Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

Joan Forns; Jordi Sunyer; Raquel Garcia-Esteban; Daniela Porta; Akhgar Ghassabian; Lise Giorgis-Allemand; Tong Gong; Ulrike Gehring; Mette Sørensen; Marie Standl; Dorothee Sugiri; Catarina Almqvist; Ainara Andiarena; Chiara Badaloní; Rob Beelen; Dietrich Berdel; Giulia Cesaroni; Marie-Aline Charles; Kirsten Thorup Eriksen; Marisa Estarlich; Mariana F Fernandez; Anne Forhan; Vincent W V Jaddoe; Michal Korek; Paul Lichtenstein; Aitana Lertxundi; Maria-Jose Lopez-Espinosa; Iana Markevych; Audrey de Nazelle; Ole Raaschou-Nielsen; Mark Nieuwenhuijsen; Rocío Pérez-Lobato; Claire Philippat; Rémy Slama; Carla M T Tiesler; Frank C Verhulst; Andrea von Berg; Tanja Vrijkotte; Anne-Marie Nybo Andersen; Barbara Heude; Ursula Krämer; Joachim Heinrich; Henning Tiemeier; Francesco Forastiere; Göran Pershagen; Bert Brunekreef; Mònica Guxens

doi:10.1097/EDE.0000000000000874

Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

Joan Forns, Jordi Sunyer, Raquel Garcia-Esteban, Daniela Porta, Akhgar Ghassabian, Lise Giorgis-Allemand, Tong Gong, Ulrike Gehring, Mette Sørensen, Marie Standl, Dorothee Sugiri, Catarina Almqvist, Ainara Andiarena, Chiara Badaloní, Rob Beelen, Dietrich Berdel, Giulia Cesaroni, Marie-Aline Charles, Kirsten Thorup Eriksen, Marisa EstarlichMariana F Fernandez, Anne Forhan, Vincent W V Jaddoe, Michal Korek, Paul Lichtenstein, Aitana Lertxundi, Maria-Jose Lopez-Espinosa, Iana Markevych, Audrey de Nazelle, Ole Raaschou-Nielsen, Mark Nieuwenhuijsen, Rocío Pérez-Lobato, Claire Philippat, Rémy Slama, Carla M T Tiesler, Frank C Verhulst, Andrea von Berg, Tanja Vrijkotte, Anne-Marie Nybo Andersen, Barbara Heude, Ursula Krämer, Joachim Heinrich, Henning Tiemeier, Francesco Forastiere, Göran Pershagen, Bert Brunekreef, Mònica Guxens

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.

METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.

RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.

CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.

Original language	English
Pages (from-to)	618-626
Number of pages	9
Journal	Epidemiology
Volume	29
Issue number	5
DOIs	https://doi.org/10.1097/EDE.0000000000000874
Publication status	Published - Sept 2018

Keywords

attention deficit disorder with hyperactivity
child development
environmental pollution
longitudinal studies
meta-analysis
nitrogen oxides
particulate matter
prospective studies

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/EDE.0000000000000874

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Forns, J., Sunyer, J., Garcia-Esteban, R., Porta, D., Ghassabian, A., Giorgis-Allemand, L., Gong, T., Gehring, U., Sørensen, M., Standl, M., Sugiri, D., Almqvist, C., Andiarena, A., Badaloní, C., Beelen, R., Berdel, D., Cesaroni, G., Charles, M.-A., Eriksen, K. T., ... Guxens, M. (2018). Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe. Epidemiology, 29(5), 618-626. https://doi.org/10.1097/EDE.0000000000000874

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title = "Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe",

abstract = "BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95\% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95\% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.",

keywords = "attention deficit disorder with hyperactivity, child development, environmental pollution, longitudinal studies, meta-analysis, nitrogen oxides, particulate matter, prospective studies",

