Prenatal Exposure To Tobacco Increases Risk of ADHD Symptoms Interview with:
Nathalie E. Holz, MA
Department of Child and Adolescent Psychiatry and Psychotherapy
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

MedicalResearch: What are the main findings of the study?

Dr. Holz: Using data from a prospective community sample followed since birth, we investigated the impact of prenatal maternal smoking on lifetime Attention-Deficit/ Hyperactivity Disorder (ADHD) symptoms and on brain structure and inhibitory control assessed with Magnetic Resonance Imaging in the adult offspring. Those who were prenatally exposed to tobacco not only exhibited more ADHD symptoms, but also showed decreased activity in the inhibitory control network encompassing the inferior frontal gyrus as well as the anterior cingulate cortex. Activity in these regions was inversely related to lifetime ADHD symptoms and novelty seeking, respectively. In addition volume in the inferior frontal gyrus was decreased in these participants.

MedicalResearch: Were any of the findings unexpected?

Dr. Holz: Although not completely unexpected, it was still surprising to find such a reliable effect of prenatal exposure to tobacco smoke on brain structure and function measured 25 years later. In addition these effects turned out to be stable after controlling for many confounders such as prenatal and postnatal adversity and the offspring’s lifetime substance abuse.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Holz: Our results underline the importance of prenatal exposure to adversity and show that prevention should start as early as pregnancy. Thereby we strongly encourage the advancement of psychoeducation programs for pregnant women and for those planning pregnancy.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Holz: Future research should concentrate on the molecular mechanisms, such as epigenetics, behind this association in order to not only prevent these detrimental effects but also to find possible treatments for those affected.


Nathalie E. Holz, MA; Regina Boecker, MA; Sarah Baumeister, MA; Erika Hohm, MA; Katrin Zohsel, PhD; Arlette F. Buchmann, PhD; Dorothea Blomeyer, PhD; Christine Jennen-Steinmetz, PhD; Sarah Hohmann, MD; Isabella Wolf, PhD; Michael M. Plichta, PhD; Andreas Meyer-Lindenberg, MD, PhD; Tobias Banaschewski, MD, PhD; Daniel Brandeis, PhD; Manfred Laucht, PhD


Last Updated on May 21, 2014 by Marie Benz MD FAAD