Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2022 Nov 14.
Published in final edited form as: Ann Epidemiol. 2021 Jun 26;63:1–6. doi: 10.1016/j.annepidem.2021.06.005

Association between Perinatal Depression and Risk of Attention Deficit Hyperactivity Disorder among Children: A Retrospective Cohort Study

Nichole L Nidey 1,2,3, Allison M Momany 4, Lane Strathearn 5,6, Knute D Carter 7, George L Wehby 8, Wei Bao 9, Guifeng Xu 9, Francesca A Scheiber 4, Karen Tabb 10, Tanya E Froehlich 2,3, Kelli Ryckman 9
PMCID: PMC9659329  NIHMSID: NIHMS1837927  PMID: 34186179

Abstract

Purpose:

Perinatal depression has previously been identified as a risk factor for attention deficit hyperactivity disorder (ADHD) in the offspring. Population-based studies utilizing diagnosis data are needed to better understand the relationship between these two variables. The objective of this study was to examine the association between perinatal depression and the risk of ADHD among children born during a 5-or-more-year follow-up period.

METHODS:

The sample was drawn from a population-based cohort of privately insured mother- child pairs within the state of Iowa. Hazard ratios for risk of ADHD by exposure to perinatal depression were estimated using adjusted Cox proportional-hazard models.

RESULTS:

Among the 5,635 mother-child pairs, 484 mothers were diagnosed with depression during the perinatal period, and 269 children were diagnosed with ADHD. After adjustment for confounders, children born to mothers with perinatal depression were over three times more likely to be diagnosed with ADHD (HR 3.16 (95% CI 2.35, 4.23)).

CONCLUSION:

Children born to mothers with perinatal depression were found to be at increased risk of ADHD. This finding suggests that ADHD and its adverse sequelae could be mitigated by increasing maternal depression intervention efforts as well as ADHD screening and treatment efforts targeted to this vulnerable population.

Keywords: Attention-deficit/hyperactivity disorder, antenatal depression, postpartum depression

Introduction

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by symptoms of impulsivity, inattention, and hyperactivity. Prevalence estimates in the United States (US) range from 2 to 18% among school-aged children. Males are at least twice as likely to be diagnosed with ADHD compared to females.1 Importantly, recent work has suggested that diagnosis rates are increasing.2 Individuals with ADHD not only experience the associated symptoms, but also are at increased risk for numerous adverse health outcomes.3 Significant costs have been associated with this condition, with healthcare costs estimated to range from 143–266 billion dollars annually in the US.4,5 Identifying potentially modifiable risk factors of this disorder should be a public health priority given the high and increasing prevalence, life-long adverse outcomes experienced by those with ADHD, and the substantial financial burden to individuals, families, and society.

ADHD is a complex disorder with high genetic heritability (~70%) 6,7 but whose etiology can also be influenced by a host of environmental risk factors.8,9 Notably, prior studies have documented a moderate shared genetic heritability for ADHD and Major Depressive Disorder (r = .32 – .44).10–12 Thus, the shared genetic liability between ADHD and Major Depressive Disorder is an important consideration in the etiology of ADHD among youth exposed to perinatal depression, as it may partially explain the emergence of perinatal depression in a mother and ADHD in a child. However, previous research indicates that several other biological and environmental factors can be involved. For instance, exposure to medications (e.g., acetaminophen and valproic acid) and maternal physical health conditions (e.g., preeclampsia) during pregnancy have been linked to offspring ADHD.13–17 Perinatal depression (depression during pregnancy and the 12 month postpartum period) is also likely relevant because of increased prenatal maternal cortisol levels and inflammation, which are thought to influence fetal development through effects on the offspring hypothalamic pituitary adrenal (HPA) axis and other aspects of stress physiology.18,19 Depression during pregnancy has also been linked to health-compromising maternal behaviors (e.g., smoking) during and after pregnancy that have been associated with adverse effects on fetal neurological development, including reductions in total brain volume.20–23 Postpartum depression occurs at the same time the infant is progressing through a sensitive time of neurodevelopment.21 As such, studies have found that depression may also influence parenting behaviors related to responsivity, sensitivity and reactivity to their children.24 More broadly, there is converging evidence that maternal mental health can influence the caregiving relationship between mother and child, potentially increasing risk of adverse developmental outcomes in their children.

