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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    • "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. "
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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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