Examining the Association Between Maternal Smoking During Pregnancy and Child Behavior Problems Using Quality-Adjusted Life Years

Maternal smoking during pregnancy is associated with both reduced birth weight and adverse neurobehavioral outcomes. The aim of this study was to investigate longitudinal associations between maternal smoking during pregnancy and childhood behavioral outcomes, and to determine the role of birth weight in mediating such associations. The study included 489 mother–child pairs. Prenatal exposures were assessed via maternal interviews conducted on average 1 year after delivery and child behavior assessments were completed at 5–12 years of age using the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Maternal smoking during pregnancy was associated with externalizing and total behavior problems according to both mother and teacher report. Maternal smoking was also associated with the following percentage increases in scores: 41% (CBCL) and 44% (TRF) for aggressive behavior and 65% (CBCL) and 47% (TRF) for attention problems. Associations with behavior problems were attenuated or no longer observed for mothers that quit smoking in early pregnancy. The proportion of the total effect of maternal smoking on behavioral outcomes explained by differences in birth weight was small and ranged from 6.6% for externalizing behavior on the CBCL to 20.1% for rule-breaking behavior on the CBCL. Our results suggest that birth weight differences explain only a small proportion of the magnitude of association between maternal smoking during pregnancy and selected behavioral outcomes.

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Frequency of Parental Report of Problem Behavior in Children Decreases with Increasing Maternal Age at Delivery

Psychological Reports ◽

10.2466/pr0.1998.82.2.395 ◽

1998 ◽

Vol 82 (2) ◽

pp. 395-404 ◽

Cited By ~ 14

Author(s):

Jacob F. Orlebeke ◽

Dirk L. Knol ◽

Dorret I. Boomsma ◽

Frank C. Verhulst

Keyword(s):

Behavior Problems ◽

Child Behavior ◽

Externalizing Behavior ◽

Maternal Age ◽

Child Behavior Problems ◽

Statistical Control ◽

Smoking During Pregnancy ◽

Linear Effect ◽

Confounding Variables ◽

Child Behavior Check List

Child behavior problems were assessed in 1377 3-yr.-old twin pairs with the Child Behavior Check List from Achenbach (translated into Dutch language by Verhulst). The association between problem scores and maternal age at delivery of the twins was analyzed with statistical control for several potential confounding variables: birth weight of twins, maternal smoking during pregnancy, being breast or bottle fed and socioeconomic status. After controlling for all available confounding covariates, a significant linear effect for maternal age was left. Especially Externalizing behavior problems as well as the separate categories that constitute Externalizing, i.e., Aggressive, Oppositional, and Overactive, appeared to decrease continuously with increasing maternal age. This was true for both boys and girls as well as for first and secondborn twins. Evidence in support of a biological explanation of the association between maternal age and child behavior problems, is presented.

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Intergenerational Health Disparities: Socioeconomic Status, Women's Health Conditions, and Child Behavior Problems

Public Health Reports ◽

10.1177/003335490512000407 ◽

2005 ◽

Vol 120 (4) ◽

pp. 399-408 ◽

Cited By ~ 37

Author(s):

Robert S. Kahn ◽

Kathryn Wilson ◽

Paul H. Wise

Keyword(s):

Socioeconomic Status ◽

Depressive Symptoms ◽

Alcohol Use ◽

Maternal Health ◽

Behavior Problems ◽

Child Behavior ◽

Maternal Smoking ◽

Child Behavior Problems ◽

Health Conditions ◽

Social Disparities

Objective. Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior. Methods. Prospective cohort data (1979–1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined. Results. Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health. Conclusions. Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children.

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