Association between maternal smoking during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children aged 4-15 years: A secondary data analysis from the NHANES dataset.

Introduction: The association between maternal smoking during pregnancy (MSDP) and the risk of attention-deficit hyperactivity disorder (ADHD) in children remains inconclusive. This study aims to investigate the relationship between MSDP and ADHD in children aged 4-15 years, with a particular focus on sex differences.

Methods: This secondary analysis used cross-sectional data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES), comprising 5548 US children and adolescents aged 4-15 years. Inclusion criteria comprised complete maternal smoking history during pregnancy and parent-reported ADHD diagnosis data. Multivariable logistic regression models were employed to assess the association between MSDP and ADHD, with further stratified analyses.

Results: Multivariable logistic regression analysis identified a significant association between MSDP exposure and elevated odds of ADHD (OR=2.11; 95% CI: 1.48-3.00). Sex-stratified analyses revealed that this association was more pronounced in female children (OR=4.18; 95% CI: 2.17-8.03) than in male children (OR=1.64; 95% CI: 1.13-2.38), the interaction between groups was significant (p for interaction <0.01).

Conclusions: MSDP showed a statistically significant association with higher ADHD odds, with more pronounced estimates observed in females compared to males.