title: Prenatal smoking exposure and neuropsychiatric comorbidity of ADHD: a finnish nationwide population-based cohort study.
abstract: Prenatal smoking exposure has been associated with attention-deficit/hyperactivity disorder (ADHD). ADHD is commonly associated with a wide spectrum of psychiatric comorbidity. The association between smoking and neuropsychiatric comorbidity of ADHD has remained understudied. The aim of this study is to examine the association between prenatal exposure to maternal smoking and offspring ADHD, and test whether the smoking-ADHD associations are stronger when ADHD is accompanied by other lifetime neuropsychiatric comorbidities.
  
  
  
  The study is based on a nested case-control design and includes all Finnish singletons born between 1991 and 2005 and diagnosed with ADHD by 2011 (n = 10,132), matched with four controls (n = 38,811) on date of birth, sex and residence in Finland.
  
  
  
  The risk for ADHD with or without comorbidity was significantly increased among offspring exposed to maternal smoking on adjusting for potential confounders (OR = 1.75, CI 95 % = 1.65-1.86). Compared to the only ADHD cases, subjects with comorbid conduct disorder or oppositional defiant disorder had a significantly stronger association with smoking exposure (OR = 1.80, CI 95 % = 1.55-2.11).
  
  
  
  Prenatal smoking represents an important risk factor for the ADHD comorbid with CD/ODD. Further research on the association between prenatal smoking exposure and neuropsychiatric comorbidity of ADHD is needed considering the increased risk among these subjects of an overall poor health outcome as compared to only ADHD. In particular, studies utilizing biomarkers or including subjects with neuropsychiatric conditions with and without comorbid ADHD are needed.
authors: Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Lastenpsykiatrian tutkimuskeskus, 20014, Turku, Finland. petteri.joelsson@utu.fi.
authors: Petteri
authors: P
authors: Joelsson
authors: Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Lastenpsykiatrian tutkimuskeskus, 20014, Turku, Finland.
authors: Roshan
authors: R
authors: Chudal
authors: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.|Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
authors: Ardesheer
authors: A
authors: Talati
authors: Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Lastenpsykiatrian tutkimuskeskus, 20014, Turku, Finland.
authors: Auli
authors: A
authors: Suominen
authors: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.|Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA.|Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
authors: Alan S
authors: AS
authors: Brown
authors: Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Lastenpsykiatrian tutkimuskeskus, 20014, Turku, Finland.|Department of Child Psychiatry, Turku University Hospital, Turku, Finland.
authors: Andre
authors: A
authors: Sourander
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008425:Maternal Behavior; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000523:psychology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult
keywords: ADHD; Conduct disorder; Oppositional defiant disorder; Risk factor; Smoking; Tobacco