European Child & Adolescent Psychiatry

, Volume 24, Issue 8, pp 919–929 | Cite as

Maternal smoking and offspring inattention and hyperactivity: results from a cross-national European survey

  • Viviane Kovess
  • Katherine M. KeyesEmail author
  • Ava Hamilton
  • Ondine Pez
  • Adina Bitfoi
  • Ceren Koç
  • Dietmar Goelitz
  • Rowella Kuijpers
  • Sigita Lesinskiene
  • Zlatka Mihova
  • Roy Otten
  • C. Fermanian
  • Daniel J. Pilowsky
  • Ezra Susser
Original Contribution


In utero exposure to tobacco smoke is associated with adverse neonatal outcomes; the association with later childhood mental health outcomes remains controversial. We used a strategy involving comparison of maternal and paternal smoking reports in a sample pooling data from six diverse European countries. Data were drawn from mother (N = 4,517) and teacher (N = 4,611) reported attention deficit and hyperactivity disorder (ADHD) symptoms in school children aged 6–11 in Turkey, Romania, Bulgaria, Lithuania, Germany, and the Netherlands, surveyed in 2010. Mothers report on self and husband’s smoking patterns during the pregnancy period. Logistic regression used with control covariates including demographics, maternal distress, live births, region, and post-pregnancy smoking. In unadjusted models, maternal prenatal smoking was associated with probable ADHD based on mother [Odds Ratio (OR) = 1.82, 95 % Confidence Interval (CI) 1.45–2.29], teacher (OR = 1.69, 95 % CI 1.33–2.14) and mother plus teacher (OR = 1.49, 95 % CI 1.03–2.17) report. Paternal prenatal smoking was similarly associated with probable ADHD in unadjusted models. When controlled for relevant confounders, maternal prenatal smoking remained a risk factor for offspring probable ADHD based on mother report (OR = 1.44, 95 % CI 1.06–1.96), whereas the effect of paternal prenatal smoking diminished (e.g., mother report: OR = 1.17, 95 % CI 0.92–1.49). Drawing on data from a diverse set of countries across Europe, we document that the association between maternal smoking and offspring ADHD is stronger than that of paternal smoking during the pregnancy period and offspring ADHD. To the extent that confounding is shared between parents, these results reflect a potential intrauterine influence of smoking on ADHD in children.


ADHD Hyperactivity Smoking Prenatal smoking In utero tobacco 



Attention deficit hyperactivity disorder


Strengths and difficulties questionnaire


Confidence interval



This project had been financed by the European Union, grant number 2006336.

Conflict of interest

The authors report no conflicts of interest.

Supplementary material

787_2014_641_MOESM1_ESM.doc (204 kb)
Supplementary material 1 (DOC 203 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Viviane Kovess
    • 1
  • Katherine M. Keyes
    • 2
    • 11
    Email author
  • Ava Hamilton
    • 2
  • Ondine Pez
    • 1
  • Adina Bitfoi
    • 3
  • Ceren Koç
    • 4
  • Dietmar Goelitz
    • 5
  • Rowella Kuijpers
    • 6
  • Sigita Lesinskiene
    • 7
  • Zlatka Mihova
    • 8
  • Roy Otten
    • 6
  • C. Fermanian
    • 1
  • Daniel J. Pilowsky
    • 2
  • Ezra Susser
    • 2
    • 9
    • 10
  1. 1.EHESP Rennes, Sorbonne Paris Cite, EA 4069Paris Descartes UniversityParisFrance
  2. 2.Departments of Epidemiology and PsychiatryColumbia University, and New York State Psychiatric InstituteNew YorkUSA
  3. 3.The Romanian League for Mental HealthBucharestRomania
  4. 4.Yeniden Health and Education SocietyIstanbulTurkey
  5. 5.Center for Applied Sciences of HealthLeuphana University of LuneburgLuneburgGermany
  6. 6.Behavioral Science InstituteRadboud University NijmegenNijmegenThe Netherlands
  7. 7.Clinic of Psychiatry, Faculty of MedicineUniversity of VilniusVilniusLithuania
  8. 8.New Bulgarian UniversitySofiaBulgaria
  9. 9.New York State Psychiatric Institute, New YorkNew YorkUSA
  10. 10.Department of PsychiatryUniversity of GöttingenGöttingenGermany
  11. 11.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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