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Commentary: Maternal pre-pregnancy BMI and offspring ADHD: a lesson in the importance of testing causal pathways

Langley, Kate ORCID: and Thapar, Anita ORCID: 2014. Commentary: Maternal pre-pregnancy BMI and offspring ADHD: a lesson in the importance of testing causal pathways. International Journal of Epidemiology 43 (1) , pp. 91-93. 10.1093/ije/dyt275

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The question of which environmental risk factors have a causal effect is extremely important for the field of child psychopathology, but one that is frequently overlooked or inadequately tested. Putative environmental risk factors, such as maternal pre-pregnancy obesity, which can be altered or avoided by the individual, are especially important to identify. However there is a need to rigorously investigate whether associated risks are causal, to ensure that preventative interventions and public health messages target factors which will actually lead to improvement in child outcomes. The paper by Chen and colleagues1 moves the field forward with just such an investigation of the relationship between maternal pre-pregnancy body mass index (BMI) and offspring attention deficit/hyperactivity disorder (ADHD). The elegance of this study is that first, in a large population cohort (n = 673 632), the authors demonstrate association between maternal pre-pregnancy overweight/obesity and increased risk for offspring ADHD (HRoverweight = 1.23, P = 0.01, HRobesity = 1.64, P = 0.01) as found in previous studies, and apply the same statistical controls for measured covariates. Using a subset of the sample (n = 272 790), Chen and colleagues then test whether the observed associations are due to intrauterine effects by comparing the risk of ADHD in full siblings discordant for exposure to maternal pre-pregnancy overweight/obesity (n = 19 814). Their finding that the previously observed association was attenuated (HRoverweight = 0.98, P = 0.82, HRobesity = 1.15, P = 0.38) suggests that familial confounding, rather than a direct intrauterine effect, accounts for the previous associations.

Item Type: Article
Date Type: Publication
Status: Published
Schools: MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Neuroscience and Mental Health Research Institute (NMHRI)
Subjects: R Medicine > R Medicine (General)
Publisher: Oxford University Press
ISSN: 0300-5771
Last Modified: 28 Oct 2022 09:43

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