Studies which examine the relationship between maternal mental health problems and risk of ADHD may improve our understanding of the etiologic underpinnings of this disorder. Indeed, several studies have suggested an increased risk of ADHD in children whose mothers experienced perinatal depression. 25–27 Although several studies have demonstrated that depression during and after pregnancy is associated with increased risk of ADHD symptoms and diagnosis,13,25,28–31 many studies have investigated each time period in isolation. 26,27 Failure to consider both time periods in the same analysis may obscure the level of risk accrued by maternal depression during these separate windows of development. Furthermore, prior studies have measured child ADHD through maternal report rather than clinical diagnostic codes. 25,29 Unfortunately, self-report is subject to recall and social desirability bias. In addition, measurement of child ADHD through maternal report may be problematic given that maternal stress may influence perception of child behavior.32

To address the above gaps in the literature, this study examined the association between perinatal (both prenatal and postpartum) depression and the risk of ADHD among offspring based on clinical data from a dataset of de-identified fully insured insurance claims. Based on existing evidence, we hypothesized that children born to mothers with a diagnosis of depression during the perinatal time period would have an increased risk of being diagnosed with ADHD.

Methods

Privately insured mother-child pairs from the state of Iowa were included in this retrospective cohort study. A database of de-identifed insurance claims for 19,007 mother-child pairs included delivery date of the child, mother’s birth year, sex of the child, inpatient and outpatient claims, and insurance enrollment. Children from this database were born between the years of 2004 and 2015 and claims data were available from 2004 to 2016. Mother-child pairs were included in this study if the mother had continuous insurance coverage one year prior to pregnancy and the child and mother had continuous insurance coverage for at least five years after delivery. If mothers had more than one child during the study period, the first child and associated pregnancy was included in this study. This study was reviewed and deemed exempt by the University of Iowa institutional review board because of the de-identified nature of the dataset.

Main measures

International Classification of Disease (ICD) 9 and 10 codes were used to identify diagnosed medical conditions in our cohort. Women with depression were identified using ICD 9 and 10 codes based on a systematic literature review (296.20–25, 296.30–35,311, F32.0–32.9, F33.0–33.3,F33.8, F33.9, F53.0). 33 Women were classified as having a depression diagnosis prior to delivery if they had an ICD 9 or 10 code for depression within one year prior to pregnancy up to the date of delivery. Women who had a diagnosis code for depression up to one year after delivery but did not have a depression code prior to delivery were considered to have postpartum depression. Women with depression prior to delivery and/or postpartum were classified as having perinatal depression, and this was the main exposure variable for this study. Diagnosis of ADHD among offspring was based on having at least two relevant ICD 9 or 10 codes (314x, F90x). Maternal conditions including gestational diabetes and pregnancy induced hypertension (including preeclampsia) were identified using relevant ICD 9 and 10 codes. Infant outcomes, including preterm birth, defined as gestational age < 37 weeks and congenital anomalies were also identified using ICD 9 and 10 codes.

Statistical analysis

Maternal and child characteristics were examined using chi square tests. Hazard ratios were estimated for risk of ADHD by exposure to perinatal depression in Cox proportional- hazard models. Follow up time for all children in the study began at the time of birth. The time metric was based on age of diagnosis of ADHD or age at censoring (end of study or loss to follow-up), whichever occurred first. Proportional hazards were checked by examining Kaplan-Meier curves and negative log-log plots. Assumptions were satisfied for all analyses. The main analysis estimated the risk for an ADHD diagnosis, with perinatal depression as the main exposure variable. The analysis was adjusted for sex of the child, maternal age at delivery, and pregnancy induced hypertension given prior evidence linking these factors to child ADHD.34–36 In a separate analysis, to examine how timing of depression onset may influence the risk of ADHD, the main analysis was repeated with fixed effects coding for timing of depression onset in mutually exclusive categories (depression diagnosed prior to delivery 0/1, depression diagnosed within first year postpartum 0/1) as the main exposure variables, and was adjusted for the same covariates as in the main analysis.

