McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada; Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France.
Sainte-Justine Hospital Research Center, Montréal, QC, Canada; Department of Pediatrics, Université de Montréal, Montréal Canada.
J Affect Disord. 2021 May 1;286:10-18. doi: 10.1016/j.jad.2021.02.047. Epub 2021 Feb 23.
Few studies investigated the association between maternal smoking during pregnancy and offspring suicide risk, none considering postnatal smoking exposure. We investigated associations between maternal smoking patterns during the pre- and postnatal periods and adolescent suicidal ideation and attempt.
We identified longitudinal patterns of maternal smoking from the prenatal period to the end of childhood (children's age 12 years, 10 assessments) among participants in the Québec Longitudinal Study of Child Development (N = 1623). We estimated associations between maternal smoking patterns and offspring self-reported suicidal ideation and attempt (ages 13-20). Background confounding factors (e.g., socioeconomic, familial, mental health) were controlled using propensity score inverse-probability weighting (IPW).
Participants reporting suicidal ideation and attempt were 9.3% and 8.4%, respectively. We identified four maternal smoking patterns: non-smoking (66.5%), increasing (5.5%), decreasing (9.3%), persistent (18.5%). Children exposed to persistent (OR=2.92, CI=1.99-4.30) and increasing (OR=2.06, CI=1.13-3.74) maternal smoking were more likely to attempt suicide, compared to non-exposed children. Accounting for confounding factors using IPW fully explained the association between increasing smoking and suicide attempt (OR=0.95, CI=0.39-2.09) but only reduced the association between persistent exposure and suicide attempt (OR=2.30, CI=1.04-4.99). No increased suicide attempt risk was found for children of mothers with a decreased smoking pattern. We found no associations for suicidal ideation.
Propensity score cannot account for unmeasured confounding factors; attrition limits generalizability.
Offspring of mothers who smoked persistently and heavily prenatally and postnatally were at increased risk of suicide attempt in adolescence. Future studies should elucidate biological and psychosocial mechanisms potentially at play in these associations.
很少有研究调查母亲怀孕期间吸烟与子女自杀风险之间的关系，也没有研究考虑产后吸烟暴露的情况。我们调查了母亲在产前和产后期间吸烟模式与青少年自杀意念和尝试之间的关联。
我们在魁北克儿童发展纵向研究（1623 名参与者）中，从产前到儿童 12 岁（共 10 次评估）确定了母亲吸烟的纵向模式。我们估计了母亲吸烟模式与子女自我报告的自杀意念和尝试之间的关联（年龄在 13-20 岁之间）。使用倾向评分逆概率加权（Inverse Probability Weighting，IPW）控制背景混杂因素（例如，社会经济、家庭、心理健康）。
报告有自杀意念和尝试的参与者分别为 9.3%和 8.4%。我们确定了四种母亲吸烟模式：不吸烟（66.5%）、增加（5.5%）、减少（9.3%）、持续（18.5%）。与未暴露于母亲吸烟的儿童相比，暴露于持续（OR=2.92，CI=1.99-4.30）和增加（OR=2.06，CI=1.13-3.74）母亲吸烟的儿童更有可能尝试自杀。使用 IPW 来解释混杂因素，完全解释了增加吸烟与自杀尝试之间的关联（OR=0.95，CI=0.39-2.09），但仅降低了持续暴露与自杀尝试之间的关联（OR=2.30，CI=1.04-4.99）。没有发现母亲吸烟减少模式的儿童自杀尝试风险增加。我们没有发现自杀意念的关联。
倾向评分不能解释未测量的混杂因素；失访限制了研究结果的普遍性。
母亲在产前和产后持续大量吸烟的子女在青少年时期自杀尝试的风险增加。未来的研究应该阐明这些关联中可能发挥作用的生物学和心理社会机制。
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