Department of Human Development and Family Studies, Purdue University, West Lafayette, IN.
Department of General Practice, Institute of Clinical Medicine, Turku University and Turku University Hospital, Turku, Finland.
Nicotine Tob Res. 2020 Jul 16;22(8):1330-1338. doi: 10.1093/ntr/ntz214.
Maternal smoking during pregnancy (SDP) is associated with disruptive behavior. However, there is debate whether the SDP-disruptive behavior association is a potentially causal pathway or rather a spurious effect confounded by shared genetic and environmental factors.
The Missouri Mothers and Their Children Study is a sibling comparison study that includes families (n = 173) selected for sibling pairs (aged 7-16 years) discordant for SDP. Critically, the sibling comparison design is used to disentangle the effects of SDP from familial confounds on disruptive behavior. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount of SDP). Multiple informants (parents and teachers) reported on disruptive behavior (i.e., DSM-IV semi-structured interview, the Child Behavior Checklist, and Teacher Report Form).
The variability in disruptive behavior was primarily a function of within-family differences (66%-100%). Consistent with prior genetically informed approaches, the SDP-disruptive behavior association was primarily explained by familial confounds (genetic and environmental). However, when using a multi-rater approach (parents and teachers), results suggest a potentially causal effect of SDP on disruptive behavior (b = 0.09, SE = 0.04, p = 0.03). The potentially causal effect of SDP remained significant in sensitivity analyses.
These findings suggest that familial confounding likely plays a complex role in the SDP-disruptive behavior association when examining both parent and teacher reports of behavior. Importantly, the current study highlights the importance of multiple raters, reflecting a more comprehensive measure of complex behaviors (e.g., disruptive behavior) to examine the teratogenic effects of SDP.
Our study provides additional evidence that controlling for genetic and family factors is essential when examining the effect of SDP on later behavioral problems, as it explains a portion of the association between SDP and later behavioral problems. However, we found a significant association between SDP and disruptive behavior when using a multi-rater approach that capitalizes on both parent and teacher report, suggesting that parent and teacher ratings capture a unique perspective that is important to consider when examining SDP-behavior associations.
母亲在怀孕期间吸烟（SDP）与破坏性行为有关。然而，关于 SDP-破坏性行为的关联是潜在的因果途径，还是仅仅是由共同的遗传和环境因素引起的虚假效应，目前仍存在争议。
密苏里州母亲及其子女研究是一项兄弟姐妹比较研究，包括为兄弟姐妹对（年龄 7-16 岁）选择的家庭（n=173），这些兄弟姐妹对 SDP 不一致。关键的是，兄弟姐妹比较设计用于消除 SDP 对破坏性行为的影响，以及家庭混淆对破坏性行为的影响。为每个孩子创建了一个 SDP 严重程度评分，该评分是使用 SDP 指标（时间、持续时间和 SDP 量）的组合创建的。多个信息提供者（父母和教师）报告了破坏性行为（即 DSM-IV 半结构化访谈、儿童行为检查表和教师报告表）。
破坏性行为的可变性主要是家庭内差异的函数（66%-100%）。与先前遗传信息的方法一致，SDP-破坏性行为的关联主要由家庭混淆（遗传和环境）解释。然而，当使用多评估者方法（父母和教师）时，结果表明 SDP 对破坏性行为可能存在因果效应（b=0.09，SE=0.04，p=0.03）。在敏感性分析中，SDP 的潜在因果效应仍然显著。
这些发现表明，在检查父母和教师对行为的报告时，家庭混淆可能在 SDP-破坏性行为关联中起着复杂的作用。重要的是，当前的研究强调了使用多个评估者的重要性，这反映了对复杂行为（例如破坏性行为）的更全面测量，以检查 SDP 的致畸作用。
我们的研究提供了更多的证据，表明在检查 SDP 对后期行为问题的影响时，控制遗传和家庭因素是至关重要的，因为它解释了 SDP 与后期行为问题之间的一部分关联。然而，当我们使用多评估者方法时，即利用父母和教师的报告，我们发现 SDP 与破坏性行为之间存在显著关联，这表明父母和教师的评价捕捉到了一个独特的视角，在检查 SDP-行为关联时需要考虑。
