Oxygen deprivation in utero linked to ADHD
New research shows a potential link between ADHD and decreased oxygen in utero or at the time of birth.
December 10th, 2012
04:29 PM ET

Oxygen deprivation in utero linked to ADHD

A study published in this week’s Pediatrics finds that infants who experienced oxygen deprivation in utero are at an increased risk of developing attention-deficit (hyperactivity) disorder in childhood.

Prenatal exposure to oxygen deprivation conditions, known as ischemic-hypoxic conditions, can result from birth asphyxia, neonatal respiratory distress syndrome and preeclampsia.

Researchers went through the medical records of nearly 82,000 children between the ages of 5 and 11 and found that children who had experienced those conditions were 16% more likely to be diagnosed with ADHD later in childhood.

According to the Centers for Disease Control, 8.4% of children between the ages of 3 and 7 have been diagnosed with ADHD, and boys are more likely than girls to have it. Annually, the CDC estimates ADHD-related illness in children to cost between $36 billion and $52.4 billion.

Dr. Darios Getahun, lead author of the study, said that although there may not be any interventions aside from monitoring a mother and her child through pregnancy, knowing these factors can better assist physicians in tracking and diagnosing ADHD in children.

Getahun, who works with the Kaiser Permanente Department of Research and Evaluation, added, “The study leads us to suggest that those children that are exposed, they are at risk. And it’s important to closely monitor these children as early diagnosis and treatment is most important.”

When looking at specific factors, children who had exposure to neonatal respiratory distress syndrome had a 47% greater risk of developing ADHD, followed by children whose mothers had preeclampsia, or high blood pressure during pregnancy, with a 34% greater risk. Children who had been exposed to birth asphyxia - when a baby doesn't receive enough oxygen at birth - carried a 26% greater risk of developing ADHD.

Researchers also found that the risk of ADHD was increased if the risk factors were present and the birth was preterm.

However, Getahun and researchers were quick to also note that the percentage of ADHD cases attributed to ischemic-hypoxic conditions is small – just about 3% - and said that rather on focusing on preventing such conditions, these factors were a tool.

“Our findings could have important clinical implications. They could help physicians identify newborns at risk that could benefit from surveillance and early diagnosis, when treatment is more effective,” Getahun said. “We suggest future research to focus on pre- and postnatal conditions and the associations with adverse outcomes, such as ADHD.”

soundoff (71 Responses)
  1. lydia

    I found this interesting. Im going to share this w/everyone. Especially my sister. My 7yr old niece has adhd.

    December 10, 2012 at 17:40 | Report abuse | Reply
    • Sandy

      Please spare your sister. Parents of kids with problems end up as experts in those problems, and don't need news flashes from well-meaning relatives. As for this study, there may well be a link, but it doesn't change the fact that the biggest risk factor for ADHD is family history. I'll buy that it could explain ADHD that occurs as an isolated instance, but more often you don't have to look far to find relatives with the condition, whether or not they've been diagnosed. (In my case, my daughter, my husband, some of his siblings, and one of his parents were clearly affected.)

      December 10, 2012 at 23:08 | Report abuse |
    • DKP

      My son was premature and both of us were in the ICU bc I had pre-eclampsia HELLP at Stanford. He is brilliant but has ADHD which was diagnosed when he was 4.

      December 11, 2012 at 00:06 | Report abuse |
    • D.I.

      Bare in mind that ADHD isn't a bad thing. I grew up with ADHD and kept through adult hood. I have learned that ADHD can be somewhat impairing, but when the parent(s) and child learns how to work with it, it becomes a great asset. I have never viewed it as a disability, more like a different tool in a one tool world (or to better put it, people with ADHD are given a circular saw in a world full of hammers and nails). Because most people don't have or have been exposed to the circular saw, they don't know how to work it or instruct the person that does. We try, instead of teaching a person how to use the saw and hammer, we try to tell them that they are the ones with a problem. Just because it is different doesn't mean it is wrong.

      December 12, 2012 at 08:02 | Report abuse |
    • Heather

      Lydia, you know your family better than any of us. If you think it would be a good idea to share this with your family, then go ahead. I live with ADHD everyday and love to read articles regarding ADHD and ASD.

      As for cause, correlation, factors: Its important to consider that these factors do not have to be mutually exclusive. My family history is spotty at best. Family members don't always give unbiased and informed histories. My mother did have preeclampsia and difficulties during child birth. The truth is that the human brain is complex and we are still struggling to understand it. That means we need to consider everything and be willing to allow our understanding of ADHD to evolve. It harms those of with ADHD when people refuse to change their understanding – I know about that one first hand!

