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Prenatal exposure to maternal smoking and childhood behavioural problems: a quasi-experimental approach
Cathal McCrory1, Richard Layte
1The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Ireland. cathal.mccrory@esri.ie
Insights
Maternal smoking during pregnancy significantly increases children's risk for behavioral problems by age nine. Promoting smoking cessation in pregnancy is crucial for preventing long-term negative child development outcomes.
Area of Science:
- Child Psychology
- Public Health
- Epidemiology
Background:
- Maternal smoking during pregnancy is a known risk factor for adverse child outcomes.
- Understanding the specific impact on behavioral problems requires controlling for confounding factors.
Purpose of the Study:
- To investigate the association between maternal smoking during pregnancy and children's behavioral problems at age nine.
- To quantify this relationship independently of numerous potential confounders.
Main Methods:
- Retrospective cross-sectional study of 7,505 nine-year-old children from the Growing Up in Ireland cohort.
- Propensity score matching used to create comparable smoking and non-smoking groups.
- Behavioral problems assessed using the Strengths and Difficulties Questionnaire (SDQ) via parent and teacher reports.
Main Results:
- Children of mothers who smoked during pregnancy were significantly more likely to exhibit problematic behavioral difficulties (3.5% parent-report, 3.4% teacher-report).
- The association was stronger for externalizing than internalizing behavioral problems.
- A dose-response relationship was observed, with higher smoking levels correlating with increased behavioral issues.
Conclusions:
- Maternal smoking during pregnancy is independently linked to a higher likelihood of behavioral problems in children at age nine.
- Targeted interventions promoting smoking cessation during pregnancy can mitigate these risks.
- Public health strategies should focus on supporting pregnant individuals to quit smoking for improved child developmental trajectories.
Abstract:
This retrospective cross-sectional paper examines the relationship between maternal smoking during pregnancy and children's behavioural problems at 9 years of age independent of a wide range of possible confounders. The final sample comprised 7,505 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information on maternal smoking during pregnancy was obtained retrospectively at 9 years of age via parental recall and children's behavioural problems were assessed using the Strengths and Difficulties Questionnaire across separate parent and teacher-report instruments. A quasi-experimental approach using propensity score matching was used to create treatment (smoking) and control (non-smoking) groups which did not differ significantly in their propensity to smoke in terms of 16 observed characteristics. After matching on the propensity score, children whose mothers smoked during pregnancy were 3.5 % (p < 0.001) and 3.4 % (p < 0.001) more likely to score in the problematic range on the SDQ total difficulties index according to parent and teacher-report respectively. Maternal smoking during pregnancy was more strongly associated with externalising than internalising behavioural problems. Analysis of the dose-response relationship showed that the differential between matched treatment and control groups increased with level of maternal smoking. Given that smoking is a modifiable risk factor, the promotion of successful cessation in pregnancy may prevent potentially adverse long-term consequences.
