Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Ryane Lester, PA-C


Background: Smoking during pregnancy has been linked to various health outcomes in offspring. The relationship between nicotine (smoke) exposure during pregnancy and behavioral disorders, such as attention deficit hyperactivity disorder (ADHD), has been studied for years yielding mixed results. These studies have varied in quality of design and methods, alluding to varied association conclusions. The purpose of this summative review is to determine the association between prenatal nicotine exposure and risk of developing behavioral disorders, such as ADHD.

Methods: A systematic search using Lindell Library and PubMed was used to find peer- reviewed studies on the topics of maternal nicotine exposure during pregnancy, and smoking during pregnancy and behavioral disorders in offspring. Specific areas of interest included maternal smoking during pregnancy and ADHD, nicotine exposure during pregnancy and effects on offspring, and ADHD.

Results: Several large sample studies indicate there is a correlation between nicotine exposure in utero and ADHD in offspring. However, a few smaller, single population or regional studies fail to confirm the relationship. This indicates more research needs to be conducted.

Conclusions: More research needs to be done on the topic, particularly prospectively, while addressing confounding variables. More recent research using various forms of nicotine exposure, such as vaping or e-cigarette use, needs to be done using a large-scale study in various populations to examine the possible associated risks. Smoking during pregnancy is still not recommended, in any form, because of the known poor health outcomes for mother and baby, and possible associated risks of behavioral disorders.


SC 11.PAS.2020.Eklund.B