Authors:
Hyun Ruisch | University Medical Center Groningen | Netherlands
Dr. Andrea Dietrich | University Medical Center Groningen | Netherlands
Dr. Jeffrey Glennon | Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center | Netherlands
Prof. Dr. Jan Buitelaar | Karakter Child and Adolescent Psychiatry University Centre | Netherlands
Prof. Dr. Pieter Hoekstra | University Medical Center Groningen | Netherlands
Objective: We aimed to conduct a comprehensive study on a variety of pre- and perinatal complications in relation to oppositional-defiant disorder (ODD) and conduct disorder (CD) symptomatology in a large, prospective, general population cohort (Avon Longitudinal Study of Parents and Children).
Methods: Our outcome of interest consisted of ODD/CD-symptom scores, rated by the mother and teacher at the age of 7 years and 9 months. Due to skewed distributions of outcome data, analyses were conducted using zero-inflated negative binomial models. Pre- and perinatal predictors were selected using a stepwise process involving single and multivariable models, and analyses were adjusted for offspring sex, IQ, maternal age, SES, and single parent status. Sample sizes for the final analyses were 4,888 for maternal and 2,808 for teacher ratings of ODD/CD-symptoms.
Results: Associations were observed between offspring ODD/CD-symptoms and maternal smoking (maternal and teacher ratings incidence rate ratio (IRR) = 1.28 (1.12-1.45) and 1.48 (1.18-1.87) respectively), alcohol use (maternal ratings IRR = 1.16 (1.05-1.28)), paracetamol use (teacher ratings IRR = 1.36 (1.11-1.66)), internalizing problems (maternal and teacher ratings IRR = 1.21 (1.15-1.28) and 1.15 (1.02-1.28) respectively), and life events stress (maternal ratings IRR = 1.15 (1.09-1.21)) during pregnancy. No associations were observed between ODD/CD-symptoms and perinatal adversities such as low birth weight or obstetric complications.
Conclusion: We added further evidence for a number of previously implicated risk factors, and are the first study to report paracetamol use during pregnancy as a predictor for offspring ODD/CD-symptoms. Shared genetic and social factors between mother and child, as well as co-existent psychopathology may, however, confound these associations. Future studies are therefore needed to advance our understanding of these effects, for example by using genetically sensitive study designs and controlling for comorbid disruptive behavior.