Maternal Smoking During Pregnancy and Neonatal Behavior: A Large-Scale Community Study

Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA.
PEDIATRICS (Impact Factor: 5.47). 06/2009; 123(5):e842-8. DOI: 10.1542/peds.2008-2084
Source: PubMed


To investigate the influence of prospectively measured smoking during pregnancy on aspects of neonatal behavior in a large community sample.
Participants were mothers and infants from the Providence, Rhode Island, cohort of the National Collaborative Perinatal Project enrolled between 1960 and 1966. Mothers with pregnancy/medical complications and infants with medical complications and/or born premature or of low birth weight were excluded. The final sample included 962 mother-infant pairs, 23% of whom were black. Maternal smoking was measured prospectively at each prenatal visit. Neonatal behavior was assessed by using the Graham-Rosenblith Behavioral Examination of the Neonate. Items from the examination were reduced to 3 subscales: irritability, muscle tone, and response to respiratory challenge.
Sixty-two percent of the sample reported smoking during pregnancy, with 24% of smokers reporting smoking 1 pack per day or more. We found a significant influence of maternal smoking exposure (none, moderate/less than 1 pack per day, heavy/1 pack per day or more) on irritability and muscle tone in the neonate, with exposed infants showing greater irritability and hypertonicity. Effects remained significant after controlling for significant covariates: maternal socioeconomic status, age, and race and infant birth weight and age. Posthoc tests suggested particular effects of heavy smoking on increased infant irritability and both moderate and heavy smoking exposure on increased muscle tone.
In a large community sample, exposure to maternal smoking was associated with increased irritability and hypertonicity in neonates. Exposure to maternal smoking did not influence neonatal response to respiratory challenge. This study is the largest-scale investigation to date of the effects of maternal smoking (heavy and moderate) on examiner-assessed neonatal behavior. Given the associations between both maternal smoking and infant irritability and later behavioral dysregulation, results have important implications for early identification and intervention with at-risk offspring.

