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      Association Between Maternal Exposure to Magnetic Field Nonionizing Radiation During Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in Offspring in a Longitudinal Birth Cohort

      research-article
      , MD, PhD 1 , , , MPH 1 , , MPH 1 , , MS 1 , , MSPH 1
      JAMA Network Open
      American Medical Association

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          Key Points

          Question

          Could human exposure to magnetic field nonionizing radiation be associated with increased risk of attention-deficit/hyperactivity disorder in children?

          Findings

          This birth cohort study found a statistically significant association between a high level of maternal exposure to magnetic field nonionizing radiation, as captured with a monitoring meter, during pregnancy and an increased risk of attention-deficit/hyperactivity disorder in offspring. The association was stronger for children who received a diagnosis of attention-deficit/hyperactivity disorder in adolescence (≥12 years of age) than for those without such a diagnosis in adolescence, and primarily for children with attention-deficit/hyperactivity disorder with immune-related comorbidities.

          Meaning

          The findings should spur more research to examine the biological association of in utero magnetic field exposure with risk of attention-deficit/hyperactivity disorder in offspring.

          Abstract

          Importance

          An association between maternal exposure to magnetic field (MF) nonionizing radiation during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) has been reported in both animal and human studies.

          Objectives

          To determine whether maternal exposure to high levels of MF nonionizing radiation is associated with an increased risk of ADHD in offspring by using more accurate measurements of MF nonionizing radiation levels and physician-diagnosed ADHD, rather than self-reports, and to determine whether the association differs for the subtypes of ADHD with or without immune-related comorbidities.

          Design, Setting, and Participants

          A longitudinal birth cohort study was conducted at Kaiser Permanente Northern California among 1482 mother-child pairs whose mothers were participants of an existing birth cohort and whose level of exposure to MF nonionizing radiation was captured during pregnancy in 2 studies conducted from October 1, 1996, to October 31, 1998, and from May 1, 2006, to February 29, 2012. The offspring were followed up from May 1, 1997, to December 31, 2017.

          Exposure

          All participating women wore a monitoring meter for 24 hours during pregnancy to capture the level of exposure to MF nonionizing radiation from any sources.

          Main Outcomes and Measures

          Physician-diagnosed ADHD and immune-related comorbidities of asthma or atopic dermatitis up to 20 years of age in offspring captured in the Kaiser Permanente Northern California electronic medical record from May 1, 1997, to December 31, 2017. Confounders were ascertained during in-person interviews during pregnancy.

          Results

          Among the 1454 mother-child pairs (548 white [37.7%], 110 African American [7.6%], 325 Hispanic [22.4%], 376 Asian or Pacific Islander [25.9%], and 95 other or unknown [6.5%]; mean [SD] maternal age, 31.4 [5.4] years]), 61 children (4.2%) had physician-diagnosed ADHD. Using Cox proportional hazards regression to account for follow-up time and confounders, compared with children whose mothers had a low level of exposure to MF nonionizing radiation during pregnancy, children whose mothers were exposed to higher levels of MF nonionizing radiation had more than twice the risk of ADHD (adjusted hazard ratio [aHR], 2.01; 95% CI, 1.06-3.81). The association was stronger for ADHD that persisted into adolescence (≥12 years of age), with an aHR of 3.38 (95% CI, 1.43-8.02). When the subtypes of ADHD were examined, the association existed primarily for ADHD with immune-related comorbidities (asthma or atopic dermatitis), with an aHR of 4.57 (95% CI, 1.61-12.99) for all ADHD cases and an aHR of 8.27 (95% CI, 1.96-34.79) for persistent cases of ADHD.

          Conclusions and Relevance

          Consistent with the emerging literature, this study suggests that in utero exposure to high levels of MF nonionizing radiation was associated with an increased risk of ADHD, especially ADHD with immune-related comorbidity. The findings should spur more research to examine the biological association of in utero MF exposure with risk of ADHD in offspring, given that almost everyone is exposed to it.

          Abstract

          This cohort study examines whether maternal exposure to high levels of magnetic field nonionizing radiation is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.

