Moms with Diabetes and Low Income May Lead to Child's ADHD

Maternal diabetes during pregnancy and/or economic status may predict a child's risk for attention-deficit/hyperactivity disorder (ADHD), results of a population-based study showed.

According to Jochen Schmitt, MD, of the Technical University Dresden in Germany, and Marcel Romanos, MD, of the University Hospital of Würzburg in Germany, low socioeconomic position and gestational diabetes mellitus were risk factors for childhood ADHD (adjusted odds ratio 2.04, 95% CI 1.56 to 2.68 and aOR 1.91, 95% CI 1.21 to 3.01, respectively),

However, fully breastfeeding the child offered some protective effect against ADHD (aOR 0.83, 95% CI 0.69 to 0.996), the authors reported in a research letter.

Earlier research suggested that the combination of maternal gestational diabetes mellitus and low socioeconomic position was a strong risk factor for childhood ADHD, but the study had a relative small sample size (Arch Pediatr Adolesc Med 2012; 166: 337-343).

"We aimed to replicate the findings in a large population-based sample," the authors explained.

They analyzed any associations between lifetime diagnosis of ADHD and maternal factors, including alcohol consumption during pregnancy, perinatal health problems, breastfeeding, and atopic eczema, in 11,222 children and their mothers.

Socioeconomic status was measured by parental education, professional status, and household income. ADHD diagnosis was based on criteria in the International Statistical Classification of Diseases, 10th Revision, which is virtually equivalent to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), the authors wrote.

Data was collected through the German Health Interview and Examination Survey for Children and Adolescents, which is a nationally representative survey of children ages 0 to 17 years. The survey also collected data on maternal age, sex, and environmental exposures during the perinatal period.

The mean participant age was 9.9 years and half were female. The prevalence of ADHD was 4.9% while the prevalence of gestational diabetes was 2.3%. The prevalence of low socioeconomic status was 25.5%.

In addition to an association between poverty or gestational diabetes, the authors found that mothers who had both had an additive risk (observed OR 3.68).

In a multivariable analysis, the authors found other maternal factors to be significantly associated with the child's development of ADHD:

• Middle class status (aOR 1.57, 95% CI 1.23 to 2.00)
• Smoking during pregnancy (aOR 1.48, 95% CI 1.19 to 1.84)
• Perinatal health problems (aOR 1.69, 95% CI 1.40 to 2.03)
• Atopic eczema (aOR 1.62, 95% CI 1.30 to 2.02)

The authors concluded that mothers who altered these environmental risks "by evidence-based prevention programs may help to decrease the burden of ADHD."

Practice Pearls:

• Note that fully breastfeeding the child offered some protective effect against ADHD.
• Maternal diabetes during pregnancy and/or economic status may predict a child's risk for attention-deficit/hyperactivity disorder (ADHD).

Schmitt J, Romanos M "Prenatal and perinatal risk factors for attention-deficit/hyperactivity disorder" Arch Pediatr Adolesc Med 2012: DOI: 10.1001/archpediatrics.2012.1078