author = "Joan Forns and Jordi Sunyer and Raquel Garcia-Esteban and Daniela Porta and Akhgar Ghassabian and Lise Giorgis-Allemand and Tong Gong and Ulrike Gehring and Mette S{\o}rensen and Marie Standl and Dorothee Sugiri and Catarina Almqvist and Ainara Andiarena and Chiara Badalon{\'i} and Rob Beelen and Dietrich Berdel and Giulia Cesaroni and Marie-Aline Charles and Eriksen, \{Kirsten Thorup\} and Marisa Estarlich and Fernandez, \{Mariana F\} and Anne Forhan and Jaddoe, \{Vincent W V\} and Michal Korek and Paul Lichtenstein and Aitana Lertxundi and Maria-Jose Lopez-Espinosa and Iana Markevych and \{de Nazelle\}, Audrey and Ole Raaschou-Nielsen and Mark Nieuwenhuijsen and Roc{\'i}o P{\'e}rez-Lobato and Claire Philippat and R{\'e}my Slama and Tiesler, \{Carla M T\} and Verhulst, \{Frank C\} and \{von Berg\}, Andrea and Tanja Vrijkotte and \{Nybo Andersen\}, Anne-Marie and Barbara Heude and Ursula Kr{\"a}mer and Joachim Heinrich and Henning Tiemeier and Francesco Forastiere and G{\"o}ran Pershagen and Bert Brunekreef and M{\`o}nica Guxens",

year = "2018",

month = sep,

doi = "10.1097/EDE.0000000000000874",

language = "English",

volume = "29",

pages = "618--626",

journal = "Epidemiology",

issn = "1044-3983",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

Forns, J, Sunyer, J, Garcia-Esteban, R, Porta, D, Ghassabian, A, Giorgis-Allemand, L, Gong, T, Gehring, U, Sørensen, M, Standl, M, Sugiri, D, Almqvist, C, Andiarena, A, Badaloní, C, Beelen, R, Berdel, D, Cesaroni, G, Charles, M-A, Eriksen, KT, Estarlich, M, Fernandez, MF, Forhan, A, Jaddoe, VWV, Korek, M, Lichtenstein, P, Lertxundi, A, Lopez-Espinosa, M-J, Markevych, I, de Nazelle, A, Raaschou-Nielsen, O, Nieuwenhuijsen, M, Pérez-Lobato, R, Philippat, C, Slama, R, Tiesler, CMT, Verhulst, FC, von Berg, A, Vrijkotte, T, Nybo Andersen, A-M, Heude, B, Krämer, U, Heinrich, J, Tiemeier, H, Forastiere, F, Pershagen, G, Brunekreef, B & Guxens, M 2018, 'Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe', Epidemiology, vol. 29, no. 5, pp. 618-626. https://doi.org/10.1097/EDE.0000000000000874

TY - JOUR

T1 - Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

AU - Forns, Joan

AU - Sunyer, Jordi

AU - Garcia-Esteban, Raquel

AU - Porta, Daniela

AU - Ghassabian, Akhgar

AU - Giorgis-Allemand, Lise

AU - Gong, Tong

AU - Gehring, Ulrike

AU - Sørensen, Mette

AU - Standl, Marie

AU - Sugiri, Dorothee

AU - Almqvist, Catarina

AU - Andiarena, Ainara

AU - Badaloní, Chiara

AU - Beelen, Rob

AU - Berdel, Dietrich

AU - Cesaroni, Giulia

AU - Charles, Marie-Aline

AU - Eriksen, Kirsten Thorup

AU - Estarlich, Marisa

AU - Fernandez, Mariana F

AU - Forhan, Anne

AU - Jaddoe, Vincent W V

AU - Korek, Michal

AU - Lichtenstein, Paul

AU - Lertxundi, Aitana

AU - Lopez-Espinosa, Maria-Jose

AU - Markevych, Iana

AU - de Nazelle, Audrey

AU - Raaschou-Nielsen, Ole

AU - Nieuwenhuijsen, Mark

AU - Pérez-Lobato, Rocío

AU - Philippat, Claire

AU - Slama, Rémy

AU - Tiesler, Carla M T

AU - Verhulst, Frank C

AU - von Berg, Andrea

AU - Vrijkotte, Tanja

AU - Nybo Andersen, Anne-Marie

AU - Heude, Barbara

AU - Krämer, Ursula

AU - Heinrich, Joachim

AU - Tiemeier, Henning

AU - Forastiere, Francesco

AU - Pershagen, Göran

AU - Brunekreef, Bert

AU - Guxens, Mònica

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.

AB - BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.

KW - attention deficit disorder with hyperactivity

KW - child development

KW - environmental pollution

KW - longitudinal studies

KW - meta-analysis

KW - nitrogen oxides

KW - particulate matter

KW - prospective studies

U2 - 10.1097/EDE.0000000000000874

DO - 10.1097/EDE.0000000000000874

M3 - Article

C2 - 29923866

SN - 1044-3983

VL - 29

SP - 618

EP - 626

JO - Epidemiology

JF - Epidemiology

IS - 5

ER -

Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

Abstract

Keywords

UN SDGs

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