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Maternal asthma and asthma exacerbation during pregnancy and attention-deficit/hyperactivity disorder in offspring: a population-based cohort study

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Abstract

The link between inflammatory disorders, such as asthma, and attention deficit hyperactivity disorder (ADHD) is attracting increasing attention but few studies have examined cross-generational associations. We sought to examine associations of maternal asthma and asthma exacerbation during pregnancy, as well as paternal asthma, with the risk of ADHD in children. This population-based cohort study used data from the Taiwan National Health Insurance Research Database from 2004 to 2017. Cox regression models compared the risk of ADHD in children of parents with and without asthma, adjusting for parental sociodemographic, physical, and mental health conditions, as well as the child’s birth weight, and number of births. A sibling control approach was employed to compensate for unmeasured confounders of asthma exacerbation during pregnancy. In the fully adjusted models, maternal and paternal asthma were both significantly associated with an increased risk of ADHD in offspring, with hazard ratios (HRs) of 1.36 (1.31-1.40) and 1.10 (1.05-1.14), respectively. Acute asthma exacerbation during pregnancy was not associated with the risk of further offspring ADHD (adjusted HR 1.00, 95% CI: 0.75-1.34). Both maternal and paternal asthma are associated with an increased risk of ADHD in offspring. The risk was higher from maternal asthma. However, no such association was found with maternal asthma exacerbation during pregnancy of sibling comparison.

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Funding

This work was supported by (i) the NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; (ii) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust; (iii) UKRI – Medical Research Council through the DATAMIND HDR UK Mental Health Data Hub (Grant Numbers: MR/W014386); (iv) the UK Prevention Research Partnership Violence, Health and Society ( Grant Numbers: MR-VO49879/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities.

Author information

Author notes

  1. Vincent Chin-Hung Chen contributed equally to first author.

Authors and Affiliations

  1. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Yi-Feng Ho & Tsai-Ching Hsu

  2. Taso-Tun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan

    Yi-Feng Ho

  3. Department of Healthcare Administration, Asia University, Taichung, Taiwan

    Yi-Lung Chen

  4. Department of Psychology, Asia University, Taichung, Taiwan

    Yi-Lung Chen

  5. King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK

    Robert Stewart

  6. South London and Maudsley NHS Foundation Trust, London, UK

    Robert Stewart

  7. Immunology Center, Chung Shan Medical University, Taichung, Taiwan

    Tsai-Ching Hsu

  8. Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan

    Tsai-Ching Hsu

  9. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Vincent Chin-Hung Chen

  10. Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

    Vincent Chin-Hung Chen

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  1. Yi-Feng Ho
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Contributions

Yi-Feng Ho, Vincent Chin-Hung Chen and Tsai-Ching Hsu contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yi-Lung Chen. The first draft of the manuscript was written by Yi-Feng Ho and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yi-Lung Chen or Tsai-Ching Hsu.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Chang Gung Medical Foundation (Date2020.05.25/No.202000880B0).

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Ho, YF., Chen, YL., Stewart, R. et al. Maternal asthma and asthma exacerbation during pregnancy and attention-deficit/hyperactivity disorder in offspring: a population-based cohort study. Eur Child Adolesc Psychiatry (2024). https://doi.org/10.1007/s00787-024-02426-6

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