Maternal Smoking During Pregnancy and the Risk of Psychiatric Morbidity in Singleton Sibling Pairs

Abstract Introduction Maternal smoking during pregnancy (SDP) is associated with disruptive behavior. However, there is debate whether the SDP-disruptive behavior association is a potentially causal pathway or rather a spurious effect confounded by shared genetic and environmental factors. Aims and Methods The Missouri Mothers and Their Children Study is a sibling comparison study that includes families (n = 173) selected for sibling pairs (aged 7–16 years) discordant for SDP. Critically, the sibling comparison design is used to disentangle the effects of SDP from familial confounds on disruptive behavior. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount of SDP). Multiple informants (parents and teachers) reported on disruptive behavior (i.e., DSM-IV semi-structured interview, the Child Behavior Checklist, and Teacher Report Form). Results The variability in disruptive behavior was primarily a function of within-family differences (66%–100%). Consistent with prior genetically informed approaches, the SDP–disruptive behavior association was primarily explained by familial confounds (genetic and environmental). However, when using a multi-rater approach (parents and teachers), results suggest a potentially causal effect of SDP on disruptive behavior (b = 0.09, SE = 0.04, p = 0.03). The potentially causal effect of SDP remained significant in sensitivity analyses. Discussion These findings suggest that familial confounding likely plays a complex role in the SDP–disruptive behavior association when examining both parent and teacher reports of behavior. Importantly, the current study highlights the importance of multiple raters, reflecting a more comprehensive measure of complex behaviors (e.g., disruptive behavior) to examine the teratogenic effects of SDP. Implications Our study provides additional evidence that controlling for genetic and family factors is essential when examining the effect of SDP on later behavioral problems, as it explains a portion of the association between SDP and later behavioral problems. However, we found a significant association between SDP and disruptive behavior when using a multi-rater approach that capitalizes on both parent and teacher report, suggesting that parent and teacher ratings capture a unique perspective that is important to consider when examining SDP–behavior associations.

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Maternal smoking during pregnancy and offpsring's psychiatric morbidity in early adulthood. Findings from the Finnish Family Competence Birth Cohort Study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.008 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S73-S73

Author(s):

S. Niemelä ◽

S. Mikola ◽

A. Sourander ◽

P. Rautava ◽

M. Sillanpää

Keyword(s):

Maternal Smoking ◽

Psychiatric Morbidity ◽

Early Adulthood ◽

Education Level ◽

Birth Cohort Study ◽

Prenatal Smoking ◽

Psychiatric Diagnoses ◽

Smoking During Pregnancy ◽

Smoking Exposure ◽

Maternal Smoking During Pregnancy

IntroductionPrenatal smoking exposure is one of the most common insults during the fetal period prevalence varying from 5 to 19% in the European countries [1].ObjectivesPrenatal smoking exposure increases the risk of psychiatric morbidity in the offspring, externalizing disorders in particular. However, less is known whether maternal smoking during pregnancy increases the risk for anxiety disorders [1].AimsTo study the associations between maternal smoking during pregnancy and offspring psychiatric morbidity in early adulthood in a Finnish birth cohort study.MethodsA prospective data collection from 10th gestational week (GW10) to early adulthood (n = 475, 37% from the original sample). Information on self-reported smoking during pregnancy was collected using questionnaires at GW10 and GW28. Offspring psychiatric diagnoses and clinically relevant symptoms were assessed using Development and Well-being Assessment (DAWBA)-interviews at age 18 to 20 years. Information on parental alcohol use, depressive mood, anxiety, and education level, as well as offspring's gender, education level, and birth weight were used as covariates.ResultsMaternal smoking during pregnancy associated independently associated with PTSD (OR = 6.9, 95% CI 1.3–35.6, P = 0.021), and conduct disorder (OR = 2.7, 95% CI 1.02–6.9, P = 0.046) in a multivariate analysis after adjusting for other psychiatric diagnoses, offspring and parental variables (OR = 1.9, 95% CI 0.5–6.9, P = 0.359).ConclusionsIn addition to conduct problems, prenatal nicotine exposure may increase the offspring's risk for posttraumatic stress disorder (PTSD). This relationship may be explained, in part, by effects on nicotinic acetylcholine receptors and uteroplacental mechanisms [1].Disclosure of interestThe authors have not supplied their declaration of competing interest.

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