Wednesday, November 11, 2009

Prenatal Tobacco Exposure Neurodevelopmental

We have known for some time that tobacco use during pregnancy is not a good idea. One of the consistent findings has been the association with tobacco use and low birth weights. Low birth weights are a nonspecific factor that correlates with fetal growth retardation which can occur from a variety of different factors. Tobacco use is one of those. Three studies recently presented at the 56th annual meeting of the American Academy of Child and Adolescent Psychiatry suggest longer term neurodevelopmental problems.

These three studies are all prospective studies. These were not chart reviews looking for correlating factors but involved looking directly at children and their behavior. The first study enrolled 304 women before their fourth month of pregnancy. Self reports were used to assess smoking during pregnancy. The investigators examined the newborn children 1-3 days after birth and at weeks 2 and 4 looking at reflex assessments, orientation to audio and visual stimuli and response to stressors. The infants of mother's who smoked were less attentive and exhibited consistently more irritability. This is consistent with previous findings that suggest some tobacco withdrawal symptoms do occur.

The second study involved 207 infants from the first study evaluated at 6 months of age. The infants exposed to tobacco prenatally showed lower attention spans than non exposed infants.

A third study evaluated self regulation and executive control in a different population of 237 otherwise normally developing three year olds. Those exposed to tobacco prenatally showed poorer ability to wait for a reward and to regulate motor behavior. While Attention Deficit Hyperactivity Disorder (ADHD) is not diagnosed in preschoolers these findings are similar to the problems that do show up in children with ADHD. The study is ongoing and will follow these children on an ongoing basis.

These three studies suggest that smoking during pregnancy is related to attention and self regulatory problems at multiple points of development. Given that about 20% of expectant mothers smoke a large number of children are affected. Tobacco cessation is difficult but perhaps these findings may increase the motivation to quit in women who smoke during pregnancy.

Thought for the day

Tobacco use during pregnancy is simply not a good idea.

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