Am J Psychiatry. 2013 Oct;170(10):1178-85. doi: 10.1176/appi.ajp.2013.12121500.
Maternal smoking during pregnancy is associated with a number of adverse externalizing outcomes for offspring from childhood to adulthood. The relationship between maternal smoking and bipolar disorder in offspring, which includes externalizing symptoms among its many manifestations, has not been investigated in depth. The authors examined whether offspring exposed to maternal smoking in utero would be at increased lifetime risk for bipolar disorder after accounting for other factors related to maternal smoking.
Individuals with bipolar disorder (N=79) were ascertained from the birth cohort of the Child Health and Development Study. Case subjects were identified by a combination of clinical, database, and direct mailing sources; all case subjects were directly interviewed and diagnosed using DSM-IV criteria. Comparison subjects (N=654) were matched to case subjects on date of birth (±30 days), sex, membership in the cohort at the time of illness onset, and availability of maternal archived sera.
After adjusting for potential confounders, offspring exposed to in utero maternal smoking exhibited a twofold greater risk for bipolar disorder (odds ratio=2.014, 95% confidence interval=1.48-2.53, p=0.01). The associations were noted primarily among bipolar offspring without psychotic features.
Prenatal tobacco exposure may be one suspected cause of bipolar disorder. However, it will be necessary to account for other unmeasured familial factors before causal teratogenic effects can be suggested.
母亲在怀孕期间吸烟会对后代的许多外部表现产生不利影响，从儿童期到成年期。在许多表现形式中都包括外部表现的后代吸烟与双相情感障碍之间的关系尚未深入研究。作者检查了在子宫内暴露于母亲吸烟的后代在考虑到与母亲吸烟有关的其他因素后，是否会增加终生患双相情感障碍的风险。
从儿童健康与发展研究的出生队列中确定了患有双相情感障碍的个体（N=79）。通过临床，数据库和直接邮寄来源的组合确定了病例对象；所有病例对象均通过DSM-IV 标准直接进行访谈和诊断。将对照对象（N=654）与病例对象相匹配，以出生日期（±30 天），性别，发病时队列中的成员身份以及是否有可存档的母亲血清为依据。
在调整了潜在混杂因素后，子宫内暴露于母亲吸烟的后代患双相情感障碍的风险增加了两倍（优势比=2.014，95％置信区间=1.48-2.53，p=0.01）。这些关联主要见于没有精神病特征的双相情感障碍后代。
产前烟草暴露可能是双相情感障碍的一个可疑原因。但是，在提出因果致畸作用之前，必须考虑其他未测量的家族因素。