      December 13, 2012 at 11:22 | Report abuse |
  2. Jaws

    ADHD isn't an illness. It's a disorder.

    December 10, 2012 at 17:42 | Report abuse | Reply
    • Gary

      I wouldn't call it a disorder. If we were still a hunter-gatherer society, I truly believe those of us with ADHD would be at a distinct advantage. In my case with ADHD I believe I am the normal one and everyone else is at a disadvantage. If I am interested in a subject, I tend to be able to process concepts and intuitively see the bigger picture before those around me. If anything I get annoyed at the "normals" because they never seem to 'get it.' I will admit the hyperfocus and seemingly OCD need to research everything to death in order to validate my intuition, plays havoc with my personal relationships.

      While undiagnosed, I had a successful decorated career in law enforcement and became a FBI certified computer forensics examiner. I am now being treated and continue to be successful minus the anxiety, self-doubt feeling of something not being 'right.'

      Recent research in cognitive functioning in people with ADHD shows a number of subtypes, all with their own strengths and weaknesses, with ADHDs frequently outperforming their "normal" counterparts.

      December 20, 2012 at 12:59 | Report abuse |
  3. Alex

    So were the children of mothers's who smoked included in the study. Smoking lowers blood oxygen levels.

    December 10, 2012 at 19:01 | Report abuse | Reply
    • Bullseye

      No doubt a huge contributor... and fetus' with their umbilical cord wrapped around their neck for months while in-utero. Fairly common...

      December 11, 2012 at 16:13 | Report abuse |
    • scott

      yeah all those mothers whom smoke while pregnant should be thrown into jail for child abuse and why does the working taxpayer have to pay for medical services on someone elses abuse there needs to be a new law put through congress on smoking while pregnant

      December 12, 2012 at 11:00 | Report abuse |
    • Miss Demi

      RE: "scott ...all those mothers whom smoke while pregnant should be thrown into jail for child abuse...why does the working taxpayer have to pay for medical services on someone elses abuse..."
      Some people, like you, aren't very bright. Ignoring them when they need help (I guess you want to PUNISH them) is considered cold or cruel by people who aren't sociopathic. Nobody is perfect, dipsnit.

      December 19, 2012 at 21:56 | Report abuse |

    I totally agree with this story and think that ...wait ..is that Sanjay Gupta up there?!? He reminds me of a guy I used to know in ..where was that? I think it was Boston, but thats another story. So like I said ADHD is a total..um..fabricated, you know, thing.

    December 10, 2012 at 19:24 | Report abuse | Reply
  5. A Mom

    This is interesting considering the high level of pitocin and other induction drugs we use here in the United States, which are known to cause oxygen problems with the baby during labor and birth.

    December 10, 2012 at 20:38 | Report abuse | Reply
    • Krista

      Thank you for bringing this up! Pitocin-induced contractions are more likely to deprived an infant from oxygen from birth. Let's start looking at the correlation using natural labor vs. induced labor for ADHD.

      February 4, 2013 at 00:19 | Report abuse |
  6. cbtx67

    It's interesting that my oldest daughter, who had the cord knotted and wrapped around her neck at birth, was the only one of my six kids with ADD.

    December 10, 2012 at 21:00 | Report abuse | Reply
    • mommajam

      Yes, my second boy of 5 also had the cord around his neck and almost flatlined before he was born. I had an oxygen mask on, but have always wondered because he is the only one with ADHD. However, it also seems to run in my family. I'm sure my father had it, my nephew has it, and I am sure I have a touch. I still think heredity is the greatest contributing factor. Are you sure there isn't a family history?

      December 11, 2012 at 08:07 | Report abuse |
  7. caitlin hollis

    i was a child with adhd and i wish this information was around a long time ago. My mother smoked all through her pregency. Iam an adult now who still is suffering from add. I thank u for this information. I found it very helpful and if i were to get pregent i would never smoke.thats a promise adhd is a serious condtion that should be looked at and find a way to get rid of it . Its ruined my life. I hope that all women who are pregent quit smoking because you are risking your childs future. Adhd effects the way you think act and respond to other people. Thank you again for this oppertunity to say my peace

    December 10, 2012 at 21:02 | Report abuse | Reply
  8. Another Mom

    Very interesting....My son has ADHD. I have a very tough delivery and he came out not breathing. It was a very short time until they got him breathing again.

