Maternal smoking in pregnancy and externalizing behavior in 18-month-old children: results from a population-based prospective study.
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.


METHODS
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 1.75% [corrected] (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).
Stene-Larsen
Kim
K
Mr. Stene-Larsen and Dr. Vollrath are with the Norwegian Institute of Public Health, Department of Psychosomatics and Health Behavior; Dr. Borge is with the Psychological Institute, University of Oslo. Electronic address: kim.stene-larsen@fhi.no.
Borge
Anne I H
AIH
Mr. Stene-Larsen and Dr. Vollrath are with the Norwegian Institute of Public Health, Department of Psychosomatics and Health Behavior; Dr. Borge is with the Psychological Institute, University of Oslo.
Vollrath
Margarete E
ME
Mr. Stene-Larsen and Dr. Vollrath are with the Norwegian Institute of Public Health, Department of Psychosomatics and Health Behavior; Dr. Borge is with the Psychological Institute, University of Oslo.
D000374:Aggression / Q000523:psychology; D001008:Anxiety Disorders / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007389:Internal-External Control; D008137:Longitudinal Studies; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D009664:Norway; D010552:Personality Assessment / Q000706:statistics & numerical data; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000523:psychology*; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology