Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Dec 19, 2024; 14(12): 1956-1970
Published online Dec 19, 2024. doi: 10.5498/wjp.v14.i12.1956
Association of premature birth and maternal education level on attention deficit hyperactivity disorder in children: A meta-analysis
Yin-Kai Zhao, Meng Li, Ting-Ting Shi, Miao-Miao Feng, Lu-Lu Hu
Yin-Kai Zhao, Ting-Ting Shi, Lu-Lu Hu, Third Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Meng Li, Academy of Marxism, Henan Open University, Zhengzhou 450061, Henan Province, China
Miao-Miao Feng, Department of Neuroelectrophysiology, Zhengzhou Central Hospital, Zhengzhou 450007, Henan Province, China
Author contributions: Zhao YK wrote the original draft; Li M contributed to the methodology and software; Feng MM participated in the project administration; Shi TT contributed to the formal analysis and writing of the original draft; Hu LL conceptualization, writing, reviewing and editing. All the authors participated in drafting the manuscript, and all the authors read, contributed to, and approved the final version of the manuscript.
Supported by Henan Medical Science and Technology Research Joint Construction Project, No. LHGJ20190360.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lu-Lu Hu, MD, Associate Chief Physician, Associate Professor, Third Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi District, Zhengzhou 450052, Henan Province, China. hululu2006@163.com
Received: September 7, 2024
Revised: September 28, 2024
Accepted: October 28, 2024
Published online: December 19, 2024
Processing time: 81 Days and 6.1 Hours
Abstract
BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood. There is growing evidence that both preterm birth and maternal education levels substantially affect the likelihood of ADHD in children. However, there are limited systematic reviews and meta-analyses examining these associations.

AIM

To systematically review and conduct a meta-analysis on the association of preterm birth and maternal education level on the risk of ADHD in children.

METHODS

We conducted a comprehensive literature search across MEDLINE (PubMed), Web of Science, Embase, and the Cochrane Library, including studies published up to June 17, 2024. Data synthesis was performed using random-effect models, and the quality of studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

This study included twelve studies, which revealed a significant association between premature delivery and an increased risk of ADHD in children [odds ratio (OR) = 2.76, 95% confidence interval (CI): 2.52-3.04, P < 0.001, I² = 1.9%). Conversely, higher maternal education levels were significantly associated with a reduced risk of ADHD in children (OR = 0.59, 95%CI: 0.48-0.73, P < 0.001, I² = 47.1%). Subgroup analysis further indicated that maternal education levels significantly influenced ADHD risk, particularly in studies conducted in China (OR = 0.59, 95%CI: 0.46-0.75, P < 0.001, I² = 81.2%), while no significant association was observed in studies from other regions (OR = 1.25, 95%CI: 0.66-2.40, P = 0.495, I² = 92.3%). The sensitivity analysis confirmed the robustness of our findings, showing no significant publication bias.

CONCLUSION

This study found that preterm birth significantly increases the risk of ADHD in children, while a higher maternal education level serves as a protective factor against ADHD. To reduce the incidence of ADHD in children, public health policies should focus on early intervention for preterm infants and improving maternal education levels.

Keywords: Attention deficit hyperactivity disorder; Maternal education level; Meta-analysis; Preterm birth; Systematic review

Core Tip: Preterm birth significantly increases the risk of attention deficit hyperactivity disorder (ADHD) in children, with those born prematurely before 32 weeks facing even higher vulnerability due to neurodevelopmental challenges. Conversely, higher maternal education levels correlate with reduced ADHD risk, particularly noted in studies from China where maternal education of more than 12 years lowered the risk significantly. The intersection of these factors compounds ADHD risk, emphasizing the need for early identification and targeted interventions. Healthcare strategies should include enhanced prenatal care and parent education programs, while policy efforts should focus on improving maternal education to mitigate ADHD risks effectively. Future research should focus on longitudinal studies and underlying mechanisms to refine preventive strategies.