Sex-specific and time-dependent effects of prenatal stress on the early behavioral symptoms of ADHD: a longitudinal study in China

Abstract

There is increasing evidence that prenatal stressful life events (SLEs) may be a potential risk factor for attention-deficit hyperactivity disorder (ADHD), but the sex-specific and time-dependent effects of prenatal stress on ADHD are less clear. In this prospective longitudinal study, data on prenatal SLEs during different stages of gestation and indicators of buffers against stress, including maternal social support and avoidance coping, were obtained from 1765 pregnant women at 32 weeks of gestation. The behavioral symptoms of ADHD in children aged 48-54 months were evaluated by reports from the parents. There were 226 children (12.8%) above the clinically significant cutoff for ADHD. After adjusting for potential confounders, boys whose mother experienced severe SLEs in the second trimester had a significantly increased risk (OR = 2.41, 95% CI: 1.03-5.66) of developing ADHD symptoms compared with boys whose mothers did not experience severe SLEs at this time. However, no significantly increased risk of ADHD symptoms was observed in girls born to mothers experienced prenatal severe SLEs. Additionally, significant interaction effects of prenatal SLEs, social support and coping style on ADHD symptoms were found in males. Boys whose mothers experienced severe SLEs during the second trimester accompanied by a higher score for avoidance coping (OR = 3.31, 95% CI: 1.13-9.70) or a lower score for social support (OR = 4.39, 95% CI: 1.05-18.31) were likely to be at a higher risk for ADHD symptoms. The epidemiological evidence in this prospective follow-up study suggests that the effect of prenatal SLEs on ADHD symptoms in offspring may depend on the timing of prenatal stress and may vary according to the sex of the offspring.

Understanding the relationship between disaster-related prenatal maternal stress and child motor development: The QF2011 Queensland Flood Study

“…These findings are similar to Zhu et al (2015), who found that, for mothers experiencing stressful life events in pregnancy, avoidant coping predicted higher odds of maternal-rated ADHD symptoms in children. These findings also are similar to Oni and colleagues (Oni et al, 2015;Oni et al, 2012) who found that humour reduced the odds of both gestation diabetes and maternal posttraumatic stress in mothers exposed to a natural disaster, while denial and venting increased the odds.…”

“…There is some evidence that, in response to Hurricane Katrina, maternal coping strategies reduced the negative impact of this stressor on mothers' subsequent mental health (Oni, Harville, Xiong, & Buekens, 2012), and were also related to reduced pregnancy complications (Oni, Harville, Xiong, & Buekens, 2015). In the only study that could be found regarding maternal coping, prenatal stress and child development, Zhu et al (2015) found that higher maternal avoidant coping increased the risk of maternalrated Attention-deficit Hyperactivity Disorder (ADHD) symptoms in children following prenatal exposure to stressful life events. Maternal coping may mitigate the negative effects of prenatal maternal stress on child development, but investigations of coping in the prenatal stress literature are only in the preliminary stages.…”

“…Focusing on stressful life events during pregnancy rather than exposure to a natural disaster, Zhu et al (2015) measured the number of events and maternal avoidant coping, and asked mothers to report their child's attention-deficit hyperactivity disorder (ADHD) symptoms at 48 to 54 months of age. Maternal avoidant coping was positively correlated with and predicted child ADHD symptoms for boys.…”

“…Only one prenatal stress study could be located that tested the extent to which maternal coping could predict the effects of prenatal stress on child development. Zhu et al (2015) measured maternal stressful life events during pregnancy and maternal avoidant coping, and asked mothers to report their child's ADHD symptoms at 48 to 54 months of age. Maternal avoidant coping was positively correlated with and predicted child ADHD symptoms for boys.…”

Prenatal Stress and its effects of human cognition, behavior and psychopathology: A review of the literature

“…Boys were also more vulnerable to ADHD symptoms in another prospective, longitudinal study. They were twice as likely to have clinically-relevant ADHD symptoms, if their mothers suffered life events that they evaluated as extremely stressful during their second pregnancy trimester [28]. For girls, severe stressful events were only predictive of ADHD if they ensued during the third trimester of pregnancy.…”