title: Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren.
abstract: OBJECTIVE
  Previous studies have demonstrated an increased risk for attention-deficit/hyperactivity disorder (ADHD) in follow-up studies of preterm survivors from NICUs. In this study we analyzed the effect of moderate as well as extreme preterm birth on the risk for ADHD in school age, taking into account genetic, perinatal, and socioeconomic confounders.
  
  
  METHODS
  Register study in a Swedish national cohort of 1 180 616 children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Logistic regression was used to test hypotheses. A within-mother-between-pregnancy design was used to estimate the importance of genetic confounding in a subpopulation of offspring (N = 34 334) of mothers who had given birth to preterm (≤34 weeks) as well as term infants.
  
  
  RESULTS
  There was a stepwise increase in odds ratios for ADHD medication with increasing degree of immaturity at birth; from 2.1 (1.4-2.7) for 23 to 28 weeks' gestation, to 1.6 (1.4-1.7) for 29 to 32 weeks', 1.4 (1.2-1.7) for 33 to 34 weeks', 1.3 (1.1-1.4) for 35 to 36 weeks', and 1.1 (1.1-1.2) for 37 to 38 weeks' gestation compared with infants born at 39 to 41 weeks' gestation in the fully adjusted model. The odds ratios for the within-mother-between-pregnancy analysis were very similar. Low maternal education increased the effect of moderate, but not extreme, preterm birth on the risk for ADHD.
  
  
  CONCLUSIONS
  Preterm and early term birth increases the risk of ADHD by degree of immaturity. This main effect is not explained by genetic, perinatal, or socioeconomic confounding, but socioeconomic context modifies the risk of ADHD in moderately preterm births.
authors.affiliation: Centre for Health Equity Studies, Karolinska Insitutet/Stockholm University, 106 91 Stockholm, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Lindström
authors.forename: Frank
authors.initials: F
authors.lastname: Lindblad
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010287:Parent-Child Relations; D018743:Perinatal Care; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D017741:Survivors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult