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Smoking in pregnancy and disruptive behaviour in 3-year-old boys and girls: an analysis of the UK Millennium Cohort Study
  1. J Hutchinson1,
  2. K E Pickett1,2,
  3. J Green1,2,
  4. L S Wakschlag3
  1. 1
    Department of Health Sciences, University of York, York, UK
  2. 2
    Hull-York Medical School, UK
  3. 3
    Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
  1. Correspondence to Dr K E Pickett, Department of Health and Sciences and Hull-York Medical School, University of York, Seebohm Rowntree Building, Area 3, Heslington, York YO10 5DD, UK; kp6{at}


Background: Maternal smoking during pregnancy has been consistently associated with disruptive behaviour in male offspring; however, results for girls are inconsistent and little is known about emergent patterns in young children. Additionally, it is unclear whether maternal smoking is independently associated in offspring with hyperactivity–inattention or only when it co-occurs with conduct problems. Further, few studies have controlled for a broad range of maternal psychosocial problems.

Methods: Associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour were analysed in more than 13 000 3-year-old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity–inattention problems were assessed using the Strength and Difficulties Questionnaire.

Results: Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity–inattention problems compared with sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, OR 1.92 (95% CI 1.29 to 2.86); and hyperactivity–inattention only for sons of light or heavy smokers, OR 1.79 (95% CI 1.27 to 2.51) and 1.64 (1.10 to 2.46). Daughters of light or heavy smokers were at significant risk of conduct-only problems, OR 1.73 (95% CI 1.14 to 2.61) and 1.73 (1.06 to 2.83). Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct 0.61(0.39 to 0.97) or co-occurring problems 0.26(0.08 to 0.82), although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors.

Conclusions: Associations between maternal smoking during pregnancy and disruptive behaviour in 3-year-old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.

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  • Competing interests None.

  • Ethics approval Ethics approval was not required for this secondary analysis of anonymised data.

  • Provenance and Peer review Not commissioned; externally peer reviewed.