Meier S M, Plessen K J, Verhulst F, Mors O, Mortensen P B, Pedersen C B, Agerbo E
National Centre for Register-Based Research NCRR, Aarhus University, Aarhus V,Denmark.
The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark.
Psychol Med. 2017 Jun;47(8):1417-1426. doi: 10.1017/S0033291716003627. Epub 2017 Jan 19.
Maternal smoking has consistently been associated with multiple adverse childhood outcomes including externalizing disorders. In contrast the association between maternal smoking during pregnancy (MSDP) and internalizing (anxiety and depressive) disorders in offspring has received less investigation.
We conducted a nationwide cohort study including 957635 individuals born in Denmark between 1991 and 2007. Data on MSDP and diagnoses of depression or anxiety disorders were derived from national registers and patients were followed up from the age of 5 years to the end of 2012. Hazard rate ratios (HRRs) were estimated using stratified Cox regression models. Sibling data were used to disentangle individual- and familial-level effects of MSDP and to control for unmeasured familial confounding.
At the population level, offspring exposed to MSDP were at increased risk for both severe depression [HRR 1.29, 95% confidence interval (CI) 1.22-1.36] and severe anxiety disorders (HRR 1.26, 95% CI 1.20-1.32) even when controlling for maternal and paternal traits. However, there was no association between MSDP and internalizing disorders when controlling for the mother's propensity for MSDP (depression: HRR 1.11, 95% CI 0.94-1.30; anxiety disorders: HRR 0.94, 95% CI 0.80-1.11) or comparing differentially exposed siblings (depression: HRR 1.18, 95% CI 0.75-1.89; anxiety disorders: HRR 0.87, 95% CI 0.55-1.36).
The results suggest that familial background factors account for the association between MSDP and severe internalizing disorders not the specific exposure to MSDP.
母亲吸烟一直与多种不良儿童期结局相关，包括外化性障碍。相比之下，孕期母亲吸烟（MSDP）与后代内化性（焦虑和抑郁）障碍之间的关联研究较少。
我们进行了一项全国性队列研究，纳入了1991年至2007年在丹麦出生的957635人。MSDP数据以及抑郁或焦虑障碍的诊断数据来自国家登记处，对患者从5岁起随访至2012年底。使用分层Cox回归模型估计风险率比（HRR）。利用兄弟姐妹数据来区分MSDP的个体和家庭层面影响，并控制未测量的家庭混杂因素。
在总体人群层面，即使控制了父母的特征，暴露于MSDP的后代患重度抑郁症[HRR 1.29，95%置信区间（CI）1.22 - 1.36]和重度焦虑症（HRR 1.26，95% CI 1.20 - 1.32）的风险均增加。然而，在控制母亲的MSDP倾向时（抑郁症：HRR 1.11，95% CI 0.94 - 1.30；焦虑症：HRR 0.94，95% CI 0.80 - 1.11），或比较暴露程度不同的兄弟姐妹时（抑郁症：HRR 1.18，95% CI 0.75 - 1.89；焦虑症：HRR 0.87，95% CI 0.55 - 1.36），MSDP与内化性障碍之间无关联。
结果表明，家庭背景因素导致了MSDP与重度内化性障碍之间的关联，而非MSDP这一特定暴露因素。
