Maternal Smoking During Pregnancy and Risk of Alcohol Use Disorders Among Adult Offspring

Abstract

ABSTRACT. Objective: The aim of this study was to evaluate the association between maternal smoking during pregnancy (MSP) and lifetime risk for alcohol use disorder (AUD) and to explore possible mechanisms through which MSP may be related to neurobehavioral conditions during infancy and childhood, which could, in turn, lead to increased risk for AUD. Method: A sample of 1,625 individuals was followed from pregnancy for more than 40 years. Capitalizing on the long follow-up time, we used survival analysis to examine lifetime risks of AUD (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in relation to levels of MSP (none, <20 cigarettes/day, and ≥20 cigarettes/day). We then used structural equation modeling to test hypotheses regarding potential mechanisms, including lower birth weight, neurological abnormalities, poorer academic functioning, and behavioral dysregulation. Results: Relative to unexposed offspring, offspring of mothers who smoked 20 cigarettes per day or more exhibited greater risks for AUD (hazard ratio = 1.31, 95% CI [1.08, 1.59]). However, no differences were observed among offspring exposed to fewer than 20 cigarettes per day. In structural equation models, MSP was associated with neurobehavioral problems during infancy and childhood, which, in turn, were associated with an increased risk for adult AUD. Conclusions: MSP was associated with an increased lifetime risk for AUD. Adverse consequences were evident from birth to adulthood. A two-pronged remedial intervention targeted at both the mother (to reduce smoking during pregnancy) and child (to improve academic functioning) may reduce the risk for subsequent AUD. (J. Stud. Alcohol Drugs, 72,

Commentary on Niemeläet al. (2017): Maternal smoking during pregnancy-an independent risk factor of postnatal health disorders

“…This paper adds further confirmation that MSDP is a risk factor for the offspring's smoking behaviors such as smoking initiation, regular smoking, and nicotine dependence. The risk of drug dependence among adolescent girls whose mothers smoked 10 or more cigarettes almost daily during pregnancy was raised as early as 1999 [9] and MSDP of ≥20 cigarettes per day has been also found to increase the risk of alcohol use disorder among offspring during a follow-up of 40 years [10]. Data from Finland have shown that MSDP is dosedependently associated not only with psychiatric comorbidities [11] and increased use of psychotropic medications [12] but also with all-cause mortality up to age 20 years [11].…”

Familial Confounding of the Association Between Maternal Smoking During Pregnancy and Offspring Substance Use and Problems

“…7, 10–14, 15 Most epidemiological research has found robust statistical associations between SDP and substance-use problems in offspring when controlling for measured covariates, 4 which is consistent with a causal inference, although some studies suggest that these associations are accounted for by correlated risks. 12–13 …”

Prenatal Smoking Exposure and the Risk of Behavioral Problems and Substance Use in Adolescence: the TRAILS Study

“…The study of Ekblad et al [5] found a relationship between MSP and ICD-10 diagnoses due to substance use, but as discussed earlier, these findings may be (partly) explained by incomplete adjustment for confounding factors. Nomura et al [50] found that the adult offspring of mothers who smoked 20 cigarettes a day or more were at greater risk for a lifetime diagnoses for alcohol use disorders, but the magnitude of the effect was modest. Fergusson et al [3] found no relationship with illicit substance use or dependency in late adolescence.…”