    December 10, 2012 at 21:11 | Report abuse | Reply
  9. Abbie

    My son has ADHD and had a difficult time coming out. They had to use the vacuum on his head...so they could pull him out.
    I also have symptoms of ADD and I also had to be pull from my mom's birth canal. I guess it is possible that this study...holds some truth.

    December 10, 2012 at 22:11 | Report abuse | Reply
  10. Joan

    I dunno. There's a significant difference between "correlation" and causality. If the cause of ADHD was truly due to oxygen deprivation in utero, why does it run in families? No one smokes in my family, my parent's families, or my siblings' families. But my dad has it. I have it, as does my brother and one of my sisters (the other sister does not have it). Of the 3 of us siblings who have ADHD, both of my kids have it, 2 of my brothers 4 kids have it, but my sister's daughter (only child) does NOT.

    There was no preeclampia with ANY of the pregancies with those ADHD. Some of us with ADHD were born due to extended labors, but others weren't. All of us (or our kids) had normal APGARs at birth, with the exception of my sister. While my sister had significant breathing problems for the first month or so of her life (premature lungs before they knew how to test for fetal lung maturity, and were still just learning how to treat it), none of the rest of us had any problems with oxygenation at birth. With a couple of exceptions, all in my family with ADHD were full term or even late.

    That said, it is interesting that the study showed a CORRELATION with prenatal oxygenation problems, I think we're a LONG way from even saying prenatal oxygenation problems increases the chance of developing ADHD.

    December 10, 2012 at 23:03 | Report abuse | Reply
    • Robert

      Genetic predisposition to difficult birth???

      December 11, 2012 at 07:34 | Report abuse |
  11. adam

    another pie in the sky disease...so they can "treat" you. considering the US is the medication nation on earth and eat the worst foods and i wonder why your are all so diseased. Continue your water fluoridation, keep eat your high fructose corn syrup and your meds...action = cause!

    December 11, 2012 at 01:50 | Report abuse | Reply
    • Natalie

      At least there is someone who can see outside the box!

      December 11, 2012 at 13:29 | Report abuse |
    • Lyndell

      MRI's have shown a difference in brain "wiring" with ADHD individuals. We never consume high fructose corn syrup,etc. Please do your homework re: the physiological differences in ADHD and non-ADHD individuals.

      December 11, 2012 at 20:19 | Report abuse |
    • Heather

      Hey Adam, do yourself a favor and actually read the research. They do it in other countries as you appear to be bigoted towards Americans. You can find research in Germany, Bangladesh, Turkey, Crete, and the UK – that is just off the top of my head. Come back after you educate yourself.

      December 13, 2012 at 11:26 | Report abuse |
  12. Darrell

    My son was a difficult delivery and suffered from "breath holding episodes" to the point of passing out from infant to about 5 yrs old. He was dx with ADHD and had problems throughout his school life. It would be interesting to include children with similar episodes in the study

    December 11, 2012 at 06:31 | Report abuse | Reply
    • Nancy

      Wow, I have 4 children and one of them held his breath to the point of passing out until 4. One time he had a mouth full of cookie and held his breath and choked. I could not clear his throat and ran him to neighbor who was paramedic who got him breathing again. He is the only child of 4 who is adha! I've always wondered if that was why? Yes, i agree they should do a correlation of these children and how many have adhd.

      November 19, 2015 at 11:11 | Report abuse |
  13. Robert

    I have a son with aspergers thanks to Kaiser not paying attention and birthing hi with his umbilical cord around his neck .

    Sam Bernstein where are you???

    December 11, 2012 at 07:32 | Report abuse | Reply
    • SarahH

      There is no evidence supporting this claim. Asperger Syndrome is more genetically linked than the rest of the autism spectrum conditions.

      December 11, 2012 at 15:30 | Report abuse |
  14. Deejay

    ADHD is not a disorder- it just is a skill that doesn't work very well in our traditional school system (desks lined up in rows). These type people are expert at noticing details, think Army Ranger or Navy Seal. And ADHD adults have created some of the best innovations of our time; DaVinci and Thomas Edison. Learn to admire and work with your child, they grow up to be successful adults given a little room for creativity. Be very careful of the stimulant medicine to treat this 'disorder' – it can cause horrific weight loss and thoughts of SUICIDE, even in young children.

