Smoking moms' offspring more likely to be treated for mental problems.

Oct 14, 2011

Ekblad, K, M Gissler, L Lehtonen and J Korkelia. 2011. Relation of prenatal smoking exposure and use of psychotropic medication up to young adulthood. American Journal of Epidemiology http://dx.doi.org/10.1093/aje/kwr150.

Synopsis by Steven Neese

A mother's smoking habits during pregnancy are related to her children's use of medications to treat mental disorders, reports a study from Finland.

Children born to mothers who smoked during pregnancy were more likely than those born to nonsmoking moms to take medications that treat mental disorders, suggests a study published in the Journal of Epidemiology. The most common prescriptions were for antidepressant and anti-anxiety drugs.

Overall, this is the first study to report a link between prenatal exposure to cigarette smoke and mental health problems during late childhood and adolescence. Measuring the use of prescription medications is a good indicator of psychiatric health effects, and with this study, allowed researchers to examine effects on milder mental health problems that don't require hospitalization.

In addition, the more a mother smoked, the more her children used medications. Exposure to smoke from more than 10 cigarettes per day related to longer continuous use of the drugs – specifically the stimulants. More cigarettes were also associated with the increased use of multiple drugs by the same individual.

Prenatal cigarette smoke exposure is related to a variety of negative health outcomes in the fetus, including low or delayed fetal growth and development. Long-term health issues can include behavioral problems, attention issues and mental health problems. These effects are known because young adults exposed to smoking while in the womb have increased hospital care for mental health disorders.  

In the study, researchers compared the mental health diagnoses and treatment of children born between 1987 and 1989 in Finland with their mother's smoking habits during pregnancy. Maternal smoking patterns were collected by interview, and categorized as "less than 10" or "more than 10" cigarettes.

Information on medication prescriptions for nearly 187,000 children was obtained from the Social Insurance Institution of Finland for the 13-year period from 1994 to 2007. Medications in the study included antipsychotics, hypnotics/anxiolytics, antidepressants, stimulants and drugs for addiction.

The researchers found an association between prenatal smoking exposure and the use of mental health medications during childhood and adolescence. Of the children exposed to smoking, 11.3 to 13.6 percent had used mental health drugs. Of those not exposed to prenatal smoke, only 8.3 percent were prescribed the drugs. Medication use was increased in all children exposed to smoke.

The increased use of drugs to treat mental health disorders still holds in low-risk populations when adjusting for other background factors that may play a role in the results – that is, when teenage mothers, preterm children and low birth weight children were excluded from the study.

This study is limited in that pregnant mothers often underestimate their smoking habits, mothers' socioeconomic status was unreported and extent of smoking after birth was not known. However, the author's point out the study "emphasizes the importance of efforts to reduce smoking during pregnancy."

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