The association between maternal tobacco smoking during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring: A systematic review and meta-analysis.

作者信息

Mohammadian Mahdi, Khachatryan Lusine G, Vadiyan Filipp V, Maleki Mostafa, Fatahian Fatemeh, Mohammadian-Hafshejani Abdollah

机构信息

Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Pediatric Diseases, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

出版信息

PLoS One. 2025 Feb 7;20(2):e0317112. doi: 10.1371/journal.pone.0317112. eCollection 2025.

DOI:10.1371/journal.pone.0317112

PMID:39919144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11805386/

Abstract

INTRODUCTION

Maternal tobacco smoking during pregnancy is a significant public health concern with potential long-lasting effects on child development. ADHD, a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, may be influenced by prenatal nicotine exposure. This systematic review and meta-analysis examine the association between maternal tobacco smoking during pregnancy and the risk of ADHD in offspring.

METHODS

Following PRISMA guidelines, we searched databases including PubMed, Web of Science, Cochrane Central, Embase, Scopus, CINAHL, LILACS, SciELO, Allied and Complementary Medicine Database (AMED), ERIC, CNKI, HTA Database, Dialnet, EBSCO, LENS, and Google Scholar for studies up to November 1, 2024. We included peer-reviewed studies reporting quantitative effect size estimates for the association between maternal tobacco smoking and ADHD. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

We identified 2,981 articles and included 55 studies (4,016,522 participants) in the analysis. The meta-analysis showed a significant association between maternal tobacco smoking during pregnancy and increased risk of ADHD in offspring (pooled Odds Ratio (OR) = 1.71, 95% CI: 1.55-1.88; P < 0.001). Egger's test indicated no publication bias (p = 0.204), but Begg's test did (p = 0.042). By employing the trim and fill method, the revised OR was estimated to be 1.54 (95% CI: 1.40-1.70; P < 0.001). The OR were 2.37 (95% CI: 1.72-3.28; P < 0.001) in cross-sectional studies, 1.72 (95% CI: 1.49-2.00; P < 0.001) in case-control studies, and 1.53 (95% CI: 1.34-1.74; P < 0.001) in cohort studies. Meta-regression showed study design and study region significantly influenced heterogeneity (P < 0.10). Sensitivity and subgroup analyses confirmed the robustness of these findings.

CONCLUSION

This systematic review and meta-analysis demonstrate a significant association between maternal tobacco smoking during pregnancy and increased odds of ADHD in offspring. These findings highlight the need for prenatal care guidelines and tobacco smoking cessation programs for pregnant women to reduce ADHD risk and promote optimal neurodevelopmental outcomes. Future research should explore underlying mechanisms and potential confounders further.

摘要