Ludwig-Maximilians University Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Munich, Germany.
Environ Health Perspect. 2010 Jan;118(1):150-4. doi: 10.1289/ehp.0901209.
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.
We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally.
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.
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.
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.
已有研究报道，产前和产后接触烟草与行为问题有关。然而，特定暴露时期接触烟草与行为问题的关联程度尚不清楚。
我们评估了宫内和产后暴露于烟草烟雾的儿童出现行为问题的相对风险。
我们对德国两个城市的一项前瞻性出生队列研究的数据进行了分析，该研究为德国婴幼儿营养干预研究。我们的样本包括 1995 年至 1998 年间出生的 5991 名儿童及其父母。我们在出生后 10 年通过儿童行为问题筛查问卷（Strength and Difficulties Questionnaire，SDQ）评估行为问题。根据 SDQ 预设的截断值，根据子量表“情绪症状”、“行为问题”、“多动/注意力不集中”、“同伴关系问题”和总困难得分，将儿童分为“正常”、“边缘”或“异常”。使用父母问卷评估烟雾暴露和其他协变量。
与未接触烟草烟雾的儿童相比，宫内和产后均接触烟草烟雾的儿童在 10 岁时，根据 SDQ 总困难得分，被归类为异常的估计风险是前者的两倍[95%置信区间（CI），1.4-3.1]。仅产前接触的儿童的相对风险增加了 90%（95%CI，0.9-4.0），而仅产后接触的儿童的相对风险增加了 30%（95%CI，0.9-1.9）。这些结果不能用父母教育、父亲就业状况、儿童花在电脑或电视屏幕前的时间、单亲家庭或母亲年龄等因素的混杂来解释。
产前接触烟草烟雾与学龄儿童的行为问题有关。尽管我们的研究结果并不排除产后接触的影响，但产前接触似乎更为重要。
