Article open access publication

Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

Epidemiology, Wolters Kluwer, ISSN 1044-3983

Volume 29, 5, 2018

DOI:10.1097/ede.0000000000000874, Dimensions: pub.1104997671, PMID: 29923866,



  1. (1) Hospital Del Mar, grid.411142.3
  2. (2) Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain.
  3. (3) From the ISGlobal, Barcelona, Spain.
  4. (4) Pompeu Fabra University, grid.5612.0
  5. (5) Department of Epidemiology Lazio Regional Health Service, ASL Roma 1, Italy.
  6. (6) Sophia Children's Hospital, grid.416135.4
  7. (7) Institut Albert Bonniot, grid.418110.d
  8. (8) Karolinska Institute, grid.4714.6
  9. (9) Utrecht University, grid.5477.1
  10. (10) Danish Cancer Society, grid.417390.8
  11. (11) Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Germany.
  12. (12) Leibniz Institute of Environmental Medicine, grid.435557.5
  13. (13) Karolinska University Hospital, grid.24381.3c
  14. (14) Faculty of Psychology, Basque Country University UPV/EHU, San Sebastian, Spain.
  15. (15) Biodonostia, grid.432380.e
  16. (16) Research Institute, Department of Pediatrics, Marien-Hospital,Wesel, Germany.
  17. (17) French Institute of Health and Medical Research, grid.7429.8
  18. (18) Paris Descartes University, grid.10992.33
  19. (19) University of Valencia, grid.5338.d
  20. (20) Instituto de Investigación Biosanitaria, grid.507088.2
  21. (21) University of Granada, grid.4489.1
  22. (22) University of the Basque Country, grid.11480.3c
  23. (23) Ludwig Maximilian University of Munich, grid.5252.0
  24. (24) Imperial College London, grid.7445.2
  25. (25) Aarhus University, grid.7048.b, AU
  26. (26) Academic Medical Center, grid.5650.6
  27. (27) University of Copenhagen, grid.5254.6, KU
  28. (28) Stockholm County Council, grid.425979.4
  29. (29) University Medical Center Utrecht, grid.7692.a


BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs. METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up. RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range. CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at,


Research Categories

Main Subject Area

Fields of Research

Links & Metrics

NORA University Profiles

Aarhus University

University of Copenhagen

Dimensions Citation Indicators

Times Cited: 17

Field Citation Ratio (FCR): 12.84

Relative Citation ratio (RCR): 2.62

Open Access Info

Green, Published