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Available from: Lewis P Lipsitt, Oct 03, 2015
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    • "Despite the need to investigate the factors influencing maternal smoking during pregnancy at multiple levels, previous research has predominately focused on the characteristics of women that are associated with an increased likelihood of smoking during pregnancy at the individual level. These maternal characteristics include being from a non-Hispanic white racial background (Mathews, 1998; Stroud et al., 2009), not being married (Flick et al., 2006; Martin et al., 2008; Orr, Newton, Tarwater, & Weismiller, 2005; Pickett, Wood, Adamson, DeSouza, & Wakschlag, 2008; Wakschlag et al., 2003), receiving late prenatal care (Wakschlag et al., 2003; Zimmer & Zimmer, 1998), and being pregnant with a second or higher order infant (Kahn, Certain, & Whitaker, 2002; Martin et al., 2008; Schramm, 1997). In addition, socioeconomically disadvantaged women-women with a low household income (Hunt & Whitman, 2011; Martin et al., 2008; Wakschlag et al., 2003), low educational attainment (Kahn et al., 2002; Martin et al., 2008; Orr et al., 2005; Wakschlag et al., 2003), or living in poverty (Yu, Park, & Schwalberg, 2002) -are also more prone to smoke during pregnancy (Pickett et al., 2008). "
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    ABSTRACT: Drawing from both the place stratification and ethnic enclave perspectives, we use multilevel modeling to investigate the relationships between women's race/ethnicity (i.e., non-Hispanic white, non-Hispanic black, Asian, and Hispanic) and maternal smoking during pregnancy, and examine if these relationships are moderated by racial segregation in the continental United States. The results show that increased interaction with whites is associated with increased probability of maternal smoking during pregnancy, and racial segregation moderates the relationships between race/ethnicity and maternal smoking. Specifically, living in a less racially segregated area is related to a lower probability of smoking during pregnancy for black women, but it could double and almost triple the probability of smoking for Asian women and Hispanic women, respectively. Our findings provide empirical evidence for both the place stratification and ethnic enclave perspectives.
    Social Science [?] Medicine 02/2014; 107C:26-36. DOI:10.1016/j.socscimed.2014.01.030 · 2.89 Impact Factor
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    • "Summarization of NNNS raw data results in scores on 13 dimensions: habituation, attention, arousal, self-regulation, special handling needed from the examiner to assist the infant through the exam, quality of movement, excitability, lethargy, non-optimal reflexes, asymmetrical reflexes, hypertonicity, hypotonicity, and stress/abstinence. The number of infants with scores on the habituation scale of the NNNS was too small for meaningful interpretation, so we excluded this scale from analyses as we have done in previous work with the NNNS [27,34] and consistent with other researchers [24,26]. The hypotonia, hypertonia, and physiological stress scales were dichotomized due to distributions in which the majority of infants acquired a score of zero and few had values greater than one. "
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    ABSTRACT: National data suggest widespread gestational exposure to organophosphate pesticides (OPs) based on the detection of OP metabolites in the urine of pregnant women. Associations with early infant neurobehavior are largely understudied, with only two studies reporting abnormal reflexes in newborns in association with gestational exposure to OPs. Our objective was to utilize biological markers of OP metabolites in pregnant women and a comprehensive assessment of infant neurobehavior to determine the association of gestational exposure to OPs with neurobehavioral outcomes during early infancy. Among a cohort of 350 mother/infant pairs, we measured six common dialkylphosphate metabolites of OP pesticides in maternal urine, at two times during pregnancy (16w & 26w gestation), then calculated aggregate concentrations of diethylphosphate, dimethylphosphate, and total dialkyphosphate metabolites. We measured infant neurobehavior at about five weeks of age using the NICU Network Neurobehavioral Scale (NNNS), a comprehensive assessment of neurobehavior in young infants. Analyses of associations between gestational exposure to OPs and neurobehavior at five weeks included multiple linear and logistic regression. After adjustment for covariates, higher creatinine-corrected urinary concentrations of diethylphosphate metabolites were associated with improved attention and reduced lethargy and hypotonia in young infants. Higher creatinine-corrected urinary concentrations of total dialkylphosphate metabolites were associated with fewer signs of autonomic stress. Women who were white, married, had advanced education, and reported more frequent consumption of fresh fruits and vegetables had higher concentrations of OP metabolites during pregnancy. In this sample of pregnant women whose urinary concentrations of dialkylphosphate metabolites are representative of national exposure levels, we found no detrimental effects of gestational exposure to OPs on neurobehavioral outcomes among young infants. These results are important as they suggest there may be minimal to no detectable adverse impact of low level prenatal OP exposure on the neurobehavior of young infants.
    Environmental Health 09/2013; 12(1):79. DOI:10.1186/1476-069X-12-79 · 3.37 Impact Factor
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    • "); die Kinder zeigten eine signifikant erhöhte Irritabilität und einen muskulären Hypertonus (Stroud et al., 2009). Auch ein niedriges Geburtsgewicht von unter 2500g erhöhte das Risiko exzessiven Schreiens um mehr als das Zweifache (Sondergaard et al., 2000). "
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    ABSTRACT: To investigate the relationship between persistent, excessive crying in 5-month-old infants and the pre- and perinatal adversities as well as postpartal mood of their mothers. A sample of 300 mother-child dyads was examined at infants' age of 18.5 weeks. All mothers exhibited psychosocial risks such as poverty, lack of social support, being underage, drug abuse or mental disorders. Excessive crying was assessed by the Wessel's «rule of threes». Pre-, peri- and postnatal problems were measured by self-report questionnaires. Multivariate data analysis revealed an increased risk for social adversities during pregnancy (OR = 17.66) and unwanted pregnancy (OR = 13.77). For the postnatal period persistent crying was associated with a higher rate of maternal postpartum depressive symptoms, maternal stress, dysfunctional mother-child interactions, perception of the infant as being «difficult» as well as bonding problems. The results point to the influence of prenatal stress in mothers and a primarily unwanted pregnancy on infants' persistent crying. An increased need for support is suggested in cases of considerably reduced well-being of the mother or bonding problems. The combined effect of prenatal variables and relationship variables influences the occurrence and perpetuation of early regulation problems.
    Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 07/2012; 40(4):239-50. · 0.99 Impact Factor
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