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

Stene‐Larsen, Kim; Borge, Anne I.H.; Vollrath, Margarete E.

doi:10.1097/chi.0b013e318195bcfb

Cited by 69 publications

(45 citation statements)

References 39 publications

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“…Currently, mood and personality disturbances as represented in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are categorized into distinct behavioral disorders� However, there often is comorbidity and overlapping symptoms between disorders, and they might have common underlying causes� Psychological problems do not always manifest all possible characteristic criteria, are often hard to describe and can refer to a number of different maladaptive behaviors that are broadly classified into internalizing and externalizing behavioral problems� Internalizing behavioral problems often refer to anxiety, depression, shyness, social withdrawal as well as others, while externalizing problems include conduct problems, oppositional defiant disorder, inattention, impulsivity, and hostile aggression (Weisz et al�, 2004)� Adding to the complexity and difficulty in evaluating behavioral abnormalities is that the behavioral phenotype of both internalizing and externalizing behaviors, changes with age, and differs between males and females (Oland & Shaw, 2005)� This broad range of different age-and gender-dependent behaviors in humans makes it difficult to establish a causal relationship between long-lasting behavioral problems and prenatal exposure to tobacco smoke� However, a number of studies have linked maternal smoking with behavioral disturbances in children, and have shown a significantly increased risk for subsequent externalizing or internalizing behavior problems (Orlebeke et al�, 1997;Williams et al�, 1998;Weissman et al�, 1999;Höök et al�, 2006;Indredavik et al�, 2007;Ashford et al�, 2008;D'Onofrio et al�, 2008;Iñiguez et al�, 2009;Stene-Larsen et al�, 2009;Brion et al�, 2010)� Together, these studies show that prenatal tobacco smoke exposure due to maternal smoking results in higher scores for both externalizing and internalizing symptoms, and maternal smoking is an indicator for the possibility that the children develop behavioral problems during childhood and adolescence, which may last into adulthood� However, there are a number of genetic and environmental confounders that affect both maternal smoking behavior and conduct problems in the offspring� Additional limitations result from the often subjective reporting of behavioral measures by parents and teachers, and self-reporting of maternal smoking levels during pregnancy, which are often understated� Despite these difficulties, a number of studies have reported that the relationship between maternal smoking and behavioral abnormalities remained after adjusting for possible confounding factors (Orlebeke et al�, 1997;Williams et al�, 1998;Höök et al�, 2006;Indredavik et al�, 2007;…”

Section: Long-term Effects Of Smoking During Pregnancy On Externalizimentioning

confidence: 98%

Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models

Abbott

Winzer‐Serhan

2012

Critical Reviews in Toxicology

149

105

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Numerous epidemiological studies in the human population clearly indicate that smoking while pregnant has deleterious effects on fetal development as well as long-term adverse consequences on postnatal development and maturation of several organ systems. Low birth weight, sudden infant death syndrome (SIDS), behavioral disorders including attention deficit hyperactivity disorder (ADHD), externalizing and internalizing behavioral problems and conduct disorders in children have all been linked to prenatal exposure to tobacco smoke. The major pharmacologically active chemical found in tobacco smoke is nicotine, and prenatal exposure to nicotine has been shown to have significant effect on the development of multiple organ systems, including the nervous, respiratory, and cardiovascular systems. In this review, we define mainstream and sidestream smoke, summarize the major classes of compounds found in cigarette smoke, and describe how use of laboratory animal models can be used to assess mechanisms of toxicity and risk in the human population in general. We then discuss the association with smoking during pregnancy and the occurrence of reduced lung function, low birth weight, the incidence of congenital structural malformations, SIDS, ADHD, cognitive impairment, and mood disorders in children, and review pertinent experimental studies using a variety of animal models of developmental nicotine exposure, including, rats, mice, monkeys, lambs, and pigs that have increased our understanding of the pathophysiology of these disorders.

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Section: Long-term Effects Of Smoking During Pregnancy On Externalizimentioning

confidence: 98%

Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models

Abbott

Winzer‐Serhan

2012

Critical Reviews in Toxicology

149

105

View full text Add to dashboard Cite

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“…Children as young as 18-24 months show increases in externalizing behaviors (Stene-Larsen et al, 2009;Wakschlag et al, 2006a) as well as internalizing and total problem scores following prenatal tobacco exposure (Carter et al, 2008). A study of 3-year-olds exposed gestationally to tobacco determined that increases in oppositional behavior were correlated to third trimester exposure .…”

Section: Tobacco/nicotinementioning

confidence: 99%

Developmental Consequences of Fetal Exposure to Drugs: What We Know and What We Still Must Learn

Ross

Graham

Money

et al. 2014

Neuropsychopharmacol

341

241

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Most drugs of abuse easily cross the placenta and can affect fetal brain development. In utero exposures to drugs thus can have long-lasting implications for brain structure and function. These effects on the developing nervous system, before homeostatic regulatory mechanisms are properly calibrated, often differ from their effects on mature systems. In this review, we describe current knowledge on how alcohol, nicotine, cocaine, amphetamine, Ecstasy, and opiates (among other drugs) produce alterations in neurodevelopmental trajectory. We focus both on animal models and available clinical and imaging data from cross-sectional and longitudinal human studies. Early studies of fetal exposures focused on classic teratological methods that are insufficient for revealing more subtle effects that are nevertheless very behaviorally relevant. Modern mechanistic approaches have informed us greatly as to how to potentially ameliorate the induced deficits in brain formation and function, but conclude that better delineation of sensitive periods, dose-response relationships, and long-term longitudinal studies assessing future risk of offspring to exhibit learning disabilities, mental health disorders, and limited neural adaptations are crucial to limit the societal impact of these exposures.

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“…Although the items indicating internalizing and externalizing problems at 18 months have been used in a previous publication 34 from the MoBa database, the use of these abbreviated and unvalidated versions of the original scales may limit the generalizability of the results. MoBa participants with data from the Medical Birth Registry in Norway (including all women giving birth in Norway) on key factors, a lower rate on some predictor variables was detected, such as higher maternal age, fewer health-related risks, and children who had received better neonatal health care relative to children of mothers not participating in MoBa.…”

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confidence: 99%

Later Emotional and Behavioral Problems Associated With Sleep Problems in Toddlers

et al. 2015

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IMPORTANCE Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. OBJECTIVE To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. DESIGN, SETTING, AND PARTICIPANTS A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. EXPOSURES Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. MAIN OUTCOMES AND MEASURESEmotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates.RESULTS Short sleep duration (Յ10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (Ն3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models. CONCLUSIONS AND RELEVANCEEarly sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.

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

Cited by 69 publications

References 39 publications

Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models

Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models

Developmental Consequences of Fetal Exposure to Drugs: What We Know and What We Still Must Learn

Later Emotional and Behavioral Problems Associated With Sleep Problems in Toddlers

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