Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring

BackgroundAdverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology.AimsTo examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms.MethodA longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.ResultsFrequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences.ConclusionsThese findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.

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Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort

Psychological Medicine ◽

10.1017/s0033291708005126 ◽

2009 ◽

Vol 39 (9) ◽

pp. 1457-1467 ◽

Cited By ~ 73

Author(s):

S. Zammit ◽

D. Odd ◽

J. Horwood ◽

A. Thompson ◽

K. Thomas ◽

...

Keyword(s):

Longitudinal Study ◽

Adverse Events ◽

Birth Cohort ◽

Early Development ◽

Gestational Age ◽

Apgar Score ◽

Psychotic Symptoms ◽

Maternal Infection ◽

Increased Risk ◽

Clinical Disorders

BackgroundNon-clinical psychosis-like symptoms (PLIKS) occur in about 15% of the population. It is not clear whether adverse events during early development alter the risk of developing PLIKS. We aimed to examine whether maternal infection, diabetes or pre-eclampsia during pregnancy, gestational age, perinatal cardiopulmonary resuscitation or 5-min Apgar score were associated with development of psychotic symptoms during early adolescence.MethodA longitudinal study of 6356 12-year-old adolescents who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Prenatal and perinatal data were obtained from obstetric records and maternal questionnaires completed during pregnancy.ResultsThe presence of definite psychotic symptoms was associated with maternal infection during pregnancy [adjusted odds ratio (OR) 1.44, 95% confidence interval (CI) 1.11–1.86, p=0.006], maternal diabetes (adjusted OR 3.43, 95% CI 1.14–10.36, p=0.029), need for resuscitation (adjusted OR 1.50, 95% CI 0.97–2.31, p=0.065) and 5-min Apgar score (adjusted OR per unit decrease 1.30, 95% CI 1.12–1.50, p<0.001). None of these associations were mediated by childhood IQ score. Most associations persisted, but were less strong, when including suspected symptoms as part of the outcome. There was no association between PLIKS and gestational age or pre-eclampsia.ConclusionsAdverse events during early development may lead to an increased risk of developing PLIKS. Although the status of PLIKS in relation to clinical disorders such as schizophrenia is not clear, the similarity between these results and findings reported for schizophrenia indicates that future studies of PLIKS may help us to understand how psychotic experiences and clinical disorders develop throughout the life-course.

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Longitudinal study of premorbid adjustment in 22q11.2 deletion (velocardiofacial) syndrome and association with psychosis

Development and Psychopathology ◽

10.1017/s0954579416000018 ◽

2016 ◽

Vol 29 (1) ◽

pp. 93-106 ◽

Cited By ~ 5

Author(s):

Petya D. Radoeva ◽

Wanda Fremont ◽

Kevin M. Antshel ◽

Wendy R. Kates

Keyword(s):

Early Adolescence ◽

Velocardiofacial Syndrome ◽

Structured Interview ◽

School Age Children ◽

Deletion Syndrome ◽

Psychotic Symptoms ◽

22Q11.2 Deletion ◽

Prodromal Symptoms ◽

Premorbid Adjustment ◽

Increased Risk

AbstractVelocardiofacial syndrome, also known as 22q11.2 deletion syndrome (22q11DS), is associated with an increased risk of major psychiatric disorders, including schizophrenia. The emergence of psychotic symptoms in individuals with schizophrenia in the general population is often preceded by a premorbid period of poor or worsening social and/or academic functioning. Our current study evaluated premorbid adjustment (via the Cannon–Spoor Premorbid Adjustment Scale [PAS]) and psychotic symptoms (via the Structured Interview for Prodromal Symptoms and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version) in youth with 22q11DS (N = 96), unaffected siblings (N = 40), and community controls (N = 50). The PAS scores indicated greater maladjustment during all developmental periods in individuals with 22q11DS compared to the controls. Many participants with 22q11DS had chronically poor (n = 33) or deteriorating (n = 6) PAS scores. In 22q11DS, chronically poor PAS trajectories and poor childhood and early adolescence academic domain and total PAS scores significantly increased the risk of prodromal symptoms or overt psychosis. Taking into account the catechol-O-methyltransferase (COMT) genotype, the best predictor of (prodromal) psychosis was the early adolescence academic domain score, which yielded higher sensitivity and specificity in the subgroup of youth with 22q11DS and the high-activity (valine) allele. PAS scores may help identify individuals at higher risk for psychosis.