Results

A total of 5,635 children had continuous insurance coverage for at least five years after delivery and were therefore eligible for inclusion in this study. The average continuous follow- up time for study’s cohort, after birth, was around 7 years (92.5 months, standard deviation 24.74), with a minimum of 5 years and a maximum of 12 years (144 months). Overall, 269 (4.77%) of the children in our cohort had a diagnosis of ADHD, including 207 males and 62 females. The average age at diagnosis was 7 years old. Perinatal depression was diagnosed in 484 (8.59%) of the mothers (among whom 30.8% were diagnosed during pregnancy or prior, and 69.2% were diagnosed postpartum). Table 1 shows the relationship between maternal characteristics and perinatal depression diagnosis and offspring ADHD. Women who were diagnosed with pregnancy induced hypertension or delivered preterm were more likely to be diagnosed with perinatal depression.

Table 1.

Characteristics of Study Population

No Perinatal Depression (n=5151) Freq (Col %) Perinatal Depression (n =484) Freq (Col %) Chi-Square P Value No ADHD in offspring (n=5366) Freq (Col %) ADHD in offspring (n=269) Freq (Col %) Chi-Square P Value
Maternal Age at Delivery (yrs.) 0.81 0.25
25 or younger 601 (11.67) 55 (11.36) 618 (11.52) 38 (14.13)
26–35 3673 (71.31) 341 (70.45) 3834 (71.45) 180 (66.91)
36 or older 877 (17.03) 88 (18.18) 914 (17.03) 51 (18.96)
Maternal Conditions
Gestational diabetes 682 (13.24) 72 (14.88) 0.31 712 (13.27) 42 (15.61) 0.27
Pregnancy induced hypertension 439 (8.52) 63 (13.02) 0.0009 472 (8.80) 30 (11.15) 0.19
Perinatal Depression -- -- -- 427 (7.96) 57 (21.19) <.0001
Child Characteristics
ADHD 212 (4.12) 57 (11.78) <.0001 -- -- --
Male 2655 (51.54) 266 (54.96) 0.15 2714 (50.58) 207 (76.95) <.0001
Preterm (less than 32 gestational weeks) 266 (5.16) 35 (7.23) 0.05 286 (5.33) 15 (5.58) 0.87
Congenital Anomaly 234 (4.54) 25 (5.17) 0.53 230 (4.29) 29 (10.78) <.0001
Open in a new tab

N= 5635

In the bivariate analysis, the risk of ADHD diagnosis was 2.39 (95% CI 1.63, 3.49) times greater among children born to mothers with perinatal depression compared to children born to a mother without a depression diagnosis during the perinatal period. Children of mothers with perinatal depression remained at an increased risk of ADHD by 3.16 times (95% CI 2.35, 4.23) after adjusting for maternal age at delivery and pregnancy induced hypertension (results are summarized in Table 2).

Table 2.

