Epidemiology. 2018 Sep;29(5):618-626. doi: 10.1097/EDE.0000000000000874.
Forns J1,2,3, Sunyer J1,2,3,4, Garcia-Esteban R1,3,4, Porta D5, Ghassabian A6, Giorgis-Allemand L7,8, Gong T9, Gehring U10, Sørensen M11, Standl M12, Sugiri D13, Almqvist C9,14, Andiarena A15,16, Badaloní C5, Beelen R10, Berdel D17, Cesaroni G5, Charles MA18,19, Eriksen KT11, Estarlich M3,20, Fernandez MF3,21,22, Forhan A18,19, Jaddoe VWV23,24,25, Korek M26, Lichtenstein P9, Lertxundi A16,27, Lopez-Espinosa MJ3,20, Markevych I12,28, de Nazelle A29, Raaschou-Nielsen O11,30, Nieuwenhuijsen M1,2,3, Pérez-Lobato R21,22, Philippat C7,8, Slama R7,8, Tiesler CMT12,31, Verhulst FC6, von Berg A17, Vrijkotte T32, Nybo Andersen AM33, Heude B18,19, Krämer U13, Heinrich J12,28, Tiemeier H6, Forastiere F5, Pershagen G26,34, Brunekreef B10,35, Guxens M1,3,4,6.
Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain.
Department of Epidemiology Lazio Regional Health Service, ASL Roma 1, Italy.
Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, The Netherlands.
Univ. Grenoble Alpes, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France.
Inserm U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France.
Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
Danish Cancer Society Research Center, Strandboulevarden, Denmark.
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Germany.
Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Faculty of Psychology, Basque Country University UPV/EHU, San Sebastian, Spain.
BioDonostia Health Research Institute, San Sebastian, Basque Country, Spain.
Research Institute, Department of Pediatrics, Marien-Hospital,Wesel, Germany.
INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and disease (ORCHAD) Team, Villejuif, France.
Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.
Universidad de Granada, Granada, Spain.
Generation R Study Group, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
Faculty of Medicine, University of the Basque Country, Leioa, Basque Country, Spain.
Institute for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
Centre for Environmental Policy, Imperial College London, UK.
Department of Public Health, Academic Medical Center, UVA, Amsterdam, The Netherlands.
Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.
Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.
We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.
There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.