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In this study, ADHD symptoms at pre-school age children in association with prenatal passive and active tobacco smoke exposure determined by maternal plasma cotinine levels in the third trimester were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a follow-up study of the birth cohort: the Hokkaido Study on Environment and Children\u2019s Health. Children whose parents answered Strengths and Difficulties Questionnaire (SDQ) to identify child ADHD symptoms (hyperactivity\/inattention and conduct problems) and total difficulties at age 5 years with available maternal plasma cotinine level at the third trimester were included (<jats:italic>n<\/jats:italic>= 3216). Cotinine levels were categorized into 4 groups; \u2266\u20090.21\u2009ng\/ml (non-smoker), 0.22\u20130.51 ng\/ml (low-passive smoker), 0.52\u201311.48\u2009ng\/ml (high-passive smoker), and \u2267\u200911.49\u2009ng\/ml (active smoker).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Maternal cotinine levels of active smokers were significantly associated with an increased risk of total difficulties (OR = 1.67) and maternal low- and high-passive smoking also increased the risk (OR = 1.11, 1.25, respectively) without statistical significance. Similarly, maternal cotinine levels of active smokers were associated with an increased risk of hyperactivity\/inattention (OR = 1.49). Maternal low- and high-passive smoking and active smoking increased the risk of hyperactivity\/inattention (OR = 1.45, 1.43, and OR = 1.59, respectively) only in boys.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings suggested that maternal active smoking during pregnancy may contribute to the increased risk of child total difficulties and hyperactivity\/inattention at pre-school age. Pregnant women should be encouraged to quit smoking and avoid exposure to tobacco smoke.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12199-019-0834-4","type":"journal-article","created":{"date-parts":[[2019,12,7]],"date-time":"2019-12-07T05:05:41Z","timestamp":1575695141000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Prenatal tobacco exposure and ADHD symptoms at pre-school age: the Hokkaido Study on Environment and Children\u2019s Health"],"prefix":"10.1186","volume":"24","author":[{"given":"Machiko","family":"Minatoya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuko","family":"Araki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Itoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumitaka","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chihiro","family":"Miyashita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiko","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reiko","family":"Kishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,7]]},"reference":[{"issue":"9","key":"834_CR1","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1001\/jamapsychiatry.2013.127","volume":"70","author":"D Gaysina","year":"2013","unstructured":"Gaysina D, Fergusson DM, Leve LD, Horwood J, Reiss D, Shaw DS, et al. 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The protocol used in this study was approved by the Institutional Ethical Board for epidemiological studies at the Hokkaido University Graduate School of Medicine (May 31, 2003) and Hokkaido University Center for Environmental and Health Sciences (reference no. 14, March 22, 2012).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"74"}}