Risk of ADHD By Exposure to Perinatal Depression

Unadjusted Model Adjusted Main Model
Characteristics Hazard Ratio (95% CI) Hazard Ratio (95% CI)
Perinatal Depression 2.39 (1.63, 3.49) 3.16 (2.35, 4.23)
Age at Delivery
 25 yrs. or less 1.29 (0.91, 1.83)
26–35 yrs. REF
36 and older 1.09 (0.79, 1.48)
Pregnancy induced hypertension 1.38 (0.94, 2.02)
Open in a new tab

Bold indicates p value <.05

We also examined the risk of ADHD diagnosis by timing of depression onset (depression diagnosed prior to delivery, depression diagnosed after delivery within one year postpartum). Regardless of the timing of depression onset, children born to mothers with perinatal depression were at an increased risk of ADHD diagnosis. When compared to children born to mothers without a depression diagnosis, children born to mothers with depression diagnosed prior to delivery had the greatest risk of ADHD diagnosis (HR 5.08; 95% CI 3.42, 7.55). In the same analysis, children whose mother was diagnosed with depression in the first year postpartum had an increased risk of ADHD by 2.31 times( 95% CI 1.56, 3.41) (Table 3 & Figure 1).

Table 3.

Risk of ADHD By Timing of Perinatal Depression

Unadjusted Model Adjusted Main Model
Characteristics Hazard Ratio (95% CI) Hazard Ratio (95% CI)
Perinatal Depression
 No depression 1.00 (REF) 1.00 (REF)
 Depression onset diagnosed prior to delivery (0/1) 5.15 (3.47, 7.64) 5.08 (3.42, 7.55)
 Depression onset postpartum (0/1) 2.37 (1.61, 3.49) 2.31 (1.56, 3.41)
Maternal Age
 25 yrs. or less 1.29 (0.91, 1.84)
 26–35 yrs. REF
 36 and older 1.09 (0.80, 1.49)
Pregnancy induced hypertension 1.39 (0.95, 2.04)
Open in a new tab

Bold indicates p value <.05, Depression onset diagnosed prior to delivery n= 149

Depression onset diagnosed postpartum n=335

Figure 1.

Figure 1.

Open in a new tab

Cumulative Incidence of Offspring ADHD Diagnosis by Timing of Depression Onset

Depression Onset Prior to Delivery = 1, Depression Onset Postpartum = 2, No Depression = 3

Discussion

In this retrospective cohort study, 8.6% of mothers had a diagnosis of perinatal depression and 4.8% of their children had a diagnosis of ADHD. In our main analysis, we found that children born to mothers with a perinatal depression diagnosis were three times more likely to receive an ADHD diagnosis than children born to non-depressed mothers. Results from this study are similar to previous studies and provide further support of the association between perinatal depression and increased risk of ADHD. 25,28,29

There are several mechanisms postulated in the literature to explain the link between perinatal depression and child development. As previously described, depression during pregnancy can have both biological effects on the developing fetus and influence maternal behavior. Specifically, depression during pregnancy has been linked to increased prenatal maternal cortisol levels, which can influence fetal development through effects on the offspring’s HPA axis and stress reactivity.18,19 Additional evidence suggests that maternal stress can affect hormones and produce an inflammatory response during pregnancy, which in turn may explain the increased risk of atypical development among offspring.19 Additionally, depression during pregnancy has been associated with a reduction in attachment to the fetus, which can have implications for maternal behavior during and after pregnancy.21,22 Previous studies have also found that depression during pregnancy can produce maternal neurocognitive changes which disrupt maternal preparation for responding to infant cues.37 Children with a mother who experiences postpartum depression are at risk of having difficulties with self- regulation, reduced academic achievement, poor stress coping skills, and reduced social competency.38 Depressed mothers tend to exhibit behaviors that may adversely affect child development, as they may be less likely to provide an environment with routines and to play with or talk to their infants.39 The extant literature has shown that cognitive development and the development of neurobehavioral disorders, such as ADHD, may be affected by both the fetal and postnatal environment. 25,28,29 Prior studies have demonstrated an association between prenatal substance use, socioeconomic disadvantage and increased risk of ADHD among offspring.40,41 In this study, we were unable to examine these factors. The comorbidity of maternal ADHD and substance use 42, along with socioeconomic disadvantage are potential alternative explanations for the current study’s findings and will need to be further examined in future studies. Furthermore, the relationship between maternal ADHD, perinatal depression, and risk of ADHD among offspring needs to be further explored in future work. Individuals with ADHD have increased difficulties with executive functions, such as planning and organizing,43 which are important for caregiving activities. New mothers with ADHD may experaince additional stress, increasing their risk of depression. To further eludicate the mechanism of risk for ADHD among offspring, the combination of the genetic liability and exposure to perinatal depression needs additional exploration in future work. Due to the limitations of our data, we were not able to examine these relationships.

