title: Smoking in pregnancy, adolescent mental health and cognitive performance in young adult offspring: results from a matched sample within a Finnish cohort.
abstract: BACKGROUND
  The association between prenatal exposure to maternal cigarette smoking (PEMCS) and adult cognition is debated, including if there are differences according to sex. We aimed to determine if there are associations between PEMCS and cognition in early adulthood in men and women and examine if observed associations were mediated by adolescent mental health factors that are associated with cognition, namely psychotic-like experiences (PLEs), inattention and hyperactivity, and other externalizing behaviors.
  
  
  METHODS
  Participants were 471 individuals drawn from the general population-based Northern Finland 1986 Birth Cohort (NFBC 1986) followed up from pregnancy and birth to early adulthood; individuals with PEMCS were matched with those without PEMCS by socioeconomic and demographic factors. Cognitive performance in adulthood was assessed with a range of tests and their association with PEMCS was measured by sex using hierarchical linear regression, unadjusted and then controlling for potential confounders, mediators and moderators, including adolescent mental health factors.
  
  
  RESULTS
  There were no associations between PEMCS and cognitive scores in females. In males, there were associations with vocabulary (beta = -0.444, 95% CI: -0.783, -0.104) and matrix reasoning (beta = -0.379, 95% CI: -0.711, -0.047).
  
  
  CONCLUSIONS
  While associations between PEMCS and cognition were limited, observed findings with measures of general intelligence in males contribute to suggestions of differences in response to PEMCS by sex. Furthermore, observed associations may be partly mediated by earlier inattention and hyperactivity. Findings add support to efforts aimed to eliminate smoking in pregnancy.
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland. drhughramsay@gmail.com.|St. Michael's House, Dublin, Ireland. drhughramsay@gmail.com.
authors.forename: Hugh
authors.initials: H
authors.lastname: Ramsay
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.|Cambridge Cognition Ltd, Cambridge, UK.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Barnett
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: Graham K
authors.initials: GK
authors.lastname: Murray
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Department of Child Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland.|Department of Psychiatry, the Middle Ostrobothnia Central Hospital, Kiuru, Finland.|Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Raahe, Finland.|Mental Health Services, Basic Health Care District of Kallio, Helsinki, Finland.|Visala Hospital, the Northern Ostrobothnia Hospital District, Oulu, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mäki
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Department of Radiology, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Hurtig
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Nordström
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Miettunen
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Department of Radiology, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
authors.forename: Vesa
authors.initials: V
authors.lastname: Kiviniemi
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.|Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland.
authors.forename: Solja
authors.initials: S
authors.lastname: Niemelä
authors.affiliation: The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Pausova
authors.affiliation: Rotman Research Institute, Baycrest, Toronto, ON, Canada.|Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada.|Child Mind Institute, New York, NY, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Paus
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Veijola
mesh_terms: D000293:Adolescent; D032721:Adult Children / Q000523:psychology* / Q000706:statistics & numerical data; D003071:Cognition; D003072:Cognition Disorders / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D005387:Finland; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis; D008297:Male; D008603:Mental Health; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D055815:Young Adult
keywords: Cognition; Inattention and hyperactivity; Prenatal smoking; Psychotic-like experiences