more research, using more genetically sensitive designs.
多项研究表明，母体产前物质使用与后代的外化障碍之间存在关联；然而，尚不确定这种关系是否具有因果关系。我们进行了一项系统综述，以确定：（1）文献是否支持母体产前物质使用对后代外化障碍诊断的因果作用；（2）这些关联是否在不同的外化障碍中存在差异。
我们在 Web of Science、Embase、PsycINFO 和 Medline 数据库中进行了检索。使用纽卡斯尔-渥太华量表（NOS）进行偏倚风险评估，对于归类为低偏倚风险的研究，尽可能进行荟萃分析。我们纳入了任何设计的研究，这些研究检查了产前吸烟、饮酒或咖啡因使用。排除了非英语语言、胎儿酒精综合征和共患自闭症谱系障碍的研究。纳入研究的参与者为母亲及其后代。测量包括产前吸烟、饮酒或咖啡因使用作为暴露，以及后代注意力缺陷多动障碍（ADHD）、品行障碍（CD）和对立违抗性障碍（ODD）的诊断作为结局。
我们纳入了 63 项研究，其中 46 项研究调查了吸烟与 ADHD。所有研究均进行了叙述性综合分析，有 7 项关于吸烟与 ADHD 的研究进行了荟萃分析。最大的荟萃分析基于遗传敏感设计，纳入了 1011546 名参与者，并未发现关联的证据[比值比（OR）=0.90，95%置信区间（CI）=0.83-1.11；OR=1.04，95%CI=0.79-1.36]。所有结局的酒精暴露研究报告了不一致的发现，对于因果关系无法得出明确的结论。咖啡因暴露的研究主要局限于 ADHD，这些研究并不支持因果效应。
似乎没有明确的证据支持母体产前吸烟与后代注意力缺陷多动障碍之间存在因果关系。需要使用更具遗传敏感性的设计，对酒精和咖啡因暴露与品行障碍和对立违抗性障碍的关系进行更多研究。
