Abstract
BackgroundMaternal smoking in pregnancy is associated with low birth weight (LBW), child conduct problems, hyperactivity and lower cognitive attainment, but associations may reflect measured and unmeasured confounding. Cross-cohort designs can aid causal inference through comparison of associations across populations with different confounding structures. We compared associations between maternal smoking in pregnancy and child conduct and hyperactivity problems, cognition and LBW across two cohorts born four decades apart.MethodsTwo national UK cohorts born in 1958 (n = 12 415) and 2000/01 (n = 11 800) were compared. Maternal smoking in pregnancy and child birth weight was assessed at or shortly after birth. Parents rated children’s conduct problems and hyperactivity, and children completed standardized tests of reading and mathematics.ResultsMaternal smoking in pregnancy was less common and more strongly associated with social disadvantage in 2000/01 compared with 1958 (interactions P < 0.001). Maternal smoking in pregnancy was robustly and equivalently associated with infant LBW in both cohorts [interactions: boys odds ratio (OR) = 1.01 (0.89, 1.16), P = 0.838; girls OR = 1.01 (0.91, 1.17), P = 0.633]. Maternal smoking was more strongly associated with conduct problems, hyperactivity and reading in the 2000/01 cohort (interactions P < 0.001).ConclusionsMarked cross-cohort change in associations between maternal smoking and child conduct problems, hyperactivity and reading highlights the likely role of confounding factors. In contrast, association with LBW was unaffected by change in prevalence of maternal smoking and patterns of confounding. The study highlights the utility of cross-cohort designs in helping triangulate conclusions about the role of putative causal risk factors in observational epidemiology.
Highlights
Maternal smoking in pregnancy shows robust statistical association with child Attention Deficit Hyperactivity Disorder (ADHD) and conduct problems in observational studies.[1,2,3] as recently reviewed,[4] genetically sensitive designs involving siblings who are discordant for exposure,[5,6,7] children born by assisted conception[8,9] and ‘negative control exposure’ designs[10] demonstrate that the association is likely to be explained by unmeasured genetic and/or social confounders
Association with low birth weight (LBW) was unaffected by change in prevalence of maternal smoking and patterns of confounding
The current study focuses on maternal smoking in pregnancy, which in one previous study using an international cross-cohort design was considered as a potential risk exposure for child conduct problems, hyperactivity and emotional problems.[25]
Summary
Maternal smoking in pregnancy shows robust statistical association with child Attention Deficit Hyperactivity Disorder (ADHD) and conduct problems in observational studies.[1,2,3] as recently reviewed,[4] genetically sensitive designs involving siblings who are discordant for exposure,[5,6,7] children born by assisted conception[8,9] and ‘negative control exposure’ designs (e.g. comparing maternal and paternal smoking)[10] demonstrate that the association is likely to be explained by unmeasured genetic and/or social confounders. Maternal smoking in pregnancy has been associated with children’s cognitive ability, but studies again suggest that these associations may be explained by confounding factors such as social disadvantage and maternal education.[11,12,13,14] In contrast, studies using a variety of designs point to maternal smoking in pregnancy having causal biologically-mediated effects on intrauterine growth and birth weight.[4,8,10,14,15]. Maternal smoking was more strongly associated with conduct problems, hyperactivity and reading in the 2000/01 cohort (interactions P < 0.001)
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