Maternal Smoking During Pregnancy and Behavioural Characteristics in 2 - 4-Month-old Infants

Zusammenfassung

Ziel der Studie war es, den Einfluss mütterlichen Rauchens während der Schwangerschaft auf das Verhaltensmuster von 2 - 4 Monate alten Säuglingen zu prüfen. Dazu wurden 250 (129 männlich, 121 weiblich) gesunde Neugeborene randomisiert ausgewählt und die Mütter nach standardisierten Verfahren befragt. 64 Mütter (25,6 %) hatten während der Schwangerschaft geraucht. Ihre Kinder waren häufiger Frühgeborene, wiesen niedrigere Geburtsgewichte und niedrigere Apgar-Werte (5 Minuten) auf und wurden seltener gestillt als im Vergleichskollektiv. Entsprechende Mütter hatten einen niedrigeren Bildungsstandard und waren seltener verheiratet. Säuglinge rauchender Mütter zeigten häufiger Konfliktreaktionen im Tagesverlauf, Abwehrverhalten bei der Pflege, Kontaktstörungen gegenüber der Mutter, häufiger inadäquate oder überschießende Reaktionen während des Windelwechsels und Abtrocknens und eine geringere Aufmerksamkeit bei Spielinteraktionen mit den Eltern. Das überschießende Verhaltensmuster blieb auch nach Korrekturversuchen erhalten und korrelierte signifikant mit dem Ausmaß des Rauchens während der Schwangerschaft. Mütterliches Rauchen während der Schwangerschaft kann als Risikofaktor für Verhaltensauffälligkeiten im Säuglingsalter betrachtet werden.

Abstract

The study aimed to assess potential relationship between maternal smoking during pregnancy and behavioural characteristics in 2 - 4-month-old infants. It covered period from 1999 to 2000 and comprised 250 randomly selected, apparently healthy singleton born infants from community setting (129 boys, 121 girls). The mothers were asked to complete the questionnaires addressing infant, maternal, demographic major characteristics with particular emphasis on maternal smoking during pregnancy. To objectively assess behavioural peculiarities of the infants, the mothers were requested to complete the Early Infancy Temperament Questionnaire. Of 250 mothers, 64. women (25.6 %) smoked during pregnancy. The infants of smoking mothers were more often born low birth weight and were also lighter at study; more frequently they were born at earlier gestational age, had lower Apgar score at 5^th minute, were less frequently breast fed at birth and at the time of study. Mothers who smoked during pregnancy were younger, had lower educational level, and less frequently were married. The infants born to smoking mothers had more frequent fussy periods occurring at about the same time of the day, protesting behaviour at face washing and washing in bath, indifferent attitude to the mother when held by new person, extreme reactions (either indifference or much feeling) during diapering and bowel movement, less attention to the parents during parent-infant play activity, and more sensitivity to the wet diaper. They were also characterised by more intensive reactions (displayed more amount of energy regardless of positive or negative behaviour) compared with the babies from the non-smoking group. This association remained after adjustment has been made for major potential confounders, and had a significant “dose-response” effect. Maternal smoking during pregnancy may serve as a risk factor for infant's behavioural deviations.

Verhalten - Kleinkinder - Schwangerschaft - plötzlicher Kindstod - Temperament

Behaviour - infants - pregnancy - smoking - sudden infant death syndrome - temperament

