The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index; none of the 29 sources its claims cite is checked for support yet.
Maternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days
Open accessAbstract
Objective To examine effects of maternal smoking during pregnancy on newborn neurobehavior at 10 to 27 days.Study design Participants were 56 healthy infants (28 smoking-exposed, 28 unexposed) matched on maternal social class, age, and alcohol use. Maternal smoking during pregnancy was determined by maternal interview and maternal saliva cotinine. Postnatal smoke exposure was quantified by infant saliva cotinine. Infant neurobehavior was assessed through the NICU Network Neurobehavioral Scale.Results Smoking-exposed infants showed greater need for handling and worse self-regulation (P < .05) and trended toward greater excitability and arousal (P < .10) relative to matched, unexposed infants (all moderate effect sizes). In contrast to prior studies of days 0 to 5, no effects of smoking-exposure on signs of stress/abstinence or muscle tone emerged. In stratified, adjusted analyses, only effects on need for handling remained significant (P < .05, large effect size).Conclusions Effects of maternal smoking during pregnancy at 10 to 27 days are subtle and consistent with increased need for external intervention and poorer self-regulation. Along with parenting deficits, these effects may represent early precursors for long-term adverse outcomes from maternal smoking during pregnancy. That signs of abstinence shown in prior studies of 0- to 5-day-old newborns did not emerge in older newborns provides further evidence for the possibility of a withdrawal process in exposed infants.
Overview
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Written from the paper’s full text.
TL;DR
In this pilot study of 56 healthy infants assessed at 10–27 days, maternal smoking during pregnancy was associated with greater need for handling and poorer self-regulation, with trends toward greater excitability and arousal. Effects on stress/abstinence and muscle tone seen in prior 0–5-day studies did not emerge, suggesting possible withdrawal or persistent subtle dysregulation.
Key findings
- Smoking-exposed infants showed significantly worse self-regulation and greater need for handling (p < .05) and trended toward greater arousal and excitability (p < .10), with moderate unadjusted effect sizes (Cohen’s deltas = .54, .57, .45, and .52, respectively).
- In adjusted analyses, only need for handling remained significant: maternal smoking during pregnancy was associated with a 0.18-unit increase in handling (95% CI = .04–.32), with a large effect size (Cohen’s delta = .76 in Results; .73 in Discussion).
- No significant effects emerged for stress/abstinence or hypertonicity/hypotonicity scales, unlike prior findings in 0–5-day-old newborns.
- Adjusted moderate effects were also observed for excitability (Cohen’s delta = .55) and arousal (Cohen’s delta = .41), though these did not reach statistical significance.
Methods
- Participants were 56 healthy, full-term, normal-birthweight infants (28 smoking-exposed, 28 unexposed) matched on maternal social class, age, and alcohol use; infants were assessed at 10–27 days (M = 17, SD = 4).
- Maternal smoking during pregnancy was determined by maternal interview and maternal saliva cotinine (>10 ng/mL); postnatal smoke exposure was quantified by infant saliva cotinine. Neurobehavior was assessed with the NICU Network Neurobehavioral Scale (NNNS) by an examiner blind to exposure status.
- Analyses used 2-sample t-tests, chi-square tests, and logistic regression for unadjusted comparisons; conditional normal regression within strata defined by maternal SES and age adjusted for pre/postnatal second-hand smoke exposure, breast-feeding, and maternal depressive symptoms; Mantel-Haenszel stratified odds ratios were used for dichotomized hypertonicity/hypotonicity. Emphasis was placed on effect size estimation due to small sample size.
Limitations
- The paper states that definitive evidence for a neonatal nicotine withdrawal syndrome and its time course has not been established, so effects at 10–27 days cannot be definitively distinguished from prolonged withdrawal versus persistent neurotoxic effects.
- The paper states that maternal saliva cotinine was assessed in the immediate postpartum period (days 1–4, mean = day 1) rather than during pregnancy, increasing the likelihood of false-negative results for smokers.
- The paper notes greater depressive symptoms in the unexposed versus smoking-exposed group, which was puzzling and inconsistent with prior research, though not statistically significant and controlled in adjusted analyses; evident limitations include the small pilot sample, low smoking exposure levels, and selection of healthy, full-term, normal-birthweight infants, which may limit generalizability.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking-exposed infants showed greater need for handling and worse self-regulation (p <.05) and trended toward greater excitability and arousal (p <.10) relative to matched, unexposed infants (all moderate effect sizes).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In stratified, adjusted analyses, only effects on need for handling remained significant (p<.05, large effect size).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast to prior studies of days 0–5, no effects of smoking-exposure on signs of stress/abstinence or muscle tone emerged.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking-exposed infants showed greater need for handling and worse self-regulation (p <.05) and trended toward greater excitability and arousal (p <.10) relative to matched, unexposed infants (all moderate effect sizes).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking-exposed infants showed greater need for handling and worse self-regulation (p <.05) and trended toward greater excitability and arousal (p <.10) relative to matched, unexposed infants (all moderate effect sizes).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking-exposed infants showed greater need for handling and worse self-regulation (p <.05) and trended toward greater excitability and arousal (p <.10) relative to matched, unexposed infants (all moderate effect sizes).”
