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Forns, Joan; Sunyer, Jordi; Garcia-Esteban, Raquel; Porta, Daniela; Ghassabian, Akhgar; Giorgis-Allemand, Lise; Gong, Tong; Gehring, Ulrike; Sorensen, Mette; Standl, Marie; Sugiri, Dorothee; Almqvist, Catarina; Andiarena, Ainara; Badaloni, Chiara; Beelen, Rob; Berdel, Dietrich; Cesaroni, Giulia; Charles, Marie-Aline; Eriksen, Kirsten Thorup; Estarlich, Marisa; Fernandez, Mariana F.; Forhan, Anne; Jaddoe, Vincent W. V.; Korek, Michal; Lichtenstein, Paul; Lertxundi, Aitana; Lopez-Espinosa, Maria-Jose; Markevych, Iana; Nazelle, Audrey de; Raaschou-Nielsen, Ole; Nieuwenhuijsen, Mark; Perez-Lobato, Rocio; Philippat, Claire; Slama, Remy; Tiesler, Carla M. T.; Verhulst, Frank C.; Berg, Andrea von; Vrijkotte, Tanja; Andersen, Anne-Marie Nybo; Heude, Barbara; Kramer, Ursula; Heinrich, Joachim; Tiemeier, Henning; Forastiere, Francesco; Pershagen, Goran; Brunekreef, Bert; Guxens, Monica (2018): Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe. In: Epidemiology, Vol. 29, No. 5: pp. 618-626
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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 mu g/m(3) increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 mu g/m(3) 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.

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