    December 11, 2012 at 09:45 | Report abuse | Reply
  15. Bob

    This article presents more evidence that many of the problems individuals have started very early in life, in this case before birth. For those who are quick to say that anyone's shortcomings are all their own fault, the evidence is clearly stacking up, in all areas of life, that perhaps one's low standing in life is not the fault of that individual. Judge not lest ye be judged.

    December 11, 2012 at 10:34 | Report abuse | Reply
  16. Dani

    The article is very interesting, but in the time of DaVinci and Edision ADHD as an illness was not discovered. Some parents really love these types of encouragements to be said. These famous people were interested in many thing, while children with ADHD are only interested in one or two things if anything at all.

    December 11, 2012 at 12:25 | Report abuse | Reply
  17. Dani

    It could be genetic or birth trauma that causing lack of oxygen. Liquids are often “cleansed” by oxygen. If these children have lower level oxygen, they are more likely to have more bacterial and fungal infections. There is not enough oxygen to cleanse.
    I never forget when my wonderful ex-box asked if these children do not eat, why are they so energetic? The question puzzled me….

    December 11, 2012 at 12:42 | Report abuse | Reply
  18. ellie

    I will be happy if ADHD is all my child will end up with.
    When your child has hypoxic ischemia at birth, you are just glad that they are alive, and secondly that there is little or no brain damage

    December 11, 2012 at 13:31 | Report abuse | Reply
  19. thinkifyoucan

    I'm curious to the level of hypoxia needed to generate this trend. If the mother is a heavy smoker, the baby gets less oxygen because the mother has less oxygen. Does minor hypoxia over extended periods of time have similar effects (like subconsussive blows having simliar effects as fewer concussive injuries to the head)?

    December 11, 2012 at 13:54 | Report abuse | Reply
  20. Pat Gallegher

    I've known this for years. I was a practicing psychologist for over a quarter century before retiring ten years ago to teach. One of my specialties was diagnosing learning disabilities and ADHD. In every evaluation I did, at some point in the evaluation I'd ask four questions: 1) Did the mother have an epidural during delivery? 2) How long was the baby stuck in the birth canal between transition and delivery and did the baby experience fetal distress or hypoxia? (more than an hour was diagnostic) 3) Was the baby delivered by forceps? and 4)Did the child have asthma during infancy and early childhood? In well over 80% of cases where I eventually diagnosed ADHD, the mothers were given an epidural, the baby was stuck in the birth canal for over an hour and did experience a lack of oxygen, or the baby was delivered by forceps, and/or the child had asthma.

    The issue has to do with the effects of hypoxia on the right prefrontal cortex of the brain. Typically, a lack of oxygen causes death of right prefrontal cortical cells, which has been linked in functional MRI studies to ADHD. This is especially true in children who have a genetic predisposition to ADHD as a result of inheriting specific genes from their parents. The higher the predisposition, the more likely hypoxia is to increase the probability of ADHD.

    December 11, 2012 at 20:04 | Report abuse | Reply
  21. Lyndell

    My son was diagnosed with ADHD at an early age, and I had a rough labor. He experienced lengthy fetal distress which resulted in an emergency C-section. In addition, he was a month premature. ADHD runs in the family, but I can't help but think his being premature and experiencing fetal distress contributed. I recall the nurse being extremely stressed while I was in labor and saying over and over my son's heart rate was way too high,etc.

    December 11, 2012 at 20:11 | Report abuse | Reply
  22. Lyndell

    hePat, I just read your excellent post, and agree 100%. I've thought for the longest time my labor was too prolonged and that my son should've been removed via C-section way sooner than was deemed appropriate. I feel he was deprived of oxygen for too great a time. Throw in the genetic predisposition and 4 week early delivery,and it was a bullseye for ADHD. Interestingly enough, my youngest brother who has Adult ADHD experienced a traumatic delivery as well. I remain frustrated to this day my son had to endure such lengthy fetal distress.

    December 11, 2012 at 20:17 | Report abuse | Reply
  23. Doug

    I was diagnosed with ADHD when I was five and I also had respiratory problems after I was born. This is very relieving to me now that I have a possible link to the cause.

