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In utero exposure to oxygen deprivation increased risk for ADHD
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Children who experienced in utero exposure to ischemic-hypoxic conditions were significantly more likely to develop attention-deficit/hyperactivity disorder later in life compared with unexposed children.
Although prior studies have indicated that genetic, environmental, and prenatal and postnatal factors could be associated with altered neurodevelopment, there is limited data on the association between ischemic-hypoxic conditions and the development of ADHD in children.
“Emerging evidence suggests that ischemic-hypoxic conditions (IHCs) in pregnancy resulting from acute and chronic perinatal events have adverse consequences on fetal brain development that are not apparent at birth,” Darios Getahun, MD, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation, and colleagues wrote. “Although previous studies noted that in utero exposure to IHC is associated with fetal brain injury, the role of IHCs in the development of ADHD is unexplored.”
To examine the connection between IHCs and ADHD, Getahun and colleagues used population-based data from children aged 5 to 11 years born in Kaiser Permanente Southern California hospitals between 1995 and 2010 (n=308,634). For each patient in the cohort, the researchers compiled data from the perinatal service system, hospital inpatient records, outpatient physician encounters, and laboratory and pharmacy records.
Children included in the study cohort were diagnosed with ADHD and received at least two prescriptions specific to ADHD during the follow-up period. For each case, five control children were matched by age at diagnosis.
Additional information extracted from perinatal service system records included maternal sociodemographic and behavioral characteristics, perinatal complications, and child race/ ethnicity, age and gender.
According to study findings, the researchers observed that among children in the study cohort, 13,613 (4.3%) had a diagnosis of ADHD.
Compared with the control cohort, children with ADHD were found to be more likely to be male and of white or black race/ethnicity. These children were also more likely to be exposed to IHCs. When stratified by gestational age, children born at 28 to 33 weeks of gestation (OR=1.6; 95% CI, 1.2-2.1), 34 to 36 weeks (OR 1.2; 95% CI, 1.1-1.3) and 37 to 42 weeks (OR 1.1; 95% CI, 1.0-1.2) were more likely to be exposed to IHCs compared with controls. IHC was associated with increased odds of ADHD across all race/ethnicity groups.
“The findings of this study suggest that IHCs, especially birth asphyxia, neonatal [respiratory distress syndrome] and preeclampsia, are associated with ADHD in childhood even after accounting for gestational age and other potential risk factors,” Getahun and colleagues wrote. “This association was strongest in preterm births. This suggests that events in pregnancy contribute to the etiology of this condition over and above the well-known familial/genetic influences.”
Disclosure: The researchers reported no relevant financial disclosures.
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