Maternal polycystic ovary syndrome and attention deficit hyperactivity disorder in offspring at 3 years of age: Odense Child Cohort

Acta Obstet Gynecol Scand. 2021 Nov;100(11):2053-2065. doi: 10.1111/aogs.14259. Epub 2021 Sep 6.


Introduction: Previous data suggested a link between maternal polycystic ovary syndrome (PCOS) and offspring attention deficit hyperactivity disorder (ADHD), which could be mediated by higher prenatal androgen exposure.

Material and methods: The study was part of the prospective Odense Child Cohort and included 1776 pregnant women, 165 (9%) with PCOS and 1607 (91%) controls. ADHD symptoms at 3 years of age were defined using the parent-reported questionnaire Child Behavior Checklist/1.5-5 (scores >90th centile of Danish national standard). Maternal blood samples were collected in the third trimester measuring total testosterone by mass spectrometry, sex hormone-binding globulin, and calculated free testosterone. Offspring anogenital distance was measured at 3 months of age. Regression models were performed with presence of ADHD symptoms as the dependent variable and adjusted for maternal age, body mass index, parity, smoking status, educational level, and parental psychiatric diagnoses.

Results: ADHD symptoms were present in 105/937 (11%) boys and 72/839 (9%) girls. In boys, maternal PCOS was positively associated with ADHD symptoms (unadjusted odds ratio [OR] 1.91, 95% CI 1.07-3.43, p = 0.03, adjusted OR 2.20, 95% CI 1.20-4.02, p = 0.01), whereas maternal PCOS was not associated with ADHD symptoms in girls. Maternal total testosterone, free testosterone, and offspring anogenital distance were not associated with higher risk of ADHD symptoms in the offspring.

Conclusions: Higher risk of ADHD in boys born of mothers with PCOS were not associated with maternal third-trimester testosterone levels or offspring anogenital distance.

Keywords: Odense Child Cohort; anogenital distance; attention deficit hyperactivity disorder; polycystic ovary syndrome; testosterone.

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Biomarkers / blood
  • Child, Preschool
  • Denmark / epidemiology
  • Female
  • Fetal Development
  • Humans
  • Male
  • Polycystic Ovary Syndrome / complications*
  • Pregnancy
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • Sex Hormone-Binding Globulin / metabolism
  • Surveys and Questionnaires
  • Testosterone / blood


  • Biomarkers
  • Sex Hormone-Binding Globulin
  • Testosterone