Prenatal smoking, alcohol and caffeine exposure and offspring externalizing disorders: a systematic review and meta‐analysis

Abstract

Background and aims Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this relationship is causal. We conducted a systematic review to determine: (1) if the literature supports a causal role of maternal prenatal substance use on offspring externalizing disorders diagnosis and (2) whether these associations differ across externalizing disorders. Methods We searched Web of Science, Embase, PsycINFO and Medline databases. Risk of bias assessment was conducted using the Newcastle–Ottawa Scale (NOS), and where possible meta‐analysis was conducted for studies classed as low risk of bias. We included studies of any design that examined prenatal smoking, alcohol or caffeine use. Studies in non‐English language, fetal alcohol syndrome and comorbid autism spectrum disorders were excluded. Participants in the included studies were mothers and their offspring. Measurements included prenatal smoking, alcohol or caffeine use as an exposure, and diagnosis of attention‐deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring as an outcome. Results We included 63 studies, 46 of which investigated smoking and ADHD. All studies were narratively synthesized, and seven studies on smoking and ADHD were meta‐analysed. The largest meta‐analysis based on genetically sensitive design included 1 011 546 participants and did not find evidence for an association [odds ratio (OR)1–9 cigarettes = 0.90, 95% confidence interval (CI) = 0.83–1.11; OR > 10 cigarettes = 1.04, 95% CI = 0.79–1.36). Studies on alcohol exposure in all the outcomes reported inconsistent findings and no strong conclusions on causality can be made. Studies on caffeine exposure were mainly limited to ADHD and these studies do not support a causal effect. Conclusions There appears to be no clear evidence to support a causal relationship between maternal prenatal smoking and offspring attention‐deficit hyperactivity disorder. Findings with alcohol and caffeine exposures and conduct disorder and oppositional–defiant disorder need more research, using more genetically sensitive designs.

Prenatal maternal PTSD as a risk factor for offspring ADHD: A register-based Swedish cohort study of 553 766 children and their mothers

“…In addition, several confounders doubled the likelihood of ADHD in the child, including single parenthood and low disposable income. The reason that single parenthood doubles the likelihood of offspring ADHD is unknown, but may be related to the fact that low disposable family income is known to be more common among single parents, and an association between parental low disposable income and offspring ADHD is found in previous studies [ 25 , 26 ]. In addition, we found that reported smoking during pregnancy is associated with offspring ADHD.…”

“…In addition, we found that reported smoking during pregnancy is associated with offspring ADHD. However, sibling- and twin-designed studies have shown that the association between smoking during pregnancy and ADHD is likely due to confounding because smoking during pregnancy is associated with ADHD/externalizing problems in the mother [ 25 ]. We therefore conclude that smoking during pregnancy is a confounding factor in our study as well.…”

Associations between prenatal caffeine exposure and child development: Longitudinal results from the Adolescent Brain Cognitive Development (ABCD) Study

“…Similar to the divergence noted above for BMI, this may be attributable to differences in sample size and caffeine groupings (i.e., our study grouping 2 or more cups into multigroup exposure and Zhang et al using a definition of 3 or more cups). There is a mixed literature surrounding associations between prenatal caffeine exposure and childhood externalizing with the majority of studies finding no evidence of association 35 , 38 . Notably, like a prior report arising from the ABCD Study finding 14 , our study revealed that daily and daily multiple cup prenatal caffeine exposure were nominally significantly associated with higher externalizing problems, but were not robust to multiple testing correction.…”

“…Child/Adolescent Behavior Problems. Associations between prenatal caffeine exposure and childhood behavioral outcomes have been less studied than BMI and have resulted in an equivocal literature 35,36 . Among child behavior problems examined, we found evidence for elevated sleep problems among children who were prenatally exposed to multiple cups daily.…”

The Influence of Prenatal Environmental Factors on the Risk and Development of ADHD: Insights from Epidemiological and Neurodevelopmental Research - Review

“…Current safety guidelines recommend a regular consumption of caffeine up to 200 mg/day, which is considered safe for the fetus [46]. Generally, low to moderate caffeine consumption during pregnancy has not been linked to attention-hyperactivity problems in offspring [8,34,[47][48][49]. The recommended upper limit for coffee consumption is between 300-384 mg/day, which is equivalent to three to four and a half cups of coffee per day [8,46,48].…”