Our study suggests that the timing of depression onset may be an important factor to consider when examining ADHD risk among exposed children. Compared to children born to mothers without any perinatal depression (one year prior to pregnancy to one year postpartum), children born to mothers with depression diagnosed prior to pregnancy had a five-fold increased risk, while children born to mothers with depression first diagnosed one year after delivery had a two-fold increased risk. The increased risk of offspring ADHD borne by women with antenatal versus postpartum depression may be explained by 1) the above noted effects of antenatal depression on maternal cortisol secretion, hormonal environment, and inflammatory response, 2) their increased likelihood of experiencing mood and anxiety disorders (which also increase maternal cortisol levels and inflammation, leading to further disruptions in child neurobehavioral development) and 3) their tendency toward more severe postpartum depressive symptoms.44–46

This study has several notable strengths. Many prior research studies in this area have been based on caregiver-report of child diagnosis of ADHD. Claims data ascertains cases of ADHD based on clinical diagnoses, and thus reduces the threat of recall or social desirability bias. Additionally, the use of claims data allowed us to examine the association between ADHD and perinatal depression in a population-based study among privately insured mother-child pairs from the entire state of Iowa, improving the generalizability of findings compared to smaller, single site studies. The results of this study are also strengthened by our investigation across the perinatal period, as many previous studies are limited by analysis of either the prenatal or postpartum period in isolation.

Despite these strengths, this study has several important limitations. Of note, emerging evidence shows that depression and ADHD have a moderate shared genetic risk which may provide an alternate explanation for the association we documented.10–12 It is also plausible that undiagnosed and hence untreated ADHD during the perinatal period may result in increased difficulties meeting the demands of caring for a newborn, leading mothers with unidentified ADHD to be diagnosed with depression. In this case, while it may appear that maternal perinatal depression is linked to child ADHD, the more salient association may be between undiagnosed maternal ADHD and child ADHD. Therefore, the findings from our current study maybe reflecting the association between perinatal depression and maternal ADHD. Hence, future studies of the association between perinatal depression and child ADHD should control for genetic factors related to both of these disorders.

An additional study limitation is our reliance on insurance claims data, which are not created for research purposes and only capture information on individuals who are receiving healthcare services. Furthermore, our study did not include data prior to one year before pregnancy, so we could not examine the effect of maternal health conditions (such as depression) diagnosed outside of the study’s observation period. Study results could also be biased by differential ascertainment of child ADHD diagnoses when mothers have experienced perinatal depression. Prior research suggests that children born to mothers with perinatal depression are less likely to receive preventive health care, potentially leading to under- identification of their ADHD.47 On the other hand, the tendency of depressed mothers to report more child behavior problems 48 may increase diagnosis of child ADHD in this group. However, the requirement that ADHD diagnosis be based on report of symptoms in two or more settings (e.g., at home, school, or work; with friends or relatives) 49 and the recommended and typical practice of basing diagnosis on ratings from multiple informants (e.g., parent and teacher)50 reduce the likelihood of that maternal over-reporting of child behavior problems will lead to spurious ADHD diagnoses. Our study is also limited by the lack of available data on parity, race, ethnicity, substance use (including alcohol and tobacco) and other important socioeconomic factors (such as education, income/poverty, and family structure) in this dataset. These factors should be considered in future studies, as they have been identified by prior studies as important variables to consider for this topic of research.25,51 Paternal contribution to the risk of ADHD may also be relevant to understanding the risk of ADHD among offspring, but these data were not available in our dataset. Additionally, mental health conditions, such as maternal depression, may be underdiagnosed, underscoring the potential for exposure misclassification. However, this limitation would bias our results towards the null, causing our findings to be an under-, rather than over-, estimation.

