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Updated: Sep 11, 2025

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Association between maternal smoking during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children

Baomei He1, Junxiong Peng2, Mengqi Wu1

  • 1Center for Reproductive Medicine, Department of Pediatrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, China.

Tobacco Induced Diseases
|August 11, 2025
PubMed

Insights

Maternal smoking during pregnancy (MSDP) significantly increases the odds of attention-deficit hyperactivity disorder (ADHD) in children. This risk is notably higher in female children compared to males.

Area of Science:

  • Pediatric Health
  • Neurodevelopmental Disorders
  • Environmental Health

Background:

  • The link between maternal smoking during pregnancy (MSDP) and attention-deficit hyperactivity disorder (ADHD) requires further clarification.
  • Existing research presents inconclusive findings on this association.

Purpose of the Study:

  • To investigate the relationship between MSDP and ADHD in children aged 4-15 years.
  • To examine potential sex differences in the association between MSDP and ADHD.

Main Methods:

  • Secondary analysis of cross-sectional data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES).
  • Inclusion of 5548 US children and adolescents (aged 4-15) with complete maternal smoking and ADHD diagnosis data.
  • Multivariable logistic regression and sex-stratified analyses were performed.

Main Results:

  • Maternal smoking during pregnancy was significantly associated with increased odds of ADHD (OR=2.11).
  • The association was more pronounced in female children (OR=4.18) compared to male children (OR=1.64).
  • A significant interaction effect was observed between MSDP exposure and sex (p < 0.01).

Conclusions:

  • Maternal smoking during pregnancy is linked to higher odds of ADHD in children.
  • The association between MSDP and ADHD is significantly stronger in females than in males.
Abstract

Keywords:
National Health and Nutrition Examination Surveyattention-deficit/hyperactivity disorder (ADHD)childrenmaternal smoking during pregnancysex differences

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