Association Analysis Between HEI-2020 Index and Maternal Pregnancy Behaviors on ADHD in Adolescent Populations: A...

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in adolescents, with maternal pregnancy behaviors and adolescent dietary quality considered risk factors for its onset and progression. This study aimed to analyze associations of maternal pregnancy behaviors and the Healthy Eating Index (HEI)-2020 with adolescent ADHD. Data from 3859 adolescents were extracted from NHANES 2013-2018. Dietary quality was assessed using two-day dietary recall data and quantified as HEI-2020 scores. Multivariate logistic regression assessed associations of HEI-2020 and maternal pregnancy behaviors with ADHD likelihood. Restricted cubic spline regression models were utilized to describe nonlinear relationships, and subgroup analyses were conducted. HEI-2020 index was linked to a lower adolescent ADHD reporting rate (OR = 0.977, 95% CI: 0.954-1.000, p = 0.048). Subgroup analysis showed that higher HEI-2020 was significantly linked to lower ADHD reporting rates when maternal age of a mother at pregnancy was < 25 or ≥ 35 years or when the child's birth weight was not overweight (OR < 1, p < 0.05), with no nonlinear relationship detected. Joint association analysis revealed that higher HEI-2020 score was significantly associated with lower ADHD reporting rates in women with maternal age at pregnancy< 25 (OR = 0.515, 95% CI: 0.310-0.851, p = 0.012). Across all HEI-2020 levels, adolescents born to non-smoking mothers had significantly lower ADHD rates than those born to smoking mothers (OR < 1, p < 0.05). A higher HEI-2020 diet was associated with lower ADHD reporting rates, whereas maternal smoking during pregnancy correlated with higher rates. Improving adolescent diet and promoting healthy pregnancy behaviors are recommended for better prevention.