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Assessment of Tobacco Exposure During Pregnancy by Meconium Analysis and Maternal Interview

Journal of Analytical Toxicology ◽

10.1093/jat/bkaa027 ◽

2020 ◽

Vol 44 (8) ◽

pp. 797-802

Author(s):

Ángela López-Rabuñal ◽

Elena Lendoiro ◽

Eva González-Colmenero ◽

Ana Concheiro-Guisán ◽

Marta Concheiro-Guisán ◽

...

Keyword(s):

Birth Weight ◽

In Utero ◽

In Utero Exposure ◽

Tobacco Exposure ◽

Smoking During Pregnancy ◽

Outcomes Measures ◽

Significant Difference ◽

The Matrix ◽

Fetal Complications ◽

Female Weight

Abstract Smoking during pregnancy can have serious obstetric and fetal complications. Therefore, it is essential to identify in utero exposure to tobacco, being meconium the matrix of choice for this purpose. Meconium (n = 565) was analyzed for nicotine, cotinine and hydroxycotinine by LC–MS-MS. Then, tobacco meconium results were compared with smoking habits during pregnancy and neonatal outcomes measures (birth weight, length, head circumference, gestational age and Apgar scores). Although meconium analysis increased identification of in-utero exposure to tobacco (17.7% meconium positive specimens vs 13.5% mothers admitting tobacco use during pregnancy), there was a statistically significant relationship between meconium results and interview answers (P < 0.001). Birth weight was significantly lower for newborns with meconium positive results in males (P = 0.023) and females (P = 0.001), while for length significance was only observed in females (P = 0.001); however, when excluding meconium specimens positive for other drugs, a statistically significant difference was only found for female weight (P = 0.045). Meconium analysis proved to be more reliable for tobacco prenatal exposure detection than maternal interview. In addition, positive meconium results increased the probability for low birth weight, especially in females.

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Association of measures of fetal and childhood growth with non-clinical psychotic symptoms in 12-year-olds: the ALSPAC cohort

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.051730 ◽

2009 ◽

Vol 194 (6) ◽

pp. 521-526 ◽

Cited By ~ 21

Author(s):

K. Thomas ◽

G. Harrison ◽

S. Zammit ◽

G. Lewis ◽

J. Horwood ◽

...

Keyword(s):

Birth Weight ◽

Odds Ratio ◽

Psychotic Symptoms ◽

Standard Deviation Increase ◽

Smoking During Pregnancy ◽

Childhood Growth ◽

Adult Growth ◽

Increased Risk ◽

Similar Association ◽

Size At Birth

BackgroundPrevious studies have suggested that impaired fetal and childhood growth are associated with an increased risk of schizophrenia, but the association of pre-adult growth with non-clinical psychotic symptoms (psychosis-like symptoms) in children is not known.AimsTo explore the associations of body size at birth and age 7.5 years with childhood psychosis-like symptoms.MethodProspective cohort of children followed up from birth to age 12: the ALSPAC cohort.ResultsData on 6000 singleton infants born after 37 weeks of gestation. A one standard deviation increase in birth weight was associated with an 18% reduction in the risk of definite psychosis-like symptoms after adjusting for age and gestation (Odds ratio (OR) = 0.82, 95% CI = 0.73–0.92, P = 0.001). This association was partly confounded by maternal anthropometry, smoking during pregnancy, socioeconomic status and IQ. A similar association was seen for birth length and psychosis-like symptoms, which disappeared after controlling for birth weight. There was little evidence for an association of 7-year height or adiposity with psychosis-like symptoms.ConclusionsMeasures of impaired fetal, but not childhood, growth are associated with an increased risk of psychosis-like symptoms in 12-year-olds.

