Joan Forns1,2,3, Jordi Sunyer1,2,3,4, Raquel Garcia-Esteban1,3,4, Daniela Porta5, Akhgar Ghassabian6, Lise Giorgis-Allemand7,8, Tong Gong9, Ulrike Gehring10, Mette Sørensen11, Marie Standl12, Dorothee Sugiri13, Catarina Almqvist9,14, Ainara Andiarena15,16, Chiara Badaloní5, Rob Beelen10, Dietrich Berdel17, Giulia Cesaroni5, Marie-Aline Charles18,19, Kirsten Thorup Eriksen11, Marisa Estarlich3,20, Mariana F Fernandez3,21,22, Anne Forhan18,19, Vincent W V Jaddoe23,24,25, Michal Korek26, Paul Lichtenstein9, Aitana Lertxundi16,27, Maria-Jose Lopez-Espinosa3,20, Iana Markevych12,28, Audrey de Nazelle29, Ole Raaschou-Nielsen11,30, Mark Nieuwenhuijsen1,2,3, Rocío Pérez-Lobato21,22, Claire Philippat7,8, Rémy Slama7,8, Carla M T Tiesler12,31, Frank C Verhulst6, Andrea von Berg17, Tanja Vrijkotte32, Anne-Marie Nybo Andersen33, Barbara Heude18,19, Ursula Krämer13, Joachim Heinrich12,28, Henning Tiemeier6, Francesco Forastiere5, Göran Pershagen26,34, Bert Brunekreef10,35, Mònica Guxens1,3,4,6. 1. From the ISGlobal, Barcelona, Spain. 2. Hospital del Mar Research Institute, Barcelona, Spain. 3. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain. 4. Pompeu Fabra University, Barcelona, Spain. 5. Department of Epidemiology Lazio Regional Health Service, ASL Roma 1, Italy. 6. Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, The Netherlands. 7. Univ. Grenoble Alpes, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France. 8. Inserm U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France. 9. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 10. Institute for Risk Assessment Sciences, Utrecht University, The Netherlands. 11. Danish Cancer Society Research Center, Strandboulevarden, Denmark. 12. Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Germany. 13. IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany. 14. Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. 15. Faculty of Psychology, Basque Country University UPV/EHU, San Sebastian, Spain. 16. BioDonostia Health Research Institute, San Sebastian, Basque Country, Spain. 17. Research Institute, Department of Pediatrics, Marien-Hospital,Wesel, Germany. 18. INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and disease (ORCHAD) Team, Villejuif, France. 19. Paris Descartes University, Paris, France. 20. Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain. 21. Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain. 22. Universidad de Granada, Granada, Spain. 23. Generation R Study Group, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 24. Department of Epidemiology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 25. Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 26. Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. 27. Faculty of Medicine, University of the Basque Country, Leioa, Basque Country, Spain. 28. Institute for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany. 29. Centre for Environmental Policy, Imperial College London, UK. 30. Department of Environmental Science, Aarhus University, Roskilde, Denmark. 31. Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Division of Metabolic Diseases and Nutritional Medicine, Munich, Germany. 32. Department of Public Health, Academic Medical Center, UVA, Amsterdam, The Netherlands. 33. Department of Public Health, University of Copenhagen. 34. Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden. 35. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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