Smoking cessation in pregnancy and the risk of child behavioural problems: a longitudinal prospective cohort study
- Monique Robinson1,3,
- Neil J McLean2,
- Wendy H Oddy1,
- Eugen Mattes1,
- Max Bulsara1,4,
- Jianghong Li3,5,6,
- Stephen R Zubrick3,
- Fiona J Stanley1,
- John P Newnham7
- 1Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- 2School of Psychology, The University of Western Australia, Perth, Australia
- 3Telethon Institute for Child Health Research, Curtin Health Innovation Research Institute, Centre for Developmental Health, Curtin University of Technology, Perth, Australia
- 4Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Australia
- 5School of Public Health, Curtin University of Technology, Perth, Australia
- 6Centre for International Health, Curtin University of Technology, Perth, Australia
- 7School of Women's and Infants' Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Australia
- Correspondence to Monique Robinson, Telethon Institute for Child Health Research, PO Box 855, West Perth, WA 6872, Australia;
- Accepted 13 July 2009
- Published Online First 24 August 2009
Background The aim of this study was to examine the influence of smoking in pregnancy on child and adolescent behavioural development, in comparison with mothers who ceased smoking in the first 18 weeks of pregnancy and with those who never smoked, in a large prospective pregnancy cohort.
Methods The Western Australian Pregnancy Cohort (Raine) Study provided comprehensive data from 2900 pregnancies. Smoking was assessed at 18 weeks gestation, and children were followed up at ages 1, 2, 3, 5, 8, 10 and 14 years. The Child Behaviour Checklist (CBCL) was used to measure problem child behaviour with continuous z-scores and clinical cut points at ages 2, 5, 8, 10 and 14 years. Potential confounders included maternal and family sociodemographic characteristics and alcohol exposure.
Results After adjusting for confounders, children of light smokers who quit smoking by 18 weeks gestation had significantly lower CBCL total z-scores, indicative of better behaviour, than children of women who never smoked, children of heavy smokers who quit and continuing smokers. Maternal smoking during pregnancy resulted in higher CBCL total, internalising and externalising scores and a higher risk of clinically meaningful behaviour problems in children from ages 2 to 14.
Conclusion The maternal decision not to quit smoking, or the inability to quit smoking, during pregnancy appears to be a particularly strong marker for poor behavioural outcomes in children. There is a need for a greater understanding of the psychosocial characteristics associated with the decision and ability to quit smoking in pregnancy.
- mental health
- prenatal risk
- Raine study
- child development
- mental health DI
- smoking and pregnancy
Funding The Western Australian Pregnancy Cohort (Raine) Study is funded by the Raine Medical Research Foundation at The University of Western Australia, the National Health and Medical Research Council of Australia (NHMRC), the Telstra Foundation, the Western Australian Health Promotion Foundation, and the Australian Rotary Health Research Fund. We would also like to acknowledge the Telethon Institute for Child Health Research and the NHMRC Program Grant which supported the 14-year follow-up (Stanley et al ID 003209).
Competing interests None.
Ethical approval The Human Ethics Committees at KEMH and/or Princess Margaret Hospital for Children approved the protocols for the study.
Provenance and peer review Not commissioned; externally peer reviewed.