Attention-deficit/hyperactivity disorder and smoking habits in pregnant women

PLoS One. 2020 Jun 18;15(6):e0234561. doi: 10.1371/journal.pone.0234561. eCollection 2020.

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) has been associated with an increased risk of tobacco smoking, and more difficulties with smoking cessation compared to non-ADHD individuals. Women with ADHD may therefore show elevated rates of smoking during pregnancy.

Aims: To examine the association between ADHD and smoking habits among pregnant women in Sweden and Norway.

Methods: Women pregnant for the first time were identified in Sweden (n = 622,037), and Norway (n = 293,383), of which 1.2% (n = 7,444), and 1.7% (n = 4,951) were defined as having ADHD, respectively. Data on smoking habits were collected early and late in pregnancy.

Results: In Sweden, ADHD was associated with an increased risk of smoking early in pregnancy, adjusted risk ratio (adjRR) 2.69 (95% confidence interval, 2.58-2.81), and late in pregnancy, adjRR 2.95 (2.80-3.10). Similar findings were observed in the Norwegian data, early in pregnancy, adjRR 2.31 (2.21-2.40), and late in pregnancy, adjRR 2.56 (2.42-2.70). Women with ADHD were more likely to continue smoking during pregnancy, compared to women without ADHD, both in Sweden adjRR 1.13 (1.10-1.17), and in Norway, adjRR 1.16 (1.12-1.20). Having a sibling diagnosed with ADHD was associated with an increased risk of smoking early and late in pregnancy, in both Sweden and Norway.

Conclusions: Women with ADHD are considerably more likely to smoke early and late in (their first) pregnancy and are less likely to stop smoking between the two time points. Smoking, early and late in pregnancy, co-aggregates in families with ADHD. Smoking prevention and intervention programs should be targeted towards women with ADHD, specifically during their childbearing years, to ensure better mother and child outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Cohort Studies
  • Female
  • Humans
  • Norway / epidemiology
  • Pregnancy
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Third
  • Risk Factors
  • Siblings
  • Smoking Cessation
  • Sweden / epidemiology
  • Tobacco Smoking / epidemiology*

Grants and funding

Henrik Larsson acknowledges financial support from the Swedish Research Council (2018-02599) and the Swedish Brain Foundation (FO2018-0273). The project has also received funding from the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework Grant no. 340-2013-5867, and the European Union’s Horizon 2020 research and innovation programme (Eat2beNICe) under grant agreement No 728018. Stiftelsen Kristian Gerhard Jebsen (SKGJ-MED-02), the Western Norway Regional Health Authorities (Helse Vest), the University of Bergen, The Norwegian research network for ADHD, and the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 667302 (CoCA). Catherine Tuvblad acknowledges financial support from the Swedish Research Council (2018-01041). Mina A. Rosenqvist reports a grant from the Swedish Research Council (2018-02119). Tor-Arne Hegvik acknowledges financial support from Dr. Nils Henrichsen og hustru Anna Henrichsens legat. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.