Low-moderate Prenatal Alcohol Exposure and Offspring Attention-deficit Hyperactivity Disorder (ADHD): Systematic Review and Meta-analysis

Purpose: To evaluate the available evidence on the association between low-to-moderate prenatal alcohol exposure (PAE) and the development of attention-deficit hyperactivity disorder (ADHD) symptoms in the offspring.

Methods: We systematically reviewed and meta-analysed studies reporting an association between low and/or moderate PAE and offspring ADHD symptoms (attention and/or hyperactivity). Systematic searches were performed in EMBASE, Pubmed, Medline, and PsycINFO and reviewed from selected references. Random effects modelling was conducted to pool adjusted odds ratios (OR) in different alcohol consumption levels (≤ 20 g/week, ≤ 50 g/week, and ≤ 70 g/week). Stratified analysis by sex per alcohol level was conducted to investigate the difference on OR and the magnitude between-study heterogeneity.

Results: Ten studies were included in the systematic review and six in the meta-analysis. Eight studies found no association and two studies suggested an apparent protective effect of low PAE in hyperactivity/inattention symptoms in boys. These results were confirmed by the meta-analysis showing no association between ≤ 20 g/week [OR 1.01 (0.68-1.49)], ≤ 50 g/week [OR 0.94 (0.85-1.03)] and ≤ 70 g/week [OR 0.94 (0.86-1.02)] and ADHD symptoms, with no evidence of publication bias. Stratified analysis by sex for a PAE ≤ 50 g/week exposed less risk of ADHD symptoms in boys compared to girls [OR 0.89 (0.83-0.96)].

Conclusions: We found no increased risk of ADHD symptoms in offspring born to mothers who drank alcohol up to 70 g/week.