- Also stated in: § Results · plain
“In stratified, adjusted analyses, only effects on need for handling remained significant (p<.05, large effect size).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast to prior studies of days 0–5, no effects of smoking-exposure on signs of stress/abstinence or muscle tone emerged.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patterns of effects of maternal smoking during pregnancy on infant neurobehavior at 10–27 days in the present study differed from those shown at 1–2 days in the previous study from our group.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effects on excitability and need for handling were evident in both the early and later neonatal period, suggesting persistent neurotoxic effects.”
- Also stated in: § DISCUSSION · plain
“exposure to maternal smoking during pregnancy was associated with increased need for external handling to maintain a quiet alert state, greater difficulties in self-regulation, and increased arousal and excitability at 10–27 days, past the half-life of nicotine/cotinine.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“although only the effects of handling attained statistical significance.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 27
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition to large effects on handling (Cohen’s delta = .76), moderate effects of MDSP were observed for both excitability and arousal (Cohen’s deltas=.55 and .41, respectively).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > NNNS Outcomes: Adjusted
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The exposed and unexposed groups are comparable on all relevant confounders after matching and adjustment.
- Rests on an assumption: The adjustment for postnatal second-hand smoke exposure and breast-feeding is sufficient to isolate the effects of maternal smoking during pregnancy from postnatal nicotine exposure.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effects of maternal smoking during pregnancy on poorer self-regulation and increased arousal were evident at 10–27 but not 1–2 days.”
- Also stated in: § DISCUSSION · plain
“exposure to maternal smoking during pregnancy was associated with increased need for external handling to maintain a quiet alert state, greater difficulties in self-regulation, and increased arousal and excitability at 10–27 days, past the half-life of nicotine/cotinine.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking-exposed infants show significantly worse self-regulation and greater need for handling and trended toward greater arousal and excitability than unexposed infants (Cohen’s deltas = .54, .57, 45, and .52, respectively).”
- Also stated in: § DISCUSSION · plain
“We found evidence for greater need for handling and poorer self-regulation in exposed compared with unexposed infants at 10–27 days.”
- Also stated in: § DISCUSSION · hedged
“Although effect sizes were moderate, exposed infants trended toward greater excitability and arousal.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > NNNS Outcomes: Unadjusted
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Handling was the only continuous NNNS scale to remain significant in the adjusted analyses; maternal smoking during pregnancy was associated with a 0.18 unit increase in need for handling (95% CI= .04–.32).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > NNNS Outcomes: Adjusted
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The exposed and unexposed groups are comparable on all relevant confounders after matching and adjustment.
- Rests on an assumption: The adjustment for postnatal second-hand smoke exposure and breast-feeding is sufficient to isolate the effects of maternal smoking during pregnancy from postnatal nicotine exposure.
In the paper
“Unlike results from the immediate newborn period,11 no significant group differences emerged for stress/abstinence or hypertonicity scales.”
- Also stated in: § DISCUSSION · plain
“In contrast to results from the immediate newborn period,11 we found no differences between exposed and unexposed groups in signs of stress/abstinence and hypertonicity.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > NNNS Outcomes: Unadjusted
What the sources say
- Not checked yetcites [11] Law, 2003, Smoking during pregnancy and newborn neurobehavior, Pediatrics source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Neither scale was significantly associated with maternal smoking during pregnancy.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > NNNS Outcomes: Adjusted
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean cigarettes smoked over the pregnancy, including three months prior was 8.6 (SD = 6.0).”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > Patterns of Maternal Smoking
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Notably, smoking-exposed infants, on average, weighed only 49 grams less than unexposed infants at birth, a difference much smaller than the 200-grams typically found in prior studies.34”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
What the sources say
- Not checked yetcites [34] Beeghly, 1994, Effects of prenatal exposure to cocaine in early infancy: toxic effects on the process of mutual regulation, Infant Ment Health J source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effects of maternal smoking during pregnancy on poorer self-regulation and increased arousal were evident at 10–27 but not 1–2 days.”
- Also stated in: § DISCUSSION · plain
“exposure to maternal smoking during pregnancy was associated with increased need for external handling to maintain a quiet alert state, greater difficulties in self-regulation, and increased arousal and excitability at 10–27 days, past the half-life of nicotine/cotinine.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, effects of maternal smoking during pregnancy on signs of stress/withdrawal, and increased muscle tension were evident 1–2 but not 10–27 days.”
- Also stated in: § DISCUSSION · hedged
“That effects of smoking exposure on signs of stress/abstinence were no longer evident past the half-life of nicotine/cotinine in the present study, but were strong at 24–48 hours in our previous study, points to a possibility of a withdrawal process in infants exposed to maternal smoking during pregnancy.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § DISCUSSION · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, effects of maternal smoking during pregnancy on signs of stress/withdrawal, and increased muscle tension were evident 1–2 but not 10–27 days.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Several adjusted effect sizes in the current study were of large-to-moderate level according to Cohen’s31 nomenclature (Handling=.73, Excitability=