References

• 1 Ajarem J S, Ahmad M. Prenatal nicotine exposure modifies behavior of mice through early development.  Pharmacol Biochem Behav. 1998;  59 (2) 313-318
• 2 Armitage P, Berry G. Statistical methods in medical research. Oxford: Blackwell 1994 3
• 3 Aronson R A, Uttech S, Soref M. The effect of maternal cigarette smoking on low birth weight and preterm birth in Wisconsin, 1991.  Wis Med J. 1993;  92 (11) 613-617
• 4 Bakketeig L S, Jacobsen G, Hoffman H J. et al . Pre-pregnancy risk factors of small-for-gestational age births among parous women in Scandinavia.  Acta Obstet Gynecol Scand. 1993;  72 (4) 273-279
• 5 Behrens O, Goeschen K, Schneider J. [Smoking as a risk factor in pregnancy? Epidemiology of smoking and sequelae in pregnancy].  Z Geburtshilfe Perinatol. 1987;  191 (6) 225-229
• 6 Berman B A, Gritz E R. Women and smoking: current trends and issues for the 1999s.  J Subst Abuse. 1991;  3 (2) 221-238
• 7 Brook J S, Brook D W, Whiteman M. The influence of maternal smoking during pregnancy on the toddler's negativity.  Arch Pediatr Adolesc Med. 2000;  154 (4) 381-385
• 8 Cabello G, Hrepic N, Astudillo I. et al . [Cigarette smoking and its relation to pregnancy and lactation in Arica (Chile)].  Rev Chil Pediatr. 1991;  62 (6) 386-389
• 9 Casey P H, Bradley R H, Caldwell B M, Edwards D R. Developmental intervention: a pediatric clinical review.  Pediatr Clin North Am. 1986;  33 899-923
• 10 Casey P H, Bradley R H, Nelson J Y, Whaley S A. The clinical assessment of a child's social and physical environment during health visits.  J Dev Behav Pediatr. 1988;  9 333-339
• 11 Chiriboga C A. Fetal effects.  Neurol Clin. 1993;  11 (3) 707-728
• 12 Clements M S, Mitchell E A, Wright S P, Esmail A, Jones D R, Ford R P. Influences on breastfeeding in southeast England.  Acta Paediatr. 1997;  86 (1) 51-56
• 13 Cnattingius S, Forman M R, Berendes H W, Graubard B I, Isotalo L. Effect of age, parity, and smoking on pregnancy outcome: a population- based study.  Am J Obstet Gynecol. 1993;  168 (1 Pt 1) 16-21
• 14 Day N L, Richardson G A, Goldschmidt L, Cornelius M D. Effects of prenatal tobacco exposure on preschoolers' behavior.  J Dev Behav Pediatr. 2000;  21 (3) 180-188
• 15 Drews C D, Murphy C C, Yeargin-Allsopp M, Decoufle P. The relationship between idiopathic mental retardation and maternal smoking during pregnancy.  Pediatrics. 1996;  97 (4) 547-553
• 16 Einspieler C. Abnormal spontaneous movements in infants with repeated sleep apnoeas.  Early Hum Dev. 1994;  36 31-48
• 17 Einspieler C, Widder J, Holzer A, Kenner T. The predictive value of behavioural risk factors for sudden infant death.  Early Hum Dev. 1988;  18 101-109
• 18 Fergusson D M, Woodward L J, Horwood L J. Maternal smoking during pregnancy and psychiatric adjustment in late adolescence.  Arch Gen Psychiatry. 1998;  55 (8) 721-727
• 19 Fried P A. Cigarettes and marijuana: are there measurable long-term neurobehavioral teratogenic effects?.  Neurotoxicology. 1989;  10 (3) 577-583
• 20 Fried P A, Watkinson B. 12- and 2 - 4-month neurobehavioural follow-up of children prenatally exposed to marihuana, cigarettes and alcohol.  Neurotoxicol Teratol. 1988;  10(4) (4) 305-313
• 21 Fried P A, Watkinson B, Dillon R F, Dulberg G S. Neonatal neurological status in a low-risk population after prenatal exposure to cigarettes, marijuana, and alcohol.  J Dev Behav Pediatr. 1987;  8 (6) 318-326
• 22 Fried P A, Watkinson B, Siegel L S. Reading and language in 9- to 12-year olds prenatally exposed to cigarettes and marijuana.  Teratol. 1997;  19 (3) 171-183
• 23 Gibson G L, Tibbetts S G. Interaction between maternal cigarette smoking and Apgar scores in predicting offending behavior.  Psychol Rep. 1998;  83 (2) 579-586
• 24 Haggart M, Giblin M J. Passive smoking and colic-like behaviour in babies.  Health Visit. 1988;  61 (3) 81-82
• 25 Hakansson A, Carlsson B. Maternal cigarette smoking, breast-feeding, and respiratory tract infections in infancy. A population-based cohort study.  Scand J Prim Health Care. 1992;  10 (1) 60-65
• 26 Heneghan A M, Silver E J, Bauman L J, Westbrook L E, Stein R E. Depressive symptoms in inner-city mothers of young children: who is at risk?.  Pediatrics. 1998;  102 (6) 1394-1400
• 27 Herschkowitz N, Kagan J, Zilles K. Neurobiological bases of behavioral development in the first year.  Neuropediatrics. 1997;  28 (6) 296-306
• 28 Hill P D, Aldag J C. Smoking and breastfeeding status.  Res Nurs Health. 1996;  19 (2) 125-132
• 29 Hoffman H J, Hillman L S. Epidemiology of the sudden infant death syndrome: maternal, neonatal, and post-neonatal risk factors. Hunt GE Clinics in perinatology: apnea and SIDS. Philadelphia: Saunders 1991 19: 717-738