ADHD is common and associated with multiple negative sequelae, such as lower academic achievement, increased risk of criminality, and unemployment.3,33,52 Given that maternal depression is a potentially modifiable risk factor 53 for offspring ADHD, findings from this study highlight the importance of depression prevention and treatment efforts among women of childbearing age to improve overall maternal and child health outcomes. In addition, previous studies have shown that early detection and intervention can improve outcomes among children with ADHD.54 Our finding of an increased risk for ADHD among children of women with perinatal depression suggests that ADHD screening efforts targeted to this vulnerable group could facilitate early diagnosis and treatment, thereby lessening adverse sequelae.

List of abbreviations and acronyms:

ADHD

Attention-deficit hyperactivity disorder

US

United States

ICD

International Classification of Disease

HPA

Hypothalamic pituitary adrenal

References

  • 1.Wehmeier PM, Schacht A, Barkley RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. J Adolesc Health. 2010;46(3):209–217. [DOI] [PubMed] [Google Scholar]
  • 2.Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997– 2016. JAMA network open. 2018;1(4):e181471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Fleming M, Fitton CA, Steiner MFC, et al. Educational and Health Outcomes of Children Treated for Attention-Deficit/Hyperactivity Disorder. JAMA pediatrics. 2017;171(7):e170691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Gupte-Singh K, Singh RR, Lawson KA. Economic Burden of Attention- Deficit/Hyperactivity Disorder among Pediatric Patients in the United States. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2017;20(4):602–609. [DOI] [PubMed] [Google Scholar]
  • 5.Doshi JA, Hodgkins P, Kahle J, et al. Economic impact of childhood and adult attention- deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry. 2012;51(10):990–1002.e1002. [DOI] [PubMed] [Google Scholar]
  • 6.Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Molecular psychiatry. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Nikolas MA, Momany AM. DRD4 Variants Moderate the Impact of Parental Characteristics on Child Attention-Deficit Hyperactivity Disorder: Exploratory Evidence from a Multiplex Family Design. Journal of abnormal child psychology. 2017;45(3):429–442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Gould KL, Coventry WL, Olson RK, Byrne B. Gene-Environment Interactions in ADHD: The Roles of SES and Chaos. Journal of abnormal child psychology. 2017. [DOI] [PubMed] [Google Scholar]
  • 9.Froehlich TE, Anixt JS, Loe IM, Chirdkiatgumchai V, Kuan L, Gilman RC. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Current psychiatry reports. 2011;13(5):333–344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Solovieff N, Cotsapas C, Lee PH, Purcell SM, Smoller JW. Pleiotropy in complex traits: challenges and strategies. Nat Rev Genet. 2013;14(7):483–495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Lee SH, Ripke S, Neale BM, et al. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet. 2013;45(9):984–994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders. Cell. 2019;179(7):1469–1482.e1411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Sciberras E, Ukoumunne OC, Efron D. Predictors of parent-reported attention- deficit/hyperactivity disorder in children aged 6–7 years: a national longitudinal study. J Abnorm Child Psychol. 2011;39(7):1025–1034. [DOI] [PubMed] [Google Scholar]
  • 14.Gumusoglu SB, Chilukuri ASS, Santillan DA, Santillan MK, Stevens HE. Neurodevelopmental Outcomes of Prenatal Preeclampsia Exposure. Trends Neurosci. 2020;43(4):253–268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Barron A, McCarthy CM, O’Keeffe GW. Preeclampsia and Neurodevelopmental Outcomes: Potential Pathogenic Roles for Inflammation and Oxidative Stress? Mol Neurobiol. 2021. [DOI] [PubMed] [Google Scholar]
