Maternal Smoking During Pregnancy and School Performance at Age 15

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Epidemiology (Impact Factor: 6.2). 10/2006; 17(5):524-30. DOI: 10.1097/
Source: PubMed


Smoking during pregnancy has been suggested to have long-term consequences for neuropsychologic development in the offspring, including behavioral problems, attention deficit disorders, and antisocial behavior. Also, findings from several studies indicate an association with impaired cognitive function in the children.
In a population-based Swedish cohort study, we examined possible associations between maternal smoking in pregnancy and educational achievement in the offspring at age 15 years among more than 400,000 male and female students born 1983 through 1987. Generalized estimating equation models were used to evaluate associations of maternal smoking, other maternal characteristics, and birth characteristics with school performance. Odds ratios (ORs) were used as a measure of risk.
In a model adjusted for maternal characteristics, maternal smoking compared with no tobacco use during pregnancy was associated with an increased risk of poor scholastic achievement: for 1-9 cigarettes per day, the OR was 1.59 (95% confidence interval = 1.59-1.63) and for 10 or more cigarettes per day, the OR was 1.92 (1.86-1.98). These risks remained unchanged when we also adjusted for smoking-related pregnancy outcomes such as fetal growth restriction and preterm birth. However, if the mother had smoked in her first pregnancy, but not in her second pregnancy, the younger sibling was also at increased risk of poor school performance.
Observed associations between maternal smoking during pregnancy and poor cognitive performance in the offspring might not be causal. We suggest that associations reported in earlier studies may instead reflect the influence of unmeasured characteristics that differ between smokers and nonsmokers.

Download full-text


Available from: James H Maccabe
  • Source
    • "The validity of recall for behavioral factors like smoking was low when mothers were asked to report continuous data within a recall period of almost 10 years. Thus, while the frequency of smoking may be a variable of interest to researchers due to its association with many long-term outcomes in offspring (Batty et al., 2006; Brook et al., 2006, 2008; Button et al., 2005; Lambe et al., 2006; Liu et al., 2013), it may be more suitable to present mothers with categorical answers, or ask within a more immediate recall period. Furthermore, since maternal knowledge and perception of the event's importance may also affect recall validity (Hewson & Bennett, 1987; Mitchell et al., 1986; Olson et al., 1997), as different pre-, peri-, and post-natal events become increasingly associated as risk factors for offspring health, doctors and nurses should emphasize the importance of this information at or around the time of the delivery event. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aims to assess the validity of maternal recall for several perinatal variables 8-10 years after pregnancy in a twin sample. Retrospective information was collected 8-10 years after the delivery event in a cohort of mothers from the University of Southern California Twin Study (N = 611) and compared with medical records for validity analysis. Recall of most variables showed substantial to perfect agreement (κ = 0.60-1.00), with notable exceptions for specific medical problems during pregnancy (κ ≤ 0.40) and substance use when mothers provided continuous data (e.g., number of cigarettes per day; r ≤ 0.24). With the exception of delivery method, neonatal intensive care unit admission, birth weight, neonatal information, and post-delivery complications were also recalled with low accuracy. For mothers of twins, maternal recall is generally a valid measure for perinatal variables 10 years after pregnancy. However, caution should be taken regarding variables such as substance use, medical problems, birth length, and post-delivery complications.
    Full-text · Article · Jun 2013 · Twin Research and Human Genetics
  • Source
    • "Some studies have found that the association between prenatal smoking and psychological, schooling and behavioral outcomes disappears after controls for observed and unobserved family characteristics (Rantakallio et al. 1992; Ernst, Moolchan and Robinson 2001; MacArthur, Knox and Lancashire 2001; Batty, Der and Deary 2006; Lambe et al. 2006). In such a case, our estimates of the role of smoking in the reproduction of intergenerational inequalities are also biased. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this article, we study the effects of prenatal health on educational attainment and on the reproduction of family background inequalities in education. Using Finnish birth cohort data, we analyze several maternal and fetal health variables, many of which have not been featured in the literature on long-term socioeconomic effects of health despite the effects of these variables on birth and short-term health outcomes. We find strong negative effects of mother's prenatal smoking on educational attainment, which are stronger if the mother smoked heavily but are not significant if she quit during the first trimester. Anemia during pregnancy is also associated with lower levels of attained education. Other indicators of prenatal health (pre-pregnancy obesity, mother's antenatal depressed mood, hypertension and preeclampsia, early prenatal care visits, premature birth, and small size for gestational age) do not predict educational attainment. Our measures explain little of the educational inequalities by parents' class or education. However, smoking explains 12%-and all health variables together, 19%-of the lower educational attainment of children born to unmarried mothers. Our findings point to the usefulness of proximate health measures in addition to general ones. They also point to the potentially important role played by early health in intergenerational processes.
    Full-text · Article · Feb 2012 · Demography
  • Source
    • "These outcomes include perinatal health problems, such as lower birthweight (Rice et al. 2009 ; Thapar et al. 2009), spontaneous abortion, fetal mortality and sudden infant death syndrome (see Ernst et al. 2001 for review). Maternal SDP is also associated with psychological problems, such as cognitive delays (Batty et al. 2006 ; Lambe et al. 2006 ; Lundberg et al. 2010), attention-deficit hyperactivity disorder (ADHD ; Thapar et al. 2009 ; Lindblad & Hjern, 2010), conduct disorder (CD ; Silberg et al. 2003 ; Brion et al. 2010), antisocial behavior (ASB ; Rice et al. 2009 ; D'Onofrio et al. 2010a ; Paradis et al. 2010) and substance use disorders (Brennan et al. 2002). Research has consistently supported a causal relationship for SDP with many perinatal health problems, but evidence has been inconsistent for its relationship with psychological problems (Rice et al. 2009 ; Thapar et al. 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Maternal smoking during pregnancy (SDP) has been studied extensively as a risk factor for adverse offspring outcomes and is known to co-occur with other familial risk factors. Accounting for general familial risk factors has attenuated associations between SDP and adverse offspring outcomes, and identifying these confounds will be crucial to elucidating the relationship between SDP and its psychological correlates. The current study aimed to disentangle the relationship between maternal SDP and co-occurring risk factors (maternal criminal activity, drug problems, teen pregnancy, educational attainment, and cohabitation at childbirth) using a population-based sample of full- (n=206 313) and half-sister pairs (n=19 363) from Sweden. Logistic regression models estimated the strength of association between SDP and co-occurring risk factors. Bivariate behavioral genetic models estimated the degree to which associations between SDP and co-occurring risk factors are attributable to genetic and environmental factors. Maternal SDP was associated with an increase in all co-occurring risk factors. Of the variance associated with SDP, 45% was attributed to genetic factors and 53% was attributed to unshared environmental factors. In bivariate models, genetic factors accounted for 21% (non-drug-, non-violence-related crimes) to 35% (drug-related crimes) of the covariance between SDP and co-occurring risk factors. Unshared environmental factors accounted for the remaining covariance. The genetic factors that influence a woman's criminal behavior, substance abuse and her offspring's rearing environment all influence SDP. Therefore, the intergenerational transmission of genes conferring risk for antisocial behavior and substance misuse may influence the associations between maternal SDP and adverse offspring outcomes.
    Full-text · Article · Nov 2011 · Psychological Medicine
Show more