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Maternal Smoking in Pregnancy and Externalizing Behavior in 18-Month-Old Children: Results From a Population-Based Prospective Study

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Abstract

Objective

The relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy.

Method

Participants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child's externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child's sex as a possible moderator.

Results

We documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03–1.70). The child's sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83–1.16).

Conclusions

Maternal smoking during pregnancy increases offspring's subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).

Section snippets

Study Design and Participants

The data collection was conducted as part of the Norwegian Mother and Child Cohort Study (www.fhi.no/morogbarn) at the Norwegian Institute of Public Health. The target population of the Norwegian Mother and Child Cohort Study study is all women who give birth in Norway. Recruitment started in 1999 and will continue until the end of 2008. The sampling frame comprises all pregnant woman attending routine ultrasound examinations, which are performed at gestation weeks 17 to 18. The participation

Results

We found that 86.9% of the mothers did not smoke during pregnancy, 9.4% smoked 1 to 9 cigarettes daily, and 3.8% smoked more than 10 cigarettes daily.

In line with earlier findings, the present study found a significant sex difference in the distribution of the externalizing behaviors (x = 413.9, p = .000), with boys being overrepresented among those with the highest scores of the scale.41

The logistic regression analyses in the total sample (Table 2) also showed a noticeable significant effect

Discussion

The main goal of this study was to explore whether an association between maternal smoking in pregnancy and externalizing behavior can be documented in children as young as 18 months old. A further goal of this study was to examine whether maternal smoking in pregnancy constitutes a general or sex-specific risk.

Indeed, we could show that maternal smoking in pregnancy increased the risk for externalizing behavior in 18-month-old children after adjusting for important confounders. Smoking showed

References (50)

  • M Ernst et al.

    Behavioral and neural consequences of prenatal exposure to nicotine

    J Am Acad Child Adolesc Psychiatry

    (2001)
  • H Lehn et al.

    Attention problems and attention-deficit/hyperactivity disorder in discordant and concordant monozygotic twins: evidence of environmental mediators

    J Am Acad Child Adolesc Psychiatry

    (2007)
  • CAM Spatola et al.

    A general population twin study of the CBCL/6–18 DSM-oriented scales

    J Am Acad Child Adolesc Psychiatry

    (2007)
  • S Ebrahim et al.

    Trends in pregnancy-related smoking rates in the United States, 1987–1996

    JAMA

    (2000)
  • L Falck et al.

    Smoking during early pregnancy affects the expression pattern of both nicotine and muscarinic acetylcholine receptors in human first trimester brainstem and cerebellum

    Neuroscience

    (2005)
  • S Jankunen et al.

    Nicotine and epibatidine alter differently nomifensine-elevated dopamine output in the rat dorsal and ventral striatum

    Eur J Pharmacol

    (2005)
  • B Höök et al.

    Prenatal and postnatal maternal smoking as risk factors for preschool children's mental health

    Acta Paediatr

    (2006)
  • Brennan P. Tobacco consumption during pregnancy and its impact on psychosocial child development. Encyclopedia on Early...
  • JS Brook et al.

    The influence of maternal smoking during pregnancy on toddler's negativity

    Arch Pediatr Adolesc Med

    (2000)
  • MS Indredavik et al.

    Prenatal smoking exposure and psychiatric symptoms in adolescence

    Acta Paediatr

    (2006)
  • KM Linnet et al.

    Cigarette smoking during pregnancy and hyperactive-distractible preschooler's: a follow-up study

    Acta Paediatr

    (2007)
  • SC Huijbregts et al.

    Maternal prenatal smoking, parental antisocial behavior, and early childhood physical aggression

    Dev Psychopathol

    (2008)
  • RE Tremblay et al.

    Physical aggression during early childhood: trajectories and predictors

    Pediatrics

    (2004)
  • LS Wakschlag et al.

    Elucidating early mechanisms of developmental psychopathology: the case of prenatal smoking and disruptive behaviour

    Child Dev

    (2006)
  • LS Wakschlag et al.

    Maternal smoking during pregnancy and severe antisocial behavior in offspring: a review

    Am J Public Health

    (2002)
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      For instance, infants born to mothers who smoke during pregnancy are found to be at increased risk of a host of health maladies including low birth weight (Pereira et al., 2017), preterm birth (Liu et al., 2020; Soneji and Beltrán-Sánchez, 2019), birth defects (Hackshaw et al., 2011), infant mortality (Dietz et al., 2010; Salihu et al., 2003), and sudden infant death syndrome (Anderson et al., 2019). Furthermore, prenatal smoking is linked with health and developmental problems as children age, such as increased likelihood of attention-deficit hyperactivity disorder (Button et al., 2005), antisocial behavior (Stene-Larsen et al., 2009; Wakschlag et al., 2002), substance use (Cornelius et al., 2012; Goldschmidt et al., 2012), being overweight (Oken et al., 2008), and a higher prevalence of asthma and breathing difficulties (Burke et al., 2012). Although rates of cigarette use in the United States have been declining for decades, from approximately 42.4% in 1965 to 13.7% in 2018 (American Lung Association, 2019), the rising use of electronic cigarettes (e-cigarettes) is a growing public health concern (National Academies of Sciences, 2018).

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    The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health, NIH/NIEHS (grant no N01-ES-85433), NIH/NINDS (grant no.1 UO1 NS 047537–01), and the Norwegian Research Council/FUGE (grant no. 151918/S10).

    The authors thank Mr. Eivind Ystrøm for guidance on the item-response theoretical analysis.

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