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Passive Tobacco Exposure and Sudden Infant Death Syndrome

PEDIATRICS ◽

10.1542/peds.92.3.505b ◽

1993 ◽

Vol 92 (3) ◽

pp. 505-506

Author(s):

PETER N. LEE

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Maternal Smoking ◽

Sudden Infant Death ◽

Sudden Infant ◽

Combined Exposure ◽

Tobacco Exposure ◽

Smoking During Pregnancy ◽

Passive Exposure ◽

Increased Risk

To the Editor.— Drs Schoendorf and Kiely1 report increased risk of SIDS, both in mothers smoking during and after pregnancy ("combined exposure") and in mothers smoking only afterward ("passive exposure"). Most previous studies2-18 that reported that maternal smoking is associated with SIDS considered only smoking during pregnancy, but some2,4,11,15 considered smoking after pregnancy. However, I am unaware of any previous study which attempted separation of smoking during and after pregnancy. Although such an attempt is commendable, certain problems with the analysis and data of Drs Schoendorf and Kiely merit comment.

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Increased Risk for Cerebral Hypoxia During Immediate Neonatal Transition After Birth in Term Neonates Delivered by Caesarean Section With Prenatal Tobacco Exposure

Frontiers in Pediatrics ◽

10.3389/fped.2021.747509 ◽

2021 ◽

Vol 9 ◽

Author(s):

Christina Helene Wolfsberger ◽

Marlies Bruckner ◽

Bernhard Schwaberger ◽

Lukas Peter Mileder ◽

Ena Pritisanac ◽

...

Keyword(s):

Birth Weight ◽

Maternal Smoking ◽

Cerebral Oxygenation ◽

Cerebral Hypoxia ◽

Tobacco Exposure ◽

Tissue Oxygen ◽

Term Neonates ◽

Smoking During Pregnancy ◽

Increased Risk ◽

Smoking Group

Introduction: Maternal tobacco smoking during pregnancy is a global health problem leading to an increased risk for fetal and neonatal morbidities. So far, there are no data of the potential impact of maternal smoking during pregnancy on the most vulnerable period after birth – the immediate postnatal transition. The aim of the present study was therefore, to compare cerebral oxygenation during immediate postnatal transition in term neonates with and without prenatal tobacco exposure.Methods: Included in this post-hoc analysis were healthy term neonates, with measurements of cerebral oxygenation (INVOS 5100C) during the first 15 min after birth, and for whom information on maternal smoking behavior during pregnancy was available. Neonates with prenatal tobacco exposure (smoking group) were matched 1:1 according to gestational age (±1 week), birth weight (±100 grams) and hematocrit (±5 %) to neonates without (non-smoking group). Cerebral regional tissue oxygen saturation (crSO2), cerebral fractional tissue oxygen extraction (cFTOE), arterial oxygen saturation (SpO2) and heart rate (HR) within the first 15 min after birth were compared between the two groups.Results: Twelve neonates in the smoking group with a median (IQR) gestational age of 39.1 (38.8–39.3) weeks and a birth weight of 3,155 (2,970–3,472) grams were compared to 12 neonates in the non-smoking group with 39.1 (38.7–39.2) weeks and 3,134 (2,963–3,465) grams. In the smoking group, crSO2 was significantly lower and cFTOE significantly higher until min 5 after birth. HR was significantly higher in the smoking group in min 3 after birth. Beyond this period, there were no significant differences between the two groups.Conclusion: Cerebral oxygenation within the first 5 min after birth was compromised in neonates with prenatal tobacco exposure. This observation suggests a higher risk for cerebral hypoxia immediately after birth due to fetal tobacco exposure.