• 30 Horta B L, Victora C G, Menezes A M, Halpern R, Barros F C. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking.  Paediatr Perinat Epidemiol. 1997;  11 (2) 140-151
• 31 Kahn A, Groswasser J, Sottiaux M. et al . Prenatal exposure to cigarettes in infants with obstructive sleep apneas.  Pediatrics. 1994;  93 (5) 778-783
• 32 Kelmanson I A. An assessment of behavioural characteristics in infants who died of sudden infant death syndrome using the Early Infancy Temperament Questionnaire.  Acta Paediatr. 1996;  85 977-980
• 33 Kristjansson E A, Fried P A, Watkinson B. Maternal smoking during pregnancy affects children's vigilance performance.  Drug Alcohol Depend. 1989;  24 (1) 11-19
• 34 Landgren M, Kjellman B, Gillberg C. Attention deficit disorder with developmental coordination disorders.  Arch Dis Child. 1998;  79 (3) 207-212
• 35 Lassen K, Oel T P. Effects of maternal cigarette smoking during pregnancy on long-term physical and cognitive parameters of child development.  Addict Behav. 1998;  23 (5) 635-653
• 36 LeClere F B, Wilson J B. Smoking behavior of recent mothers, 18 - 44 years of age, before and after pregnancy: United States, 1990.  Adv Data. 1997;  288 1-11
• 37 Leech S L, Richardson G A, Goldschmidt L, Day N L. Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds.  Neurotoxicol Teratol. 1999;  21 (2) 109-118
• 38 Medoff-Cooper B, Carey W B, McDevitt S C. The early infancy temperament questionnaire.  J Dev Behav Pediatr. 1993;  14 230-235
• 39 Milberger S, Biederman J, Faraone S V, Jones J. Further evidence of an association between maternal smoking during pregnancy and attention deficit hyperactivity disorder: findings from a high-risk sample of siblings.  J Clin Child Psychol. 1998;  27 (3) 352-358
• 40 Naeye R L, Messmer J, Specht T, Merritt T A. Sudden infant death syndrome temperament before death.  J Pediatr. 1976;  88 511-515
• 41 Nugent J K, Lester B M, Greene S M, Wieczorek-Deering D, O'Mahony P. The effects of maternal alcohol consumption and cigarette smoking during pregnancy on acoustic cry analysis.  Child Dev. 1996;  67 (4) 1806-1815
• 42 Nuwayhid I A, Yamout B, Azar G, Kambris M A. Narghile (hubble-bubble) smoking, low birth weight, and other pregnancy outcomes.  Am J Epidemiol. 1998;  148 (4) 375-383
• 43 Nylander G, Matheson I. [Breast feeding. Effects of smoking and education].  Tidsskr Nor Laegeforen. 1989;  109 (9) 970-973
• 44 O'Gallaghan M J, Williams G M, Andersen M J, Bor W, Najman J M. Obstetric and perinatal factors as predictors of child behaviour at 5 years.  J Paediatr Child Health. 1997;  33 (6) 497-503
• 45 Obel C, Henriksen T B, Hedegaard M, Secher N J, Ostergaard J. Smoking during pregnancy and babbling abilities of the 8-month-old infant.  Paediatr Perinat Epidemiol. 1998;  12 (1) 37-48
• 46 Olds D L, Henderson C R, Tatelbaum R. Prevention of intellectual impairment in children of women who smoke cigarettes during pregnancy [published erratum appears in Pediatrics 1994 Jun;93(6 Pt 1): 973).  Pediatrics. 1994;  93 (2) 228-233
• 47 Orlebeke J F, Knol D L, Verhulst F G. Increase in child behaviour problems resulting from maternal smoking during pregnancy.  Arch Environ Health. 1997;  52 (4) 317-321
• 48 Orlebeke J F, Knol D L, Verhulst F G. Child behavior problems increased by maternal smoking during pregnancy.  Arch Environ Health. 1999;  54 (1) 15-19
• 49 Oyemade U J, Cole O J, Johnson A A. et al . Prenatal substance abuse and pregnancy outcomes among African American women.  J Nutr. 1994;  124 (6 Suppl) 994S-999S
• 50 Scher M S, Richardson G A, Robles N. et al . Effects of prenatal substance exposure: altered maturation of visual evoked potentials.  Pediatr Neurol. 1998;  18 (3) 236-243
• 51 Schulte-Hobein B, Schwartz-Bickenbach D, Abt S, Plum C, Nau H. Cigarette smoke exposure and development of infants throughout the first year of life: influence of passive smoking and nursing on nicotine levels in breast milk and infant's urine.  Acta Paediatr. 1992;  81 (6-7) 550-557
• 52 Slotkin T A. Fetal nicotine or cocaine exposure: which one is worse?. .  J Pharmacol Exp Ther. 1998;  285 (3) 931-945
• 53 Slotkin T A, Epps T A, Stenger M L, Sawyer K J, Seidler F J. Cholinergic receptors in heart and brainstem of rats exposed to nicotine during development: implications for hypoxia tolerance and perinatal mortality.  Brain Res Dev Brain Res. 1999;  113 (1-2) 1-12
• 54 Thomas A, Chess S. Temperament and development. New York: Brunner/Mazel 1977
• 55 Tomblin J B, Hammer C S, Zhang X. The association of parental tobacco use and SLI.  Int J Lang Commun Disord. 1998;  33 (4) 357-368
• 56 Vlajinac H, Petrovic R, Marinkovic J, Kocev N, Sipetic S. [The effect of cigarette smoking during pregnancy on fetal growth].  Srp Arh Celok Lek. 1997;  125(9-10) 267-271