          Related collections

          Most cited references27

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          Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis

          Background Reports of frequent manifestation of allergic diseases in children with attention deficit hyperactivity disorder (ADHD) have been the subject of mounting clinical interest. However, evidence supporting the association between ADHD and allergies is inconsistent and has yet to be systematically reviewed. The objective of this study was to compile and assess available studies on the association between ADHD and allergic diseases in children. Methods A comprehensive search using MEDLINE, EMBASE, the Cochrane library, and CINAHL databases was completed in 23 November 2015. The inclusion criteria for studies were that the research assessed allergic diseases in children, 18 years of age and younger, with a diagnosis of ADHD and that a distinct comparison group was incorporated. Any comparative studies, encompassing both randomized controlled trials and observational studies, were considered for inclusion. Two review authors independently assessed the quality of the selected studies by the use of validated assessment tools, performed data extraction and conducted meta-analysis according to Cochrane Collaboration guidelines. Results Five eligible studies were included in this systematic review. Of these studies, three were case-control and two were cross sectional studies. A majority of information from the five studies was classified as having low or unclear risk of bias. The meta-analysis showed an association between children with ADHD and asthma compared with the control groups (OR: 1.80, 95% CI: 1.57 - 2.07; five studies, low quality of evidence), but did not indicate an association between food allergy and ADHD (OR: 1.13, 95% CI: 0.88 - 1.47; three studies very low quality of evidence). The odds of experiencing allergic rhinitis, atopic dermatitis, and allergic conjunctivitis were slightly higher in children with ADHD compared with control groups, though a substantial statistical heterogeneity was notable in the overall effect estimates. Conclusions The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1281-7) contains supplementary material, which is available to authorized users.
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            Update on environmental risk factors for attention-deficit/hyperactivity disorder.

            Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder affecting 5% to 10% of children. Although considered to be a highly familial disorder, ADHD heritability estimates of 60% to 80% highlight the considerable role that environmental factors may still play in disorder susceptibility. Proposed ADHD environmental risk factors include prenatal substance exposures, heavy metal and chemical exposures, nutritional factors, and lifestyle/psychosocial factors. This paper reviews the literature published in 2010 investigating the association between environmental risk factors and ADHD or related symptomatology. Sources of risk factor exposure and the proposed mechanism by which each exposure is linked to ADHD-related neurobehavioral changes are also reported. Methodologic limitations of the current literature are discussed, and guidelines for future study are proposed. An improved understanding of the role that environmental factors play in ADHD etiology is critical to future ADHD prevention efforts.
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              Attention-Deficit/Hyperactivity Disorder in Offspring of Mothers With Inflammatory and Immune System Diseases.

              Prenatal inflammatory mechanisms may play a role in the pathogenesis of psychiatric disorders and could be relevant for attention-deficit/hyperactivity disorder (ADHD). We investigated maternal chronic somatic diseases with immune components as possible risk factors for ADHD in offspring.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                24 March 2020
                March 2020
                24 March 2020
                : 3
                : 3
                : e201417
                Affiliations
                [1 ]Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, California
                Author notes
                Article Information
                Accepted for Publication: January 30, 2020.
                Published: March 24, 2020. doi:10.1001/jamanetworkopen.2020.1417
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Li D-K et al. JAMA Network Open.
                Corresponding Author: De-Kun Li, MD, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ( dkl@ 123456dor.kaiser.org ).
                Author Contributions: Dr Li had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Li.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Li.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Li, Chen, Ferber, Hirst.
                Obtained funding: Li.
                Administrative, technical, or material support: Li, Ferber, Odouli.
                Supervision: Li.
                Conflict of Interest Disclosures: None reported.
                Funding/Support: This study was supported through funds provided by the National Institute of Environmental Health Sciences and the California Public Health Foundation.
                Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Article
                zoi200077
                10.1001/jamanetworkopen.2020.1417
                7093768
                32207831
                121c6b6e-9097-46b5-8c3a-e781fd9685ff
                Copyright 2020 Li D-K et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 11 October 2019
                : 30 January 2020
                Categories
                Research
                Original Investigation
                Online Only
                Environmental Health

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