title: Pre-conceptual and prenatal supplementary folic acid and multivitamin intake, behavioral problems, and hyperkinetic disorders: A study based on the Danish National Birth Cohort (DNBC).
abstract: OBJECTIVE
  To evaluate whether early folic acid or multivitamin supplementation during pregnancy prevents diagnosis of hyperkinetic disorders (HKD), treatment for attention deficit hyperactivity disorder (ADHD), and ADHD-like behaviors reported by parents participating in the DNBC for children at age 7.
  
  
  METHODS
  HKD diagnosis and ADHD medication use data were obtained from the Danish National Hospital, Central Psychiatric and Pharmaceutical registers. We estimated hazard ratios (HRs) for HKD diagnosis and ADHD medication use and risk ratios (RRs) for parent-reported ADHD behavior collected with the Strength and Difficulties Questionnaire (SDQ), comparing children whose mothers took folic acid or multivitamin supplements early in pregnancy defined as starting periconceptionally (4 weeks prior to their last menstrual period (LMP)) through 8 weeks after their LMP (4-8 weeks), to children whose mothers indicated no supplement use for the same entire period.
  
  
  RESULTS
  We identified 384 children (1.1%) with a hospital diagnosis for HKD and 642 children (1.8%) treated with ADHD medication. We found no association between risk of HKD diagnosis or intake of ADHD medication and early maternal folic acid use. However, early multivitamin use was associated with an approximately 30% reduction in risk for HKD diagnosis (aHR: 0.70, 95% CI: 0.52-0.96) and 21% reduction in treatment with ADHD medication (aHR: 0.79, 95% CI: 0.62-0.98). We observed a reduced risk in parent-reported ADHD behaviors, but these results were attenuated after adjustment.
  
  
  CONCLUSIONS
  Our data suggest that multivitamin use in early pregnancy may reduce risk for HKD diagnosis and treatment for ADHD in the offspring.
authors.affiliation: a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA.
authors.forename: Jasveer
authors.identifier: http://orcid.org/0000-0002-9053-0413
authors.initials: J
authors.lastname: Virk
authors.affiliation: a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA.
authors.forename: Zeyan
authors.initials: Z
authors.lastname: Liew
authors.affiliation: b Department of Public Health, Institute of Epidemiology and Social Medicine , Aarhus University , Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
authors.affiliation: c Department of Obstetrics and Gynecology , Odense University Hospital , Denmark.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Nohr
authors.affiliation: d Department of Obstetrics & Gynecology , University of Pittsburgh , PA , USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Catov
authors.affiliation: a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA.
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000097:blood / Q000517:prevention & control*; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D018977:Micronutrients; D005492:Folic Acid
keywords: ADHD; Nutrition; Perinatal; Protective factors