Table 6. Association between trimester, route, and number of exposures to prenatal antimicrobials and ADHD.
| Exposure | N (%) of Children with ADHD | Model 1a | Model 2b | Model 3c | |
|---|---|---|---|---|---|
| RRd (95% CI) | |||||
| Prenatal antibiotic use by trimester | |||||
| 1st trimester | No | 79 (18.9%) | 1.00 (Reference) | 1.00 (Reference) | ---e |
| Yes | 29 (21.3%) | 1.12 (0.74, 1.69) | 0.98 (0.64, 1.50) | ||
| 2nd trimester | No | 84 (18.3%) | 1.00 (Reference) | 1.00 (Reference) | |
| Yes | 24 (25.0%) | 1.26 (0.82, 1.93) | 1.38 (0.92, 2.06) | ||
| 3rd trimester | No | 68 (18.5%) | 1.00 (Reference) | 1.00 (Reference) | |
| Yes | 40 (21.3%) | 1.06 (0.72, 1.56) | 1.17 (0.80, 1.72) | ||
| Interaction p-valuef | 0.82 | 0.50 | |||
| Prenatal antifungal use by trimester | |||||
| 1st trimester | No | 99 (18.9%) | 1.00 (Reference) | 1.00 (Reference) | ---e |
| Yes | 9 (28.1%) | 1.38 (0.74, 2.58) | 1.61 (0.87, 2.96) | ||
| 2nd trimester | No | 95 (18.4%) | 1.00 (Reference) | 1.00 (Reference) | |
| Yes | 13 (34.2%) | 1.76 (1.06, 2.92) | 1.66 (1.01, 2.72) | ||
| 3rd trimester | No | 94 (18.6%) | 1.00 (Reference) | 1.00 (Reference) | |
| Yes | 14 (28.6%) | 1.66 (1.01, 2.75) | 1.54 (0.96, 2.47) | ||
| Interaction p-valuef | 0.81 | 0.97 | |||
| Number of prenatal antibiotic exposures | |||||
| 0 | 48 (18.8%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | |
| 1 | 22 (13.9%) | 0.66 (0.40, 1.09) | 0.82 (0.47, 1.42) | 0.73 (0.51, 1.03) | |
| 2 | 15 (19.5%) | 0.90 (0.51, 1.58) | 1.16 (0.67, 2.01) | 1.02 (0.67, 1.55) | |
| 3+ | 23 (35.4%) | 1.63 (1.01, 2.63) | 1.66 (0.96, 2.85) | 1.58 (1.10, 2.29) | |
| Route of antifungal exposure | |||||
| Systemic | No | 94 (18.8%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| Yes | 14 (25.9%) | 1.43 (0.85, 2.39) | 1.41 (0.86, 2.32) | 1.23 (0.81, 1.85) | |
| Vaginal | No | 89 (18.0%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| Yes | 19 (31.2%) | 1.61 (1.02, 2.54) | 1.67 (1.03, 2.70) | 1.47 (1.04, 2.09) | |
ADHD, attention deficit hyperactivity disorder.
aInverse probability weights; unadjusted; complete-case estimate.
bInverse probability weights; adjusted for maternal age, household income, marital status, maternal education, mom smoked during pregnancy, prenatal environmental tobacco smoke exposure, prenatal indoor pets, maternal body mass index, child sex, race-ethnicity of child, first born child, mode of delivery, breastfeeding status at 1 month, gestational age at delivery, and birthweight z-score; complete-case estimate.
cInverse probability weights; adjusted for maternal age, household income, marital status, maternal education, mom smoked during pregnancy, prenatal environmental tobacco smoke exposure, prenatal indoor pets, maternal body mass index, child sex, race-ethnicity of child, first born child, mode of delivery, breastfeeding status at 1 month, gestational age at delivery, and birthweight z-score; multiple imputation estimate.
dRisk ratio (RR) is interpreted as ratio of the probability of attention deficit hyperactivity disorder in offspring, in comparator group vs. reference group.
eMultiple imputation estimates unable to be calculated for multiple informant models.
fTest for evidence of a trimester-specific effect calculated by multiple informant models.