Perceived Stress During Pregnancy and Offspring Attention-Deficit/Hyperactivity Disorder: Findings From the ECHO Cohort Study

Objective Attention deficit hyperactivity disorder (ADHD) affects an increasing number of children in the United States. Identifying risk factors is paramount to decreasing ADHD burden in the population. This study sought to examine the prospective association between maternal prenatal perceived stress and ADHD diagnosis in offspring. Method A diverse subset of 6,080 mother-child dyads from the Environmental Influences on Child Health Outcomes (ECHO) cohort study met our analytic inclusion criteria. Child age ranged from 3 to 15 years. Associations between maternal perceived stress during pregnancy and prospective offspring: (1) ADHD diagnosis, by a health care provider, or (2) ADHD symptoms, assessed with the Child Behavior Checklist, were evaluated using generalized regression models, adjusted for sociodemographic and lifestyle covariates. Sex- and age-stratified models assessed possible effect measure modification. Results High maternal perceived stress during pregnancy was associated with increased odds of offspring ADHD diagnosis (aOR = 2.46 [1.47, 4.15]) and higher scores on CBCL ADHD-related subscales (aOR ADHD DSM5 clinical vs normal = 5.14 [2.44, 10.86] and , β externalizing problems = 7.66 [6.57, 8.75] among preschool aged children, and aOR ADHD DSM5 clinical vs normal = 4.94 [1.22, 20.03] and β externalizing problems = 7.04 [4.34, 9.75] among school aged children). Conclusion Findings suggest that maternal prenatal perceived stress is associated with increased ADHD diagnosis risk and symptoms in offspring. Minimizing stress during pregnancy through stress management or other programs may facilitate improved management of ADHD symptoms in youth.