    December 11, 2012 at 22:00 | Report abuse | Reply
  24. Heather

    I have heard this before from my sons doctor. My son has ADHA' he was stuck in the birth canal for almost 6 hours' I knew something was wrong since my first 2 children were born in 2 hours from start to finish. I kept asking for a doctor but he refused to come into my room, it turns out reading the newspaper and watching the football game consumed him outside my room. While in labor it felt like my left leg was being pulled apart in my groin area' I knew this was not normal, I ended up breaking both of his clavical bones on the same side that my leg felt torn off' he was stuck in the birth canal so long that he started to breathe in the fluid and both lungs colapsed, he got a horrible lung infection, the doctor induced me 5 weeks to early so his lungs were also undeveloped, he spent 3 weeks in NICU, died twice, he was bruised so badly, liver funtion low, We feel blessed that he lived and is now 18 years old, He has a lot of difficulty in life with with ADHD, he frustrates easily, does not handle stress well and emotionally he acts more like he is 13, he graduated highschool on the A/B honor roll with awesome teachers, he holds a full time job and his employers love him since he does one thing at a time very well. I believe this article is accurate, ADHD does not run in our family, he is the only one in 3 children to have it.

    December 11, 2012 at 23:14 | Report abuse | Reply
    • D.I.

      I grew up with ADHD, my brother with ADD. I think your son was misdiagnosed unless he learned how to do one thing at a tie slowly in life.

      December 12, 2012 at 08:03 | Report abuse |
  25. henry

    i find this very interesting..i am 21 years old, but when i was 7 i was diagnosed with adhd...i wouldve never thought that my birthcompplications couldve played a roll..when i was being born my umbilical cord was wraped around my neck. l

    December 14, 2012 at 21:03 | Report abuse | Reply
  26. Aman

    Have fun with that! LazyGal always gives me a marekr to aim for. There's a woman I see at family gatherings who brags when she reads 100 books a year. I always bite my tongue. She can't know I read half again as many in a slower year. But then, LazyGal and I are abnormal. At 38 books in 3 months, you're wonderfully abnormal, too.

    December 21, 2012 at 06:02 | Report abuse | Reply
  27. Beth

    I had pre-e when pregnant with my son, my oldest, and of my 3 kids, he is also ADHD.

    What is also interesting to me is that high blood pressure during pregnancy is thought to be hereditary, and so is ADHD...another link there maybe?

    December 22, 2012 at 08:57 | Report abuse | Reply
  28. Annette

    My son was cord was wrapped around his neck and under his arm. I was given oxygen but they never took a scan to see why his hart was dropping. It wasn't until the very end and eveything got serious. Michael was diagnosed with ADHD, then later with Bi-polar now he has schitzophrenia. Could any of this be related. He's in the hospital for the 5 times since May. He went back in last Tuesday. He's only 21 and his life is over.

    January 18, 2013 at 11:27 | Report abuse | Reply
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  30. cynthia curran

    Well, I didn't breath at birth and was given Oxygen and at age 6 the doctors said I had hyperactivity, the old name for ADHD in the 1960's. Academy behind my fellow classmates, so probably some learning disabilities as well as the hyperactivity. Copy of IQ tests did better as I aged from 6 to 12 years, there is a delay with ADHD in certain abilities even with normal intelligent. This all makes sense, unfortunately in the 1960's, they only had a tiny picture of the ADHD picture and I had to find this out as a middle aged person, that it was true that I do have ADHD.

    August 13, 2013 at 01:07 | Report abuse | Reply
  31. cynthia curran

    My son was cord was wrapped around his neck and under his arm. I was given oxygen but they never took a scan to see why his hart was dropping. It wasn't until the very end and eveything got serious. Michael was diagnosed with ADHD, then later with Bi-polar now he has schitzophrenia. Could any of this be related. He's in the hospital for the 5 times since May. He went back in last Tuesday. He's only 21 and his life is over.
    This is very possible, I was thought a moron as a child but the ADHD and learning difficulties might have lowered the earlier IQ tests but had to spend 6 years in an EMR Class before I was placed in a regular class.

    August 13, 2013 at 01:11 | Report abuse | Reply
  32. cynthia curran

    I dunno. There's a significant difference between "correlation" and causality. If the cause of ADHD was truly due to oxygen deprivation in utero, why does it run in families? No one smokes in my family, my parent's families, or my siblings' families. But my dad has it. I have it, as does my brother and one of my sisters (the other sister does not have it). Of the 3 of us siblings who have ADHD, both of my kids have it, 2 of my brothers 4 kids have it, but my sister's daughter (only child) does NOT.
    Its a combination of factors, my father might had ADHD and dyslexia since he reads at 6th grade with normal intelligent. The lack of Oxygen may make the genetic factors lead a person to have ADHD in some situations. My father was born in 1929 and I was born in 1957 when ADHD and the learning disabilities theories were started being developed in may childhood.

    August 13, 2013 at 01:25 | Report abuse | Reply
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