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the ‘schizophrenia Postdrome’: A Study of Low-level Positive Symptoms after Remission of First Episode Schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(09)71353-7 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

K. Burley ◽

R. Upthegrove ◽

M. Birchwood ◽

P. Patterson ◽

A. Skeate

Keyword(s):

Structured Interview ◽

Primary Objective ◽

Psychotic Symptoms ◽

First Episode ◽

Positive Symptoms ◽

Low Level ◽

Increased Risk ◽

Friedman's Test ◽

Remission Criteria ◽

First Episode Of Schizophrenia

Background:Despite remission being the primary objective following the first episode of schizophrenia, clinically stabilised patients are rarely studied.Aims:To assess the extent and fluctuation of low-level positive symptoms in patients who are in remission following their first episode of schizophrenia, and consider whether symptoms displayed are similar to those exhibited in the prodromal population.Methods:Eleven patients who had recovered for at least six months following one episode of schizophrenia and subsequently fulfilled remission criteria were interviewed four times over the course of three months. Interviews were based on the Structured Interview of Prodromal Symptoms (SIPS), an in-depth assessment of low-level symptoms that is widely used in the prodromal group. Data was compared to equivalent results from the prodromal population (with data provided by the local ED:IT service).Results:Over the course of the interviews 73% of participants displayed attenuated positive symptoms, predominantly unusual thought content and suspiciousness. 18% experienced brief limited intermittent psychotic symptoms (BLIPS). Analysis with Friedman's test revealed no significant fluctuation in positive symptoms, indicating that they are stable over time. Furthermore, the symptoms exhibited in the sample were closely comparable to those in the prodromal group in the ED:IT service.Conclusions:The majority of patients in remission are experiencing a form of ‘postdrome’, which appears to be an enduring state. the presence of these symptoms may put patients at an increased risk of relapse. Larger-scale research is required to follow-up this novel preliminary study.Declaration of interest:None.

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Exposure to tobacco smoke in utero or during early childhood and risk of hypomania: Prospective birth cohort study

European Psychiatry ◽

10.1016/j.eurpsy.2016.06.001 ◽

2017 ◽

Vol 39 ◽

pp. 33-39 ◽

Cited By ~ 3

Author(s):

D.F. Mackay ◽

J.J. Anderson ◽

J.P. Pell ◽

S. Zammit ◽

D.J. Smith

Keyword(s):

Birth Cohort ◽

Tobacco Smoke ◽

Maternal Smoking ◽

In Utero ◽

Secondary Outcome ◽

Psychotic Symptoms ◽

Birth Cohort Study ◽

Smoking During Pregnancy ◽

Paternal Smoking ◽

Prospective Birth Cohort

AbstractObjectivesUsing data from a prospective birth cohort, we aimed to test for an association between exposure to tobacco smoke in utero or during early development and the experience of hypomania assessed in young adulthood.MethodsWe used data on 2957 participants from a large birth cohort (Avon longitudinal study of parents and children [ALSPAC]). The primary outcome of interest was hypomania, and the secondary outcome was “hypomania plus previous psychotic experiences (PE)”. Maternally-reported smoking during pregnancy, paternal smoking and exposure to environmental tobacco smoke (ETS) in childhood were the exposures of interest. Multivariable logistic regression was used and estimates of association were adjusted for socio-economic, lifestyle and obstetric factors.ResultsThere was weak evidence of an association between exposure to maternal smoking in utero and lifetime hypomania. However, there was a strong association of maternal smoking during pregnancy within the sub-group of individuals with hypomania who had also experienced psychotic symptoms (OR = 3.45; 95% CI: 1.49–7.98; P = 0.004). There was no association between paternal smoking, or exposure to ETS during childhood, and hypomania outcomes.ConclusionsExposure to smoking in utero may be a risk factor for more severe forms of psychopathology on the mood-psychosis spectrum, rather than DSM-defined bipolar disorder.