  • 16.Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168(4):313–320. [DOI] [PubMed] [Google Scholar]
  • 17.Christensen J, Pedersen L, Sun Y, Dreier JW, Brikell I, Dalsgaard S. Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Risk for Attention- Deficit/Hyperactivity Disorder in Offspring. JAMA Netw Open. 2019;2(1):e186606. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Zijlmans MA, Riksen-Walraven JM, de Weerth C. Associations between maternal prenatal cortisol concentrations and child outcomes: A systematic review. Neurosci Biobehav Rev. 2015;53:1–24. [DOI] [PubMed] [Google Scholar]
  • 19.Nazzari S, Fearon P, Rice F, et al. Beyond the HPA-axis: Exploring maternal prenatal influences on birth outcomes and stress reactivity. Psychoneuroendocrinology. 2019;101:253–262. [DOI] [PubMed] [Google Scholar]
  • 20.Liu W, Mumford EA, Petras H. Maternal patterns of postpartum alcohol consumption by age: a longitudinal analysis of adult urban mothers. Prev Sci. 2015;16(3):353–363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Erickson N, Julian M, Muzik M. Perinatal depression, PTSD, and trauma: Impact on mother-infant attachment and interventions to mitigate the transmission of risk. International review of psychiatry (Abingdon, England). 2019:1–19. [DOI] [PubMed] [Google Scholar]
  • 22.Alhusen JL, Gross D, Hayat MJ, Rose L, Sharps P. The role of mental health on maternal-fetal attachment in low-income women. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. 2012;41(6):E71–81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.El Marroun H, Schmidt MN, Franken IH, et al. Prenatal tobacco exposure and brain morphology: a prospective study in young children. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2014;39(4):792–800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Lovejoy MC, Graczyk PA, O’Hare E, Neuman G. Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev. 2000;20(5):561–592. [DOI] [PubMed] [Google Scholar]
  • 25.Wolford E, Lahti M, Tuovinen S, et al. Maternal depressive symptoms during and after pregnancy are associated with attention-deficit/hyperactivity disorder symptoms in their 3- to 6-year-old children. PLoS One. 2017;12(12):e0190248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Van Batenburg-Eddes T, Brion MJ, Henrichs J, et al. Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross-cohort consistency study. Journal of child psychology and psychiatry, and allied disciplines. 2013;54(5):591–600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Van den Bergh BRH, van den Heuvel MI, Lahti M, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev. 2017. [DOI] [PubMed] [Google Scholar]
  • 28.Chen LC, Chen MH, Hsu JW, et al. Association of parental depression with offspring attention deficit hyperactivity disorder and autism spectrum disorder: A nationwide birth cohort study. J Affect Disord. 2020;277:109–114. [DOI] [PubMed] [Google Scholar]
  • 29.Park M, Brain U, Grunau RE, Diamond A, Oberlander TF. Maternal depression trajectories from pregnancy to 3 years postpartum are associated with children’s behavior and executive functions at 3 and 6 years. Archives of women’s mental health. 2018;21(3):353–363. [DOI] [PubMed] [Google Scholar]
  • 30.Eilertsen EM, Hannigan LJ, McAdams TA, et al. Parental Prenatal Symptoms of Depression and Offspring Symptoms of ADHD: A Genetically Informed Intergenerational Study. J Atten Disord. 2020:1087054720914386. [DOI] [PubMed] [Google Scholar]
  • 31.Mulraney M, Giallo R, Efron D, Brown S, Nicholson JM, Sciberras E. Maternal postnatal mental health and offspring symptoms of ADHD at 8–9 years: pathways via parenting behavior. Eur Child Adolesc Psychiatry. 2019;28(7):923–932. [DOI] [PubMed] [Google Scholar]
