Talati Ardesheer, Wickramaratne Priya J, Wesselhoeft Rikke, Weissman Myrna M
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Sackler Institute for Developmental Psychobiology, Columbia University, New York, NY, USA.
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Biostatistics, Mailman School of Public Health of Columbia University, New York, NY, USA.
Psychiatry Res. 2017 Jun;252:346-352. doi: 10.1016/j.psychres.2017.03.016. Epub 2017 Mar 8.
Although prenatal tobacco exposure (PTE) is associated with several adverse offspring mental health outcomes, mechanisms remain unclear. We test whether associations between PTE and offspring psychopathology are explained by birthweight, one of the earliest-occurring outcomes of PTE. The analysis focuses on 238 offspring from a family study of depression with (1) collected prenatal histories and (2) at least one clinical interview in adulthood to assess psychiatric problems. Exposure was categorized by maternal smoking of ≥10 cigarettes daily/nearly daily; diagnostic outcomes were confirmed by clinicians using the best-estimate procedure, blind to exposure. After adjusting for potential confounders, PTE was associated with 0.7lb(9%) lower birthweight (p=0.0002), increased rates of disruptive behavior disorders [males: OR=2.66(1.15,6.16), and (trend) substance use disorders [females: OR=2.23(0.98,5.09)], and decreased rates of mood disorders (males: OR=0.42(0.17,0.98)]. Birthweight was not independently associated with diagnoses and did not mediate the association between exposure and psychopathology. Maternal smoking has long-term adverse consequences for offspring. Although birthweight cannot be manipulated, smoking is a modifiable risk factor. Thus, cessation efforts focused on pregnant women may not only improve maternal wellbeing, but also mitigate adverse proximal (e.g., birthweight) and long-term (psychopathology) outcomes in offspring.
尽管产前烟草暴露（PTE）与多种不良的子代心理健康结局相关，但其机制仍不清楚。我们检验PTE与子代精神病理学之间的关联是否由出生体重来解释，出生体重是PTE最早出现的结局之一。该分析聚焦于一项抑郁症家庭研究中的238名子代，这些子代满足：（1）收集了产前病史；（2）成年期至少有一次临床访谈以评估精神问题。暴露情况根据母亲每天/几乎每天吸烟≥10支进行分类；诊断结果由临床医生采用最佳估计程序确认，且对暴露情况不知情。在调整潜在混杂因素后，PTE与出生体重降低0.7磅（9%）相关（p = 0.0002），破坏性行为障碍发生率增加[男性：OR = 2.66（1.15，6.16）]，（呈趋势性）物质使用障碍发生率增加[女性：OR = 2.23（0.98，5.09）]，以及情绪障碍发生率降低（男性：OR = 0.42（0.17，0.98）]。出生体重与诊断结果无独立关联，也未介导暴露与精神病理学之间的关联。母亲吸烟对后代有长期不良后果。虽然出生体重无法控制，但吸烟是一个可改变的风险因素。因此，针对孕妇的戒烟努力不仅可能改善母亲的健康状况，还可能减轻子代的不良近期（如出生体重）和长期（精神病理学）结局。
