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Published on: June 30, 2020
Antenatal active maternal asthma and other atopic disorders is associated with ADHD behaviors among school-aged
Whitney J Cowell1, David C Bellinger2, Robert O Wright1
1Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Maternal prenatal atopy, such as asthma, is linked to increased attention deficit hyperactivity disorder (ADHD) symptoms in children. This association appears stronger in girls, suggesting a potential sex-specific risk factor for ADHD development.
Area of Science:
- Neuroscience
- Pediatrics
- Immunology
Background:
- Prenatal inflammatory conditions, including maternal asthma and atopic disorders, are increasingly associated with neurobehavioral issues in children.
- Some research indicates that these prenatal factors may have sex-specific effects on neurodevelopment.
- Identifying modifiable risk factors is crucial for developing early prevention strategies for attention deficit hyperactivity disorder (ADHD).
Purpose of the Study:
- To investigate the association between maternal active asthma or atopy during pregnancy and ADHD symptoms in mid-childhood.
- To examine potential sex-specific modifying effects of this association, given the higher prevalence of ADHD in boys.
Main Methods:
- The study included 250 mother-child pairs from the Boston-based Asthma Coalition on Community, Environment and Social Stress (ACCESS) pregnancy cohort.
- Maternal antenatal atopy was defined by self-reported asthma, allergic rhinitis, or atopic dermatitis during or one year prior to pregnancy.
- Children's ADHD symptoms were assessed around age 6 using standardized parent rating scales, with analysis employing multivariable quantile regression.
Main Results:
- Maternal antenatal atopy was significantly associated with increased ADHD behaviors, particularly on the Conners' Parent Rating Scale-Revised ADHD index.
- This association was notably stronger in girls compared to boys, with a significant interaction effect observed (p=0.01).
- Similar trends were seen for the Behavior Assessment System for Children 2nd Edition Parent Rating Scale Attention Problems subscale in girls, though not all reached statistical significance.
Conclusions:
- Maternal antenatal active atopy may represent a significant risk factor for the development of ADHD-like symptoms in offspring.
- The findings suggest a potential sex-specific vulnerability, with girls appearing more susceptible to the effects of maternal atopy on ADHD symptom development.
Background:
Identifying modifiable risk factors for neuropsychological correlates of attention deficit hyperactivity disorder (ADHD) in early childhood can inform prevention strategies. Prenatal inflammatory states, such as maternal asthma and other atopic disorders, have been increasingly linked to enhanced risk for neurobehavioral disorders in children, with some studies suggesting sex-specific effects.
Objectives:
To assess the association between maternal active asthma and/or atopy in the antenatal period and child symptoms of ADHD during mid-childhood and, given the male-bias in ADHD prevalence, to examine modifying effects of child sex.
Study Design:
The study sample includes 250 maternal-child pairs enrolled in the Boston-based Asthma Coalition on Community, Environment and Social Stress (ACCESS) pregnancy cohort. We defined antenatal active atopy based on maternal report of current asthma, allergic rhinitis or atopic dermatitis during and/or in the year before pregnancy. When children were approximately 6 years old, mothers completed a battery of standardized child behavior rating scales designed for evaluating symptoms of ADHD. We used multivariable quantile regression to assess the relations between maternal antenatal atopy and symptoms of ADHD among children.
Results:
In adjusted models, maternal atopy was significantly associated with greater risk for ADHD behaviors, as indicated by scores on the Conners' Parent Rating Scale-Revised ADHD index (β = 3.32, 95% CI: 0.33, 6.32). In sex-stratified models this association was stronger among girls (5.96, 95% CI = 0.95, 10.96) compared to boys (-2.14, 95% CI = -5.75, 1.45, p-interaction = 0.01). Among girls, we observed a similar finding for the Behavior Assessment System for Children 2nd Edition Parent Rating Scale Attention Problems subscale (β = 7.77, 95% CI = 1.57, 13.97). Results from other outcome subscales were similar in magnitude and direction, however, associations did not reach statistical significance at the p = 0.05 level.
Conclusions:
Maternal antenatal active atopy may be a risk factor for the development of ADHD-like symptoms, especially among girls.
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