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

ABSTRACT

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.

Download full-text

Full-text

Available from: Lewis P Lipsitt
    • "Specifically, our results complement prior cross-sectional and longitudinal studies of the later neonatal period (postnatal days 10–30), which have shown alterations in attentional and regulatory processes in exposed infants, including measures of attention and self-regulation, as well as increased need for external soothing (Espy et al., 2011;Stroud, Paster, Papandonatos, et al., 2009;Yolton et al., 2009). Our results with respect to MSDP and infant neurobehavior are inconsistent with prior studies of the immediate neonatal period (postnatal days 1–5), in which MSDP-exposed infants showed signs of abstinence, irritability, and increased muscle tone consistent with a withdrawal process (Godding et al., 2004;Law et al., 2003;Mansi et al., 2007;Stroud, Paster, Goodwin, et al., 2009). Although our study bridged the immediate and later neonatal periods, our focus on main effects of MSDP may have obscured dissipating effects of MSDP on signs of with- drawal. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Epigenetic regulation of the placental glucocorticoid receptor gene (NR3C1) was investigated as a mechanism underlying links between maternal smoking during pregnancy (MSDP) and infant neurobehavior in 45 mother–infant pairs (49% MSDP-exposed; 52% minorities; ages 18–35). The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale was administered 7 times over the 1st postnatal month; methylation of placental NR3C1 was assessed via bisulfite pyrosequencing. Increased placental NR3C1 methylation was associated with increased infant attention and self-regulation, and decreased lethargy and need for examiner soothing over the 1st postnatal month. A causal steps approach revealed that NR3C1 methylation and MSDP were independently associated with lethargic behavior. Although preliminary, results highlight the importance of epigenetic mechanisms in elucidating pathways to neurobehavioral alterations from MSDP.
    No preview · Article · Feb 2016 · Child Development
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2014 · Social Science [?] Medicine
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2013 · Environmental Health
Show more