A Family-Based Study of the Association Between Labor Induction and Offspring Attention-Deficit Hyperactivity Disorder and Low Academic Achievement

Abstract

The current study examined associations between labor induction and both (1) offspring attention-deficit hyperactivity disorder (ADHD) diagnosis in a Swedish birth cohort born 1992-2005 (n = 1,085,008) and (2) indices of offspring low academic achievement in a sub-cohort born 1992-1997 (n = 489,196). Associations were examined in the entire sample (i.e., related and unrelated individuals) with adjustment for measured covariates and, in order to account for unmeasured confounders shared within families, within differentially exposed cousins and siblings. We observed an association between labor induction and offspring ADHD diagnosis and low academic achievement in the population. However, these associations were fully attenuated after adjusting for measured covariates and unmeasured factors that cousins and siblings share. The results suggest that observed associations between labor induction and ADHD and low academic achievement may be due to genetic and/or shared environmental factors that influence both mothers' risk of labor induction and offspring neurodevelopment.

Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings

“…Our study therefore adds to the accumulated evidence that does not support a causal interpretation of the associations between labor epidural analgesia with offspring neurodevelopmental disorders. Moreover, our findings are consistent with the literature reporting that a broader set of pre-and perinatal risk markers (eg, cesarean deliveries, 46 labor induction, 47,48 maternal infections, 49 and smoking during pregnancy 50e52 ) are not associated with offspring neurodevelopmental disorders once unmeasured familial confounders have been adequately accounted for.…”

Maternal Infection during Pregnancy and Attention-Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis

“…After removing 42 duplicate records, 333 articles were screened by titles and abstracts, of which 16 articles met the eligibility criteria. Of them, four articles ( 23 , 31 – 33 ) were discarded because did not meet eligibility criteria. After an update search, one other article was retrieved and finally, 13 articles ( 16 , 21 , 22 , 34 – 43 ) were considered for the systematic review and of these, 9 articles ( 16 , 21 , 22 , 36 – 39 , 42 , 43 ) provides adjusted RRs on association between maternal infection during pregnancy and ADHD and they met the criteria for the meta-analysis.…”

Is there an association between labor induction and attention-deficit/hyperactivity disorder among children?

“…1 . The following studies were included: 4 cohort studies [ 9 , 14 - 16 ] including 2,885,743 participants; and 3 case-control studies [ 4 , 8 , 10 ] including 51,135 participants (10,961 with ADHD and 40,174 in control groups) for a total sample size of 2,936,878 participants ( Table 1 ). Silva et al [ 10 ] reported the results separately for males and females.…”

“…We obtained the minimum desired I 2 threshold (50%) by omitting one study from the meta-analysis assessing the association between labor induction and the risk of ADHD. The removal of this reference [ 16 ] increased the heterogeneity to 6.4% (OR, 1.03; 95% CI, 1.01–1.05; P =0. 000).…”