Maternal psychosocial stress and children’s ADHD diagnosis: a prospective birth cohort study

<b>Objective:</b> Examine the association of mothers’ psychosocial stressors before and during pregnancy with their children’s diagnosis of attention deficit hyperactivity disorder (ADHD). <b>Methods:</b> This study included 2140 mother–child pairs who had at least one postnatal pediatric visit at the Boston Medical Center between 2003 and 2015. Child ADHD was determined via <i>International Classification of Diseases, Ninth Revision</i> (ICD-9) codes documented in electronic medical records. Latent factors of maternal stress and social support and measures of the physical home environment and psychosocial adversities were constructed using exploratory factor analysis. The association between the latent factors and child ADHD diagnosis was examined using multiple logistic regression, controlling for known risk factors for ADHD. <b>Results:</b> Children were 1.45 (95% CI: 1.06, 1.99) and 3.03 (95% CI: 2.19, 4.20) times more likely to receive an ADHD diagnosis if their mother experienced a major stressful event during pregnancy or reported a high level of perceived stress, respectively. The number of family adversities increases the risk of ADHD diagnosis [second quartile: OR = 1.90; CI (1.31, 2.77); third quartile: OR = 1.96 CI (1.34, 2.88); fourth quartile: OR = 2.89 CI (2.01, 4.16)] compared to first quartile. <b>Conclusions:</b> In this prospective, predominantly urban, low-income, minority birth cohort, mothers’ psychosocial stress before and during pregnancy appears to be an independent risk factor for the development of ADHD in their children.

**研究目的**：探讨母亲孕前及孕期的社会心理应激因素与子女罹患注意缺陷多动障碍（ADHD）的关联。
**研究方法**：本研究纳入2003年至2015年间于波士顿医学中心至少完成1次产后儿科随访的2140对母婴对。儿童注意缺陷多动障碍的确诊依据电子病历中记录的《国际疾病分类第9版》（International Classification of Diseases, Ninth Revision, ICD-9）编码。本研究采用探索性因子分析构建母亲应激与社会支持的潜在因子，以及家庭物理环境与社会心理逆境的测量指标；通过多因素logistic回归分析上述潜在因子与儿童注意缺陷多动障碍诊断的关联，并控制已知的ADHD危险因素。
**研究结果**：结果显示，若母亲在孕期经历重大应激事件或报告较高水平的感知压力，则其子女被诊断为注意缺陷多动障碍的风险分别为对照组的1.45倍（95% CI: 1.06, 1.99）和3.03倍（95% CI: 2.19, 4.20）。与第一四分位数组相比，家庭逆境事件数量的增加会提升ADHD诊断风险：第二四分位数组：优势比（odds ratio, OR）=1.90，95% CI (1.31, 2.77)；第三四分位数组：OR=1.96，95% CI (1.34, 2.88)；第四四分位数组：OR=2.89，95% CI (2.01, 4.16)。
**研究结论**：在这项以城市低收入少数族裔出生队列为主的前瞻性研究中，母亲孕前及孕期的社会心理应激似乎是子女罹患注意缺陷多动障碍的独立危险因素。