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The epigenetics of maternal cigarette smoking during pregnancy and effects on child development

Development and Psychopathology ◽

10.1017/s0954579412000776 ◽

2012 ◽

Vol 24 (4) ◽

pp. 1377-1390 ◽

Cited By ~ 148

Author(s):

Valerie S. Knopik ◽

Matthew A. Maccani ◽

Sarah Francazio ◽

John E. McGeary

Keyword(s):

Cigarette Smoking ◽

Fetal Growth ◽

Growth And Development ◽

Well Being ◽

In Utero ◽

Smoke Exposure ◽

Smoking During Pregnancy ◽

Maternal Cigarette Smoking ◽

Increased Risk ◽

And Behavior

AbstractThe period of in utero development is one of the most critical windows during which adverse intrauterine conditions and exposures can influence the growth and development of the fetus as well as the child's future postnatal health and behavior. Maternal cigarette smoking during pregnancy remains a relatively common but nonetheless hazardous in utero exposure. Previous studies have associated prenatal smoke exposure with reduced birth weight, poor developmental and psychological outcomes, and increased risk for diseases and behavioral disorders later in life. Researchers are now learning that many of the mechanisms whereby maternal smoke exposure may affect key pathways crucial for proper fetal growth and development are epigenetic in nature. Maternal cigarette smoking during pregnancy has been associated with altered DNA methylation and dysregulated expression of microRNA, but a deeper understanding of the epigenetics of maternal cigarette smoking during pregnancy as well as how these epigenetic changes may affect later health and behavior remain to be elucidated. This article seeks to explore many of the previously described epigenetic alterations associated with maternal cigarette smoking during pregnancy and assess how such changes may have consequences for both fetal growth and development, as well as later child health, behavior, and well-being. We also outline future directions for this new and exciting field of research.

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Prenatal exposure to tobacco and future nicotine dependence: population-based cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.100123 ◽

2012 ◽

Vol 200 (3) ◽

pp. 202-209 ◽

Cited By ~ 28

Author(s):

Mina Rydell ◽

Sven Cnattingius ◽

Fredrik Granath ◽

Cecilia Magnusson ◽

Maria Rosaria Galanti

Keyword(s):

Nicotine Dependence ◽

Tobacco Use ◽

Prenatal Exposure ◽

Statistical Significance ◽

Smoking Behaviour ◽

Tobacco Exposure ◽

Prospective Longitudinal Study ◽

Smoking During Pregnancy ◽

Increased Risk ◽

Prospective Longitudinal

BackgroundMaternal smoking during pregnancy may increase the risk of nicotine dependence, especially in girls, but data are conflicting and confounding by other familial factors cannot be ruled out.AimsTo clarify the relationship between prenatal tobacco exposure and adolescent tobacco uptake and dependence in boys and girls respectively, while taking confounding factors into close consideration.MethodWe conducted a prospective longitudinal study, comprising 3020 Swedish youths followed from 11 to 18 years of age. Exposure and outcome information was elicited via self-administered parental and repeated youth questionnaires. Hazard ratios (HRs), odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated as measures of associations.ResultsGirls prenatally exposed to maternal tobacco use had a two-to threefold increased odds of experiencing a high number of withdrawal symptoms (OR = 2.83, 95% CI 1.68–4.87), craving for tobacco (OR = 2.04, 95% CI 1.28–3.32) and heavy tobacco use (five or more cigarettes or snus dips per day) (OR = 1.93, 95% CI 1.30–2.86). These associations were weaker among boys, and did not reach formal statistical significance. Associations between prenatal tobacco exposure and onset of regular tobacco use in both genders appeared to be mostly explained by parents' social position and postnatal smoking behaviour.ConclusionsPrenatal exposure to tobacco is linked to an increased risk of nicotine dependence among adolescent girls.

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