Maternal Smoking During Pregnancy and Risk of Alcohol Use Disorders Among Adult Offspring*

Department of Psychology, Queens College, The City University of New York, 65-30 Kissena Boulevard, Flushing, NY 11367, USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.76). 03/2011; 72(2):199-209. DOI: 10.15288/jsad.2011.72.199
Source: PubMed


The aim of this study was to evaluate the association between maternal smoking during pregnancy (MSP) and lifetime risk for alcohol use disorder (AUD) and to explore possible mechanisms through which MSP may be related to neurobehavioral conditions during infancy and childhood, which could, in turn, lead to increased risk for AUD.
A sample of 1,625 individuals was followed from pregnancy for more than 40 years. Capitalizing on the long follow-up time, we used survival analysis to examine lifetime risks of AUD (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in relation to levels of MSP (none, <20 cigarettes/day, and ≥20 cigarettes/day). We then used structural equation modeling to test hypotheses regarding potential mechanisms, including lower birth weight, neurological abnormalities, poorer academic functioning, and behavioral dysregulation.
Relative to unexposed offspring, offspring of mothers who smoked 20 cigarettes per day or more exhibited greater risks for AUD (hazard ratio = 1.31, 95% CI [1.08, 1.59]). However, no differences were observed among offspring exposed to fewer than 20 cigarettes per day. In structural equation models, MSP was associated with neurobehavioral problems during infancy and childhood, which, in turn, were associated with an increased risk for adult AUD.
MSP was associated with an increased lifetime risk for AUD. Adverse consequences were evident from birth to adulthood. A two-pronged remedial intervention targeted at both the mother (to reduce smoking during pregnancy) and child (to improve academic functioning) may reduce the risk for subsequent AUD.

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    • "Stene-Larsen et al., 2009; Hutchinson et al., 2010; Nomura et al., 2010; Wakschlag et al., 2006). In addition, offspring of mothers who smoked during pregnancy have been shown to have greater risk of substance use and dependence in adolescence and adulthood (Nomura et al., 2011; Monshouwer et al., 2011; Lawlor et al., 2005; Al Mamun et al., 2006; Buka et al., 2003; Kandel et al., 1994; Munafò et al., 2006; Roberts et al., 2005). However, the observed relationship between smoking during pregnancy and offspring outcomes may not be causal but instead due to confounding, and isolating the specific causal effects of intrauterine exposure (as opposed to the effects of parental smoking behaviour in childhood and adolescence) can be difficult. "
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    ABSTRACT: Background Comparison of the associations of maternal and mother's partner smoking with offspring outcomes is, in theory, a useful method for assessing whether there may be an intrauterine effect of tobacco exposure on these outcomes. However, this approach assumes that the effects of passive smoking from exposure to partner smoking during pregnancy are minimal. We evaluated this assumption using a biochemical measure of tobacco exposure in pregnant women. Methods Cotinine levels taken during the first trimester of pregnancy were measured in a sample of 3,928 women from the Avon Longitudinal Study of Parents and Children. Median cotinine values were compared across categories of smoking heaviness (cigarettes per day) of the women during the first trimester and in non-smoking women by the smoking heaviness of their partner. Results Cotinine levels were substantially higher in women who smoked compared to non-smokers (range of medians across smoking heaviness categories: 900 to 5,362 ng/ml versus 20 ng/ml, interquartile range (IQR) (0 to 63) for non-smokers). In contrast, cotinine levels in non-smoking women were only very weakly related to partner smoking status (range of medians in women with smoking partners: 34 to 69 ng/ml versus 12 ng/ml, IQR (0 to 48) in women with non-smoking partners). Conclusions Levels of tobacco exposure from partner smoking, as assessed by cotinine, were low in non-smoking pregnant women. This suggests that using mother's partner's smoking as a negative control for investigating intrauterine effects is valid.
    Full-text · Article · Jun 2014 · Drug and alcohol dependence
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    ABSTRACT: To study the prospective relationship between maternal smoking during pregnancy (MSP) and behavioral problems, heavy alcohol use, daily smoking, and ever use of cannabis in the offspring, and to assess the role of confounding and mediating factors in a systematic way. Population-based cohort study of 2,230 respondents, starting in 2001 when respondents were around the age of 11 years, and two follow-up measurements at intervals of about 2.5 years (response rates of 96.0 and 81.4%). Almost one third of the respondents' mothers had smoked tobacco during pregnancy. These respondents were at an increased risk for all outcomes except internalizing problems (significant odds ratios ranged from 1.40 to 2.97). The successive models showed that the potential confounding factors reduced the strength of all relationships. In the full model, the strongest relationship was found for mothers who smoked more than 10 cigarettes a day during pregnancy and daily smoking in early adolescence (odds ratio: 1.56), but none of the relationships were statistically significant. MSP is a marker for future behavioral outcomes in the offspring, but reducing the prevalence of MSP is unlikely to make a meaningful contribution to the prevention of these problems in adolescents.
    Full-text · Article · Nov 2011 · European Addiction Research
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    ABSTRACT: CONTEXT Previous epidemiological, animal, and human cognitive neuroscience research suggests that maternal smoking during pregnancy (SDP) causes increased risk of substance use/problems in offspring. OBJECTIVE To determine the extent to which the association between SDP and offspring substance use/problems depends on confounded familial background factors by using a quasi-experimental design. DESIGN We used 2 separate samples from the United States and Sweden. The analyses prospectively predicted multiple indices of substance use and problems while controlling for statistical covariates and comparing differentially exposed siblings to minimize confounding. SETTING Offspring of a representative sample of women in the United States (sample 1) and the total Swedish population born during the period from January 1, 1983, to December 31, 1995 (sample 2). PATIENTS OR OTHER PARTICIPANTS Adolescent offspring of the women in the National Longitudinal Survey of Youth 1979 (n = 6904) and all offspring born in Sweden during the 13-year period (n = 1 187 360). MAIN OUTCOME MEASURES Self-reported adolescent alcohol, cigarette, and marijuana use and early onset (before 14 years of age) of each substance (sample 1) and substance-related convictions and hospitalizations for an alcohol- or other drug-related problem (sample 2). RESULTS The same pattern emerged for each index of substance use/problems across the 2 samples. At the population level, maternal SDP predicted every measure of offspring substance use/problems in both samples, ranging from adolescent alcohol use (hazard ratio [HR]moderate, 1.32 [95% CI, 1.22-1.43]; HRhigh, 1.33 [1.17-1.53]) to a narcotics-related conviction (HRmoderate, 2.23 [2.14-2.31]; HRhigh, 2.97 [2.86-3.09]). When comparing differentially exposed siblings to minimize genetic and environmental confounds, however, the association between SDP and each measure of substance use/problems was minimal and not statistically significant. CONCLUSIONS The association between maternal SDP and offspring substance use/problems is likely due to familial background factors, not a causal influence, because siblings have similar rates of substance use and problems regardless of their specific exposure to SDP.
    Full-text · Article · Nov 2012 · Archives of general psychiatry
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