Prenatal nicotine exposure and child behavioural problems.

Carla M T Tiesler,Joachim Heinrich

doi:10.1007/s00787-014-0615-y

Abstract

In utero exposure to tobacco smoke has been related to numerous adverse health effects in new-borns, infants, children, adolescents and adults. The aim of this review was to summarise findings on prenatal nicotine exposure and its relationship with behavioural problems in the offspring. The majority of studies, and especially several recent epidemiological studies, observed a higher likelihood for attention-deficit/hyperactivity disorder (ADHD) or ADHD symptoms in exposed subjects. However, both human and animal studies have failed to provide clear evidence on causality. Existing literature on studies investigating the association between prenatal nicotine exposure and conduct or externalising problems in the offspring suggests a causal effect. The establishment of a final conclusion concerning the relationship between prenatal nicotine exposure and internalising problems in the offspring is complicated by insufficient data and mixed results in epidemiological studies. Prenatal nicotine exposure has been associated with altered brain structure and function in human offspring, and a proposed biological mechanism is related to nicotine’s adverse influence on neurotransmitter systems during brain development. In conclusion, establishing a statement on the causality of the relationship between prenatal nicotine exposure and behavioural problems in children remains a challenging task. Nevertheless, considering the results of an increasing number of studies which link prenatal exposure to nicotine to externalising problems applying different methodologies to account for confounding and in view of other adverse health effects known to be caused by this exposure, parents should consider smoking cessation.

Highlights

Maternal smoking during pregnancy has been related to multiple adverse effects including pregnancy complications and risks of preterm delivery, lower birth weight, reduced lung function in infants and sudden infant deathEur Child Adolesc Psychiatry (2014) 23:913–929 syndrome [1]
The establishment of a final conclusion concerning the relationship between prenatal nicotine exposure and internalising problems in the offspring is complicated by insufficient data and mixed results in epidemiological studies
Even though a large number of studies support a relationship between intrauterine exposure to tobacco smoke and later behavioural problems and plausible biological mechanisms exist, some studies reported no association or only a weak one

Summary

Introduction

Maternal smoking during pregnancy has been related to multiple adverse effects including pregnancy complications and risks of preterm delivery, lower birth weight, reduced lung function in infants and sudden infant death. A longer half-life of nicotine and similar half-life of cotinine compared to adults have been reported which have been suggested to be due to differences in the sensitivity of the clearance rates of these two chemicals to alterations of hepatic blood flow [5] Maternal matrices such as blood, urine, saliva and hair can be used for detection of the above-mentioned biomarkers to assess ETS exposure or active smoking [10, 12]. They compared the risks of ADHD symptoms in children aged 7.5 years whose mother smoked during pregnancy, with those whose mother did not smoke but was exposed to the smoking behaviour of the father They assessed the effect of passive smoking in families in which neither parent smoked but where the mother reported ETS exposure at work or living with household members who smoked. The authors concluded that the associations between maternal smoking and ADHD in the children may be confounded by genetic factors or factors on the household level and are to a lesser extent attributable to causal effects of an exposure in utero [20]

Results

Items on hyperactivity from a 100-item battery of child characteristics

Conclusion