Prenatal Smoking and Internalizing and Externalizing Problems in Children Studied From Childhood to Late Adolescence

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Abstract

Objective

To study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence.

Method

Child Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems.

Results

Children whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables.

Conclusions

Maternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):779–787.

Section snippets

Participants, Design, and Procedures

Subjects participated in a longitudinal general population study on the development of children from early childhood onward (described in detail elsewhere31). Children were assessed at age 2 years (not included in this study) and at 5, 10 to 11, and 18 years of age. The sample was randomly drawn and stratified by age and sex from the inoculation register of the Dutch province of Zuid-Holland and from the Rotterdam municipal population register in 1989 (age 2 years). This resulted in a sample of

Descriptive Statistics

The final sample in this study consisted of 396 children (201 boys, 50.8%; 195 girls). For 297 of the 396 (75 %) children, data were complete. No significant differences with regard to sex of the child (51.5% versus 48.5% boys; χ21 = .27, p > .05, ϕ = .03) or prenatal smoking status (11.1% versus 5.7% smoking during pregnancy; χ21 = 3.28, p >.05, ϕ = .09) were found among children with complete data and children with incomplete data. However, children with missing data were more likely to come

Discussion

This study sought to clarify the association of prenatal smoking with the course of internalizing as well as externalizing problems from ages 5 to 18 years. For externalizing outcomes, links with prenatal smoking had already been established.1, 3, 4, 5, 6 For internalizing problems, the association with prenatal smoking was uncertain, especially because co-occurring externalizing problems had not been adequately controlled for. The main conclusion is that even after controlling for possible

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      Similar to prenatal alcohol exposure, we found a null association for late pregnancy (at 34 weeks) exposure to tobacco. The finding of this study was consistent with evidence from some previous studies (Ashford, van Lier et al. 2008, Robinson, McLean et al. 2010, Moylan, Gustavson et al. 2015, Biederman, Martelon et al. 2017), but not all (Batstra, Hadders-Algra et al. 2003, Chudal, Brown et al. 2015, Talati, Wickramaratne et al. 2017). A study from the USA examined the association between prenatal tobacco use and psychopathology in offspring with a mean follow-up of 27.7 years (Talati, Wickramaratne et al. 2017).

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    This study was supported by grant 224 from the Sophia Foundation for Medical Research.

    This article is the subject of an editorial by Dr. Kathleen A. Pajer in this issue.

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