Is Smoking During Pregnancy a Risk Factor for Psychopathology in Young Children? A Methodological Caveat and Report on Preschoolers

Department of Child and Adolescent Psychiatry, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Mary Ann and J. Milburn Smith, Child Health Research Program, Children's Memorial Research Center, Chicago, IL 60614, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 01/2011; 36(1):10-24. DOI: 10.1093/jpepsy/jsq044
Source: PubMed


While studies of the effects of prenatal smoking on child psychopathology have found positive relationships, most studies (1) failed to control for a range of correlates of maternal smoking that could affect children's behavior; (2) have been conducted with school-age rather than younger children, so it is not clear when such problems emerge; and (3) have not examined the effects on internalizing problems.
This study examined the effects of prenatal smoke exposure on behaviors associated with externalizing and internalizing behavior problems and negative temperament in a diverse community sample of 679 4-year-olds.
After controlling for correlates that include socioeconomic status, life stress, family conflict, maternal depression, maternal scaffolding skills, mother-child attachment, child negative affect and effortful control, smoking during pregnancy was no longer associated with child behavior or emotional problems.
Future studies need to control for a wide range of covariates of maternal smoking.

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    • "Weaker associations between prenatal smoking and offspring internalizing behaviors than with externalizing behaviors have previously been observed, but why these associations are less strong, is unclear (Lavigne et al. 2011; Monshouwer et al. 2011; Orlebeke et al. 1999). Underlying genetic factors may in part explain this difference. "
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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.
    Full-text · Article · Sep 2015 · Behavior Genetics
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    • "However, almost simultaneously with Ekblad and coauthors [5], another study by Lavigne et al questioned the role of maternal SDP as a risk factor for psychopathology in young children [6]. The analysis by Lavigne et al controlled for a more detailed set of potential confounders, such as socioeconomic status, life stress, family conflict, maternal depression, maternal scaffolding skills, mother–child attachment, and other variables that were not available in the large record linkage databases used by Ekblad et al [5]. "
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    ABSTRACT: A recent population-based, longitudinal study from Finland observed a dose-response association between smoking during pregnancy (SDP) and use of psychotropic medications in exposed children and young adults. However, this association may be confounded by unmeasured familial characteristics related to both SDP and offspring mental health. Consequently, we aim to investigate the effect of SDP by means of a sibling design that to some extent allows controlling for unknown environmental and genetic confounders. Using the Swedish Medical Birth Register (1987-1993), which was linked to the Swedish Prescribed Drugs Register (July 2005-December 2008), we investigated 579,543 children and among them 39, 007 were discordant for use of psychotropic medication and 4,021 siblings discordant for both use of psychotropic medication and for smoking exposure. Replicating the Finnish study using traditional logistic regression methods we found an association between exposure to ≥10 cigarettes per day during pregnancy and psychotropic drug use (odds ratio = 1.61, 95% confidence interval 1.56, 1.66). Similar in size to the association reported from Finland (odds ratio = 1.63; 95% confidence interval 1.53, 1.74). However, in the adjusted sibling analysis using conditional logistic regression, the association was considerably reduced (odds ratio 1.22; 95% confidence interval 1.08, 1.38). Preventing smoking is of major public health importance. However, SDP per se appears to have less influence on offspring psychotropic drug use than previously suggested.
    Full-text · Article · May 2013 · PLoS ONE
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    • "One way to separate these mechanisms is to utilize research designs that can separate genetic and environmental influences on child development (Knopik 2009; Lynskey, Agrawal, & Heath, 2010). Such genetically informed twin and adoption studies have suggested that unmeasured maternal factors associated with smoking during pregnancy, and not prenatal smoking per se, may account for behavioral problems in early childhood (Lavigne et al., 2011), behavioral difficulties in adolescence (Kuja-Halkola, D'Onofrio, Iliadou, Långström, & Lichtenstein, 2010), and the later development of criminal behavior in adulthood (D'Onofrio et al., 2010). Stated differently, maternal psychological factors associated with both the decision to continue smoking during pregnancy and the parenting behaviors after birth may confound the relationship between pregnancy smoking and child behavior problems. "
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    ABSTRACT: Introduction: Although remarkable interindividual differences among pregnant smokers' decision/ability to quit have been documented, the psychological factors that may account for these differences have received less attention and comprised the primary aim of this review. Methods: We searched the medical and behavioral sciences literature from 1996 to November 2011 using PubMed and PsycINFO(®). Fifty-one articles were identified based on titles or abstracts. These articles were reviewed in full and searched for quantitative observational studies of population-based or clinical samples, with the main topic of comparing smokers who quit spontaneously during pregnancy with those who did not, utilizing multivariable analyses. Results: The eight pertinent studies reviewed herein included four longitudinal studies and four cross-sectional analyses. Amidst significant variability among measures used, social support, depressive symptoms, and anxiety appeared unrelated to smoking cessation during pregnancy. Furthermore, when severity of nicotine dependence was controlled, maternal history of attention-deficit/hyperactivity disorder, depression, bipolar disorder, and schizophrenia all showed no independent relationship with smoking cessation during pregnancy, whereas maternal history of conduct disorder did. Secure attachment, prosocial personality, self-esteem, and perceived parenting competence were additional predictors of cessation during pregnancy. Conclusions: A greater understanding of psychological factors that differentiate smokers who spontaneously quit during pregnancy from those who do not is crucial to the design of more effective prenatal smoking cessation interventions and also may elucidate causal mechanisms that underlie the well-established link between maternal smoking during pregnancy and offspring behavioral problems. Directions for future research and public health and policy implications are discussed.
    Full-text · Article · Sep 2012 · Nicotine & Tobacco Research
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