Pregnancy risk factors in relation to oppositional-defiant and conduct disorder symptoms in the Avon Longitudinal Study of Parents and Children

J Psychiatr Res. 2018 Jun;101:63-71. doi: 10.1016/j.jpsychires.2018.02.020. Epub 2018 Feb 23.


Background: Pregnancy factors have been implicated in offspring oppositional-defiant disorder (ODD) and conduct disorder (CD) symptoms. Literature still holds notable limitations, such as studying only a restricted set of pregnancy factors, use of screening questionnaires which assess broadly defined outcome measures, and lack of control for disruptive behavior comorbidity and genetic confounds. We aimed to address these gaps by prospectively studying a broad range of pregnancy factors in relation to both offspring ODD and CD symptomatology in the Avon Longitudinal Study of Parent and Children.

Methods: Outcomes were ODD and CD symptom scores at age 7;9 years using the Development and Well-Being Assessment interview. We analyzed maternal (N ≈ 6300) and teacher ratings (N ≈ 4400) of ODD and CD scores separately using negative binomial regression in multivariable models. Control variables included comorbid attention-deficit/hyperactivity disorder symptoms, ODD or CD symptoms as appropriate, and genetic risk scores based on an independent CD genome-wide association study.

Results: Higher ODD symptom scores were linked to paracetamol use (IRR = 1.24 [98.3% confidence interval 1.05-1.47], P = 0.002, teacher ratings) and life events stress (IRR = 1.22 [1.07-1.39], P = 0.002, maternal ratings) during pregnancy. Higher CD symptom scores were linked to maternal smoking (IRR = 1.33 [1.18-1.51], P < 0.001, maternal ratings), life events stress (IRR = 1.24 [1.11-1.38], P < 0.001, maternal ratings) and depressive symptoms (IRR = 1.14 [1.01-1.30], P = 0.006, maternal ratings) during pregnancy.

Conclusions: Common and potentially preventable pregnancy risk factors were independently related to both offspring ODD and CD symptomatology in children from the general population. Future studies should further address genetic confounds and confounding by environmental factors later in life.

Keywords: ALSPAC; Conduct disorder; Oppositional defiant disorder; Paracetamol; Prenatal exposure; Smoking during pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / adverse effects*
  • Analgesics, Non-Narcotic / adverse effects*
  • Attention Deficit and Disruptive Behavior Disorders* / chemically induced
  • Attention Deficit and Disruptive Behavior Disorders* / epidemiology
  • Attention Deficit and Disruptive Behavior Disorders* / etiology
  • Child
  • Conduct Disorder / chemically induced
  • Conduct Disorder / epidemiology
  • Conduct Disorder / etiology
  • Depression* / complications
  • Depression* / epidemiology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Pregnancy
  • Prenatal Exposure Delayed Effects* / chemically induced
  • Prenatal Exposure Delayed Effects* / epidemiology
  • Prenatal Exposure Delayed Effects* / etiology
  • Risk Factors
  • Smoking* / adverse effects
  • Smoking* / epidemiology
  • Stress, Psychological* / complications
  • Stress, Psychological* / epidemiology
  • United Kingdom / epidemiology


  • Analgesics, Non-Narcotic
  • Acetaminophen