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Association between preeclampsia and attention‐deficit hyperactivity disorder: a population‐based and sibling‐matched cohort study
Author(s) -
Maher G. M.,
Dalman C.,
O’Keeffe G. W.,
Kearney P. M.,
McCarthy F. P.,
Kenny L. C.,
Khashan A. S.
Publication year - 2020
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.13162
Subject(s) - preeclampsia , sibling , medicine , proportional hazards model , confounding , attention deficit hyperactivity disorder , cohort study , population , cohort , pregnancy , hazard ratio , pediatrics , obstetrics , psychiatry , psychology , confidence interval , developmental psychology , genetics , environmental health , biology
Objective To examine the association between preeclampsia and attention‐deficit hyperactivity disorder (ADHD), using a large Swedish‐based registry cohort. Methods This study comprised 2 047 619 children, with 114 934 (5.6%) cases of ADHD. Preeclampsia was based on two alternate definitions: (i) preeclampsia (using ICD‐9/ICD‐10) and (ii) preeclampsia and small for gestational age (SGA) combined. ADHD was determined in one of two ways: (i) if a diagnosis of ADHD was present in the National Patient Register or (ii) if an individual was in receipt of ADHD medication in the Prescribed Drug Register. Multivariate Cox proportional hazards regression analysis allowed adjustment for several perinatal/sociodemographic factors. Sibling‐matched analysis further controlled for shared genetic and familial confounding. Results In the adjusted Cox model, preeclampsia was associated with an increase in likelihood of ADHD (HR: 1.15, 95% CI: 1.12, 1.19). The HR for preeclampsia and those born SGA was 1.43 (95% CI: 1.31, 1.55) in the adjusted model, compared to those unexposed to preeclampsia/SGA. The sibling‐matched analysis did not materially change these associations (HR: 1.13, 95% CI: 1.05, 1.22) and 1.55 (95% CI: 1.28, 1.88). Conclusions Exposure to preeclampsia or preeclampsia/SGA was associated with ADHD, independent of genetic/familial factors shared by siblings. However, it is important to note that sibling‐matched analysis can only adjust for factors that are constant between pregnancies; therefore, residual confounding cannot be ruled out. Further research is needed to explore modifiable risk factors and identify those most‐at‐risk babies following delivery.