Original article
Parsing the Associations Between Prenatal Exposure to Nicotine and Offspring Psychopathology in a Nonreferred Sample

https://doi.org/10.1016/j.jadohealth.2008.12.003Get rights and content

Abstract

Purpose

Several studies have suggested an association between maternal smoking during pregnancy and both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in the offspring of women who smoke during pregnancy. However, it is unclear whether one or both of the documented links are spurious, given the considerable comorbidity between these disorders. The main aim of this study was to disentangle the association between maternal smoking during pregnancy with psychopathological outcomes, adjusting for possible confounders.

Methods

Two large, identically designed, longitudinal, case-control family studies of male and female probands with and without ADHD were combined. We used data from the nonreferred siblings of the probands from both studies (n = 536). All subjects were blindly assessed with structured diagnostic interviews. Logistic regression analysis was used to determine the adjusted effect of exposure to maternal smoking during pregnancy.

Results

Among all siblings, maternal smoking during pregnancy was significantly associated with ADHD, independent of CD and other covariates. In contrast, maternal smoking during pregnancy was a risk factor for CD only in siblings of control probands, after adjusting for covariates.

Conclusions

These results support the hypothesis that maternal smoking during pregnancy is a risk factor for both ADHD and CD, independently of each other. However, the risk for CD appears to be conditional on family risk status.

Section snippets

Subjects

Subjects were siblings of both genders derived from two identically designed, longitudinal case-control family studies conducted at the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital (MGH). Detailed study methodology has been previously reported [24], [25]. Briefly, these studies included male and female youth probands with and without ADHD and their first-degree relatives (hereafter referred to as the Boys and Girls ADHD study,

Demographic characteristics

Among the 577 siblings available for study, 34 (6%) were excluded because of missing maternal smoking during pregnancy data. Another seven subjects were excluded because of missing data on other covariates. Thus, the final sibling sample used for this study was 536. Of the sample, 21% (n = 115) was exposed to maternal smoking during pregnancy. The demographic characteristics of this sample, stratified by maternal smoking during pregnancy exposure, are presented in Table 1. As shown, there were

Discussion

In a large, nonreferred sample of siblings of ADHD and non-ADHD probands of both genders, we found that maternal smoking during pregnancy was associated with a significantly increased risk for ADHD independently of CD. These results confirm and extend previous findings [1], [2], [3]. These findings also extend our previous work [5] by expanding the sample to include nonreferred siblings of probands with and without ADHD and by incorporating more stringent statistical control for potential

Acknowledgments

This work was supported in part by a grant from USPHS (NICHD), grant 5RO1 HD-36317-07 (to J.B.), and a grant from USPHS (NICHD), 5RO1 HD-36317-07 (to J.B.).

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