Ekblad Mikael, Lehtonen Liisa, Korkeila Jyrki, Gissler Mika
Department of General Practice, Turku University Hospital, Turku, Finland.
Institute of Medicine, University of Turku, Turku, Finland.
Nicotine Tob Res. 2017 May 1;19(5):597-604. doi: 10.1093/ntr/ntx001.
Maternal smoking during pregnancy has been associated with an increased risk for psychiatric morbidity. We further studied this with Finnish siblings to control for genetic/familial factors.
From the Finnish Medical Birth Register, sibling pairs were selected as the first two children born 1987-1995 to the same mother (n = 150 168 pairs), along with information on maternal smoking (no smoking/smoking). Information on the children's psychiatric diagnoses related to outpatient care visits (1998-2013) and inpatient care (1987-2013), and the mothers' psychiatric morbidity (1969-2013) was derived from the Finnish Hospital Discharge Register. The first pair analysis compared siblings of mothers who only smoked in the first pregnancy (Quitters, 4.7%) and mothers who smoked in both pregnancies (Smokers, 9.6%); the second analysis included mothers who smoked only in the second pregnancy (Starters, 3.3%) and mothers who did not smoke in either pregnancy (Nonsmokers, 77.5%). Smoking information was missing for 5.0% of pairs. Psychiatric morbidity of the siblings and mother was included in the statistical analyses.
The risk of psychiatric diagnoses was significantly lower for the second child of quitters (adjusted OR 0.77, 95% CI 0.72-0.83) compared to the risk among smokers. A higher risk for psychiatric diagnoses was found for the second child of starters (1.39, 1.30-1.49) compared to the risk among nonsmokers. The effect of smoking was more robust for externalizing diagnoses.
Maternal smoking was independently associated with a higher risk for psychiatric morbidity in children, even when controlling thoroughly for genetic and familial factors.
Maternal smoking during pregnancy has an independent effect on the risk of psychiatric morbidity in children, even after controlling for non-measurable genetic/familial factors by using a sibling pair design. The effect of maternal smoking was robust for externalizing diagnoses. Maternal smoking during pregnancy had an effect on diagnoses both in outpatient and inpatient care.
孕期母亲吸烟与精神疾病发病率增加有关。我们利用芬兰的兄弟姐妹样本进一步研究此问题，以控制遗传/家族因素。
从芬兰医疗出生登记处选取1987年至1995年同一母亲生育的头两个孩子作为兄弟姐妹对（n = 150168对），并获取母亲吸烟情况（不吸烟/吸烟）信息。有关儿童与门诊就诊（1998 - 2013年）和住院治疗（1987 - 2013年）相关的精神疾病诊断信息，以及母亲的精神疾病发病率（1969 - 2013年）来自芬兰医院出院登记处。首次配对分析比较了仅在首次怀孕时吸烟的母亲的兄弟姐妹（戒烟者，4.7%）和两次怀孕都吸烟的母亲的兄弟姐妹（吸烟者，9.6%）；第二次分析纳入了仅在第二次怀孕时吸烟的母亲（开始吸烟者，3.3%）和两次怀孕都不吸烟的母亲（不吸烟者，77.5%）。5.0%的配对缺失吸烟信息。兄弟姐妹和母亲的精神疾病发病率纳入统计分析。
与吸烟者相比，戒烟者的第二个孩子患精神疾病诊断的风险显著更低（调整后的比值比为0.77，95%置信区间为0.72 - 0.83）。与不吸烟者相比，开始吸烟者的第二个孩子患精神疾病诊断的风险更高（1.39，1.30 - 1.49）。吸烟对行为外化性诊断的影响更强。
即使在充分控制遗传和家族因素后，母亲吸烟仍与儿童精神疾病发病率较高独立相关。
孕期母亲吸烟对儿童精神疾病发病风险有独立影响，即使通过兄弟姐妹配对设计控制了不可测量的遗传/家族因素。母亲吸烟对外化性诊断的影响很强。孕期母亲吸烟对门诊和住院治疗的诊断均有影响。
