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Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population-based cohort study

European Journal of Epidemiology volume 35, pages 795–805 (2020)Cite this article

Abstract

Although maternal use of hormones has been suspected of increasing the risk for childhood attention-deficit/hyperactivity disorder (ADHD), no study has examined hormonal contraception use in this context. We examined the association between maternal hormonal contraception use before or during pregnancy and ADHD risk in children. This nationwide population-based cohort study included 1,056,846 children born in Denmark between 1998 and 2014. Prescriptions for hormonal contraceptives redeemed by the mother was categorized as: no use, previous use (> 3 months before pregnancy), and recent use (≤ 3 months before or during pregnancy). Children were followed for ADHD, from birth until 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During 9,819,565 person-years of follow-up (median: 9.2), ADHD was diagnosed or a prescription for ADHD medication redeemed for 23,380 children (2.2%). The adjusted HR for ADHD was higher in children of mothers who had previously (HR 1.23; 95% CI 1.18–1.28) or recently (HR 1.30; 95% CI 1.24–1.37) used hormonal contraception than in those of mothers with no use. The highest estimates were seen for use of non-oral progestin products with HRs of 1.90 (95% CI 1.59–2.26) for previous use, 2.23 (95% CI 1.96–2.54) for recent use, and 3.10 (95% CI 1.62–5.91) for use during pregnancy. Maternal use of hormonal contraception was associated with an increased risk for ADHD in the offspring; more pronounced for non-oral progestin-only than other products.

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Funding

No specific funding was obtained for the project which was supported by internal funding from the Unit Virus, Lifestyle and Genes at the Danish Cancer Society Research Center.

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Authors and Affiliations

  1. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark

    Caroline H. Hemmingsen, Susanne K. Kjaer, Andrea H. Jezek, Lina S. Mørch & Marie Hargreave

  2. Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark

    Susanne K. Kjaer

  3. Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands

    Frank C. Verhulst

  4. Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Frank C. Verhulst & Anne Katrine Pagsberg

  5. Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Mads Kamper-Jørgensen

  6. Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark

    Lina S. Mørch

Authors
  1. Caroline H. Hemmingsen
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  2. Susanne K. Kjaer
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  3. Andrea H. Jezek
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  4. Frank C. Verhulst
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  5. Anne Katrine Pagsberg
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  6. Mads Kamper-Jørgensen
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  7. Lina S. Mørch
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  8. Marie Hargreave
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Contributions

MH, LSM and SKK initiated the study. MH, LSM, SKK and CHH designed the study. CHH and MH analysed the data; they are guarantors for the paper. CHH wrote the initial manuscript and all authors interpreted the results and revised the manuscript critically. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Corresponding author

Correspondence to Marie Hargreave.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Danish Data Protection Agency (Registration Number 2017-41-5221). As this study is based solely on data from electronic databases and registries, informed consents are not required.

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Hemmingsen, C.H., Kjaer, S.K., Jezek, A.H. et al. Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population-based cohort study. Eur J Epidemiol 35, 795–805 (2020). https://doi.org/10.1007/s10654-020-00673-w

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  • DOI: https://doi.org/10.1007/s10654-020-00673-w

Keywords

  • Attention-deficit/hyperactivity disorder
  • ADHD
  • Hormonal contraception
  • Cohort study