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Klin Padiatr 2002; 214(6): 359-364
DOI: 10.1055/s-2002-35369
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

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

Rauchen während der Schwangerschaft: Verhaltensmuster bei 2 - 4 Monate alten SäuglingenI.  A.  Kelmanson1 , L.  V.  Erman1 , S.  V.  Litvina1
  • 1St. Petersburg State Paediatric Medical Academy
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Publication History

Publication Date:
08 November 2002 (online)

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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 5th 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.

Schlüsselwörter

Verhalten - Kleinkinder - Schwangerschaft - plötzlicher Kindstod - Temperament

Keywords

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
    CrossrefPubMedSearch in Google Scholar
  • 2 Armitage P, Berry G. Statistical methods in medical research. Oxford: Blackwell 1994 3
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 11 Chiriboga C A. Fetal effects.  Neurol Clin. 1993;  11 (3) 707-728
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 16 Einspieler C. Abnormal spontaneous movements in infants with repeated sleep apnoeas.  Early Hum Dev. 1994;  36 31-48
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Fried P A. Cigarettes and marijuana: are there measurable long-term neurobehavioral teratogenic effects?.  Neurotoxicology. 1989;  10 (3) 577-583
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 24 Haggart M, Giblin M J. Passive smoking and colic-like behaviour in babies.  Health Visit. 1988;  61 (3) 81-82
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 27 Herschkowitz N, Kagan J, Zilles K. Neurobiological bases of behavioral development in the first year.  Neuropediatrics. 1997;  28 (6) 296-306
    PubMedSearch in Google Scholar
  • 28 Hill P D, Aldag J C. Smoking and breastfeeding status.  Res Nurs Health. 1996;  19 (2) 125-132
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 34 Landgren M, Kjellman B, Gillberg C. Attention deficit disorder with developmental coordination disorders.  Arch Dis Child. 1998;  79 (3) 207-212
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 38 Medoff-Cooper B, Carey W B, McDevitt S C. The early infancy temperament questionnaire.  J Dev Behav Pediatr. 1993;  14 230-235
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 40 Naeye R L, Messmer J, Specht T, Merritt T A. Sudden infant death syndrome temperament before death.  J Pediatr. 1976;  88 511-515
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 43 Nylander G, Matheson I. [Breast feeding. Effects of smoking and education].  Tidsskr Nor Laegeforen. 1989;  109 (9) 970-973
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 52 Slotkin T A. Fetal nicotine or cocaine exposure: which one is worse?. .  J Pharmacol Exp Ther. 1998;  285 (3) 931-945
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 54 Thomas A, Chess S. Temperament and development. New York: Brunner/Mazel 1977
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar

Prof. MD PhD I. A. Kelmanson

Department of Paediatrics No. 3, St. Petersburg State Paediatric
Medical Academy

Litovskaya 2

St. Petersburg, 194 100

Russia

Phone: (812) 53528-50

Email: ikel@atrium.cor.neva.ru