Prenatal Smoking Exposure and the Risk of Psychiatric Morbidity Into Young Adulthood

Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
Archives of general psychiatry (Impact Factor: 14.48). 08/2010; 67(8):841-9. DOI: 10.1001/archgenpsychiatry.2010.92
Source: PubMed


Prenatal smoking exposure modulates brain development, which may deviate mental development of the offspring.
To study the effects of prenatal smoking exposure on psychiatric morbidity and mortality among Finnish young adults by means of population-based longitudinal register data.
Information on maternal smoking as reported by the mothers (0, <10, or >10 cigarettes a day) and other background factors (maternal age and parity and child's sex, gestational age, birth weight, and 5-minute Apgar score) was derived from the Finnish Medical Birth Register. Information on children's psychiatric diagnoses related to outpatient visits (1998-2007), children's inpatient care (1987-2007), and mothers' psychiatric inpatient care (1969-1989) was derived from the Finnish Hospital Discharge Register. Information on deaths and their causes for the children (1987-2007) was received from the Cause-of-Death Register.
Population-based study of all singletons born in Finland from 1987 to 1989 with information on prenatal smoking exposure. Patients The source population included all singleton births in Finland from January 1, 1987, through December 31, 1989 (n = 175 869), excluding children with major congenital anomalies (3.1%) and children who died during the first week of life (0.3%).
Psychiatric morbidity and mortality.
The prevalence of maternal smoking was 15.3%. The risk of psychiatric morbidity was significantly higher in the exposed children than in the unexposed children. Among the offspring of mothers who smoked fewer than 10 cigarettes a day, 21.0% had any psychiatric diagnoses (adjusted odds ratio [OR], 1.53 [95% confidence interval (CI), 1.47-1.60]) compared with 24.7% among those of mothers who smoked more than 10 cigarettes a day (1.85 [1.74-1.96]) and 13.7% in the unexposed children (the reference group). The risk was significantly increased for most of the psychiatric diagnoses. The strongest effects were in psychiatric disorders due to psychoactive substance use and in behavioral and emotional disorders. The risk of mortality was significantly higher in children exposed to more than 10 cigarettes a day (OR, 1.69 [95% CI, 1.31-2.19]) compared with unexposed children.
Prenatal smoking exposure is associated with an increased risk of psychiatric morbidity, whereas prenatal exposure to more than 10 cigarettes a day increases the risk of mortality in childhood, adolescence, and young adulthood.

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Available from: Jyrki Korkeila, Oct 07, 2015
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    • "We note some limitations of this study, including the absence of information on maternal psychopathology. The association between prenatal maternal smoking may disappear after maternal psychopathology is included (Lavigne et al. 2011; Monshouwer et al. 2011; Roza et al. 2008), however in other studies, the association was attenuated, but remained significant (Boutwell et al. 2011; Cornelius et al. 2011; Ekblad et al. 2010; Paradis et al. 2011). However, our conclusions rest in part on the comparison between maternal and paternal SDP, which showed that maternal SDP was more strongly associated with offspring externalizing problems. "
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    ABSTRACT: Maternal smoking during pregnancy (SDP) is associated with increased risk of externalizing and internalizing behaviors in offspring. Two explanations (not mutually exclusive) for this association are direct causal effects of maternal SDP and the effects of genetic and environmental factors common to parents and offspring which increase smoking as well as problem behaviors. Here, we examined the associations between parental SDP and mother rated offspring externalizing and internalizing behaviors (rated by the Child Behavior Checklist/2-3) at age three in a population-based sample of Dutch twins (N = 15,228 pairs). First, as a greater effect of maternal than of paternal SDP is consistent with a causal effect of maternal SDP, we compared the effects of maternal and paternal SDP. Second, as a beneficial effect of quitting smoking before pregnancy is consistent with the causal effect, we compared the effects of SDP in mothers who quit smoking before pregnancy, and mothers who continued to smoke during pregnancy. All mothers were established smokers before their pregnancy. The results indicated a greater effect of maternal SDP, compared to paternal SDP, for externalizing, aggression, overactive and withdrawn behavior. Quitting smoking was associated with less externalizing, overactive behavior, aggression, and oppositional behavior, but had no effect on internalizing, anxious depression, or withdrawn behavior. We conclude that these results are consistent with a causal, but small, effect of smoking on externalizing problems at age 3. The results do not support a causal effect of maternal SDP on internalizing behaviors.
    Behavior Genetics 09/2015; DOI:10.1007/s10519-015-9738-2 · 3.21 Impact Factor
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    • "Although these initial results require replication, there appears to be an association between PEMS and greater hallucination severity at initial hospitalization for FEP. This is consistent with limited prior studies indicating that PEMS may elevate risk for psychotic symptoms/disorders (Spauwen et al., 2004; Zammit et al., 2009; Ekblad et al., 2010). We found a lower severity of deficit symptoms, which is inconsistent with the prior report indicating that PEMS was associated with greater negative symptom severity (Stathopoulou et al., 2013). "
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    ABSTRACT: Prenatal exposure to maternal smoking (PEMS) has been linked to diverse negative perinatal outcomes (Cnattingius, 2004) and far- reaching neurobehavioral consequences, including impaired cognition, attention-deficit/hyperactivity disorder, and conduct disorder (Cornelius and Day, 2009; Gaysina et al., 2013). Although one study did not demon- strate a link between PEMS and risk for schizophrenia (Baguelin-Pinaud et al., 2010), Stathopoulou et al. (2013) found that prenatal tobacco expo- sure was independently associated with a later schizophrenia diagnosis.
    Schizophrenia Research 05/2015; 164(1-3):277-278. DOI:10.1016/j.schres.2015.02.012 · 3.92 Impact Factor
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    • "This design allows assessment of the influence of the mood disorder on the health of the offspring. In the same vein, many early studies have not controlled for the influence of alcohol use and smoking with their independent adverse effects (Ekblad et al., 2010). Nonetheless, a good number of clinical studies and population based case-control studies have controlled for these factors. "
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    ABSTRACT: The paper by Robinson posits that risks from prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants are not different from the risks encountered in the general population and that untoward effects of SSRIs are difficult to distinguish from those of the mood disorder. Indeed, maternal depression and anxiety can have negative consequences for fetal and postnatal development. Fortunately, experimental evidence suggests that mood and anxiety disorder symptoms often respond to psychosocial interventions. If pharmacotherapy becomes necessary, it is, however, important to know that even if SSRI drugs have been shown to be safe overall, research has shown that fetal development can be adversely affected by in utero exposure to SSRIs in a subgroup of neonates. Examples would be the transient neonatal adaptation syndrome, an increased risk of persistent pulmonary hypertension of the newborn, and small, albeit measurable, changes in motor and social adaptability in infancy and childhood.
    Journal of Nervous & Mental Disease 03/2015; 203(3):167-9. DOI:10.1097/NMD.0000000000000258 · 1.69 Impact Factor
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