  • 32.Talge NM, Neal C, Glover V. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of child psychology and psychiatry, and allied disciplines. 2007;48(3–4):245–261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Nigg JT. Attention-deficit/hyperactivity disorder and adverse health outcomes. Clin Psychol Rev. 2013;33(2):215–228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry. 2019;28(4):481–489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Hvolgaard Mikkelsen S, Olsen J, Bech BH, Obel C. Parental age and attention- deficit/hyperactivity disorder (ADHD). Int J Epidemiol. 2017;46(2):409–420. [DOI] [PubMed] [Google Scholar]
  • 36.Maher GM, O’Keeffe GW, Kearney PM, et al. Association of Hypertensive Disorders of Pregnancy With Risk of Neurodevelopmental Disorders in Offspring: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75(8):809–819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Pearson RM, Lightman SL, Evans J. Attentional processing of infant emotion during late pregnancy and mother-infant relations after birth. Archives of women’s mental health. 2011;14(1):23–31. [DOI] [PubMed] [Google Scholar]
  • 38.Letourneau NL, Dennis CL, Cosic N, Linder J. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depression and anxiety. 2017;34(10):928–966. [DOI] [PubMed] [Google Scholar]
  • 39.McLearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W. Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Archives of pediatrics & adolescent medicine. 2006;160(3):279–284. [DOI] [PubMed] [Google Scholar]
  • 40.Azuine RE, Ji Y, Chang HY, et al. Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population. JAMA Netw Open. 2019;2(6):e196405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Russell AE, Ford T, Williams R, Russell G. The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review. Child Psychiatry Hum Dev. 2016;47(3):440–458. [DOI] [PubMed] [Google Scholar]
  • 42.Klassen LJ, Bilkey TS, Katzman MA, Chokka P. Comorbid attention deficit/hyperactivity disorder and substance use disorder: treatment considerations. Curr Drug Abuse Rev. 2012;5(3):190–198. [DOI] [PubMed] [Google Scholar]
  • 43.Christiansen H, Hirsch O, Albrecht B, Chavanon ML. Attention-Deficit/Hyperactivity Disorder (ADHD) and Emotion Regulation Over the Life Span. Curr Psychiatry Rep. 2019;21(3):17. [DOI] [PubMed] [Google Scholar]
  • 44.Heterogeneity of postpartum depression: a latent class analysis. The lancet Psychiatry. 2015;2(1):59–67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Lahti-Pulkkinen M, Girchenko P, Robinson R, et al. Maternal depression and inflammation during pregnancy. Psychol Med. 2019:1–13. [DOI] [PubMed] [Google Scholar]
  • 46.Osborne S, Biaggi A, Chua TE, et al. Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood - Depression (PRAM-D) Study. Psychoneuroendocrinology. 2018;98:211–221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Minkovitz CS, Strobino D, Scharfstein D, et al. Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics. 2005;115(2):306–314. [DOI] [PubMed] [Google Scholar]
  • 48.Ordway MR. Depressed mothers as informants on child behavior: methodological issues. Res Nurs Health. 2011;34(6):520–532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013. [DOI] [PubMed] [Google Scholar]
  • 50.Wolraich ML, Hagan JF, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Pryor L, Strandberg-Larsen K, Nybo Andersen AM, Hulvej Rod N, Melchior M. Trajectories of family poverty and children’s mental health: Results from the Danish National Birth Cohort. Soc Sci Med. 2019;220:371–378. [DOI] [PubMed] [Google Scholar]
  • 52.Erskine HE, Norman RE, Ferrari AJ, et al. Long-Term Outcomes of Attention- Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta- Analysis. Journal of the American Academy of Child and Adolescent Psychiatry. 2016;55(10):841–850. [DOI] [PubMed] [Google Scholar]
  • 53.Mendelson T, Eaton WW. Recent advances in the prevention of mental disorders. Social psychiatry and psychiatric epidemiology. 2018;53(4):325–339. [DOI] [PubMed] [Google Scholar]
  • 54.Sonuga-Barke EJ, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? Journal of child psychology and psychiatry, and allied disciplines. 2010;51(4):368–389. [DOI] [PubMed] [Google Scholar]

RESOURCES