Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population-based cohort study
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PSYCHIATRIC EPIDEMIOLOGY
Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population‑based cohort study Caroline H. Hemmingsen1 · Susanne K. Kjaer1,2 · Andrea H. Jezek1 · Frank C. Verhulst3,4 · Anne Katrine Pagsberg4 · Mads Kamper‑Jørgensen5 · Lina S. Mørch1,6 · Marie Hargreave1 Received: 31 October 2019 / Accepted: 4 August 2020 / Published online: 23 September 2020 © Springer Nature B.V. 2020
Abstract Although maternal use of hormones has been suspected of increasing the risk for childhood attention-deficit/hyperactivity disorder (ADHD), no study has examined hormonal contraception use in this context. We examined the association between maternal hormonal contraception use before or during pregnancy and ADHD risk in children. This nationwide population-based cohort study included 1,056,846 children born in Denmark between 1998 and 2014. Prescriptions for hormonal contraceptives redeemed by the mother was categorized as: no use, previous use (> 3 months before pregnancy), and recent use (≤ 3 months before or during pregnancy). Children were followed for ADHD, from birth until 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During 9,819,565 person-years of follow-up (median: 9.2), ADHD was diagnosed or a prescription for ADHD medication redeemed for 23,380 children (2.2%). The adjusted HR for ADHD was higher in children of mothers who had previously (HR 1.23; 95% CI 1.18–1.28) or recently (HR 1.30; 95% CI 1.24–1.37) used hormonal contraception than in those of mothers with no use. The highest estimates were seen for use of non-oral progestin products with HRs of 1.90 (95% CI 1.59–2.26) for previous use, 2.23 (95% CI 1.96–2.54) for recent use, and 3.10 (95% CI 1.62–5.91) for use during pregnancy. Maternal use of hormonal contraception was associated with an increased risk for ADHD in the offspring; more pronounced for non-oral progestin-only than other products. Keywords Attention-deficit/hyperactivity disorder · ADHD · Hormonal contraception · Cohort study
Introduction Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, with an estimated worldwide prevalence of approximately 5% [1, 2]. It is characterized by abnormal inattention, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10654-020-00673-w) contains supplementary material, which is available to authorized users. * Marie Hargreave [email protected] 1
Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
2
Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark
3
Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
impulsivity and hyperactivity [3]. While the aetiology is to some extent still unknown, current knowledge suggests both genetic and environmental contributing factors, including low parental age and ed
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