Prenatal and postnatal tobacco exposure and behavioral problems in 10-year-old children: results from the GINI-plus prospective birth cohort study
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Simon Rückinger1, Peter Rzehak, Chih-Mei Chen
1Ludwig-Maximilians University Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Munich, Germany. simon.rueckinger@med.uni-muenchen.de
Insights
Prenatal tobacco smoke exposure significantly increases children's risk for behavioral problems. This risk is higher than postnatal exposure, highlighting the importance of avoiding smoking during pregnancy for child development.
Area of Science:
- Pediatric Health
- Environmental Health
- Developmental Psychology
Background:
- Prenatal and postnatal tobacco exposure are linked to behavioral issues in children.
- The specific impact of exposure during different developmental periods remains unclear.
Purpose of the Study:
- To determine the relative risk of behavioral problems associated with prenatal and postnatal tobacco smoke exposure.
- To analyze the impact of tobacco exposure at specific life stages.
Main Methods:
- A prospective birth cohort study involving 5,991 children in Germany.
- Behavioral problems assessed using the Strength and Difficulties Questionnaire (SDQ) at age 10.
- Parental questionnaires collected data on smoke exposure and covariates.
Main Results:
- Children exposed both pre- and postnatally had double the risk of abnormal behavioral scores (SDQ total difficulties).
- Prenatal-only exposure showed a 90% increased risk, while postnatal-only exposure showed a 30% increased risk.
- Results were independent of parental education, employment, and other demographic factors.
Conclusions:
- Prenatal tobacco smoke exposure is a significant factor associated with behavioral problems in school-aged children.
- Prenatal exposure appears to have a more substantial impact on behavioral outcomes than postnatal exposure.
Background:
Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear.
Objective:
We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally.
Methods:
We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as "normal," "borderline," or "abnormal" according to the subscales "emotional symptoms," "conduct problems," "hyperactivity/inattention," "peer-relationship problems," and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires.
Results:
Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4-3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9-4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9-1.9). These results could not be explained by confounding by parental education, father's employment, child's time spent in front of computer or television screen, being a single father or mother, or mother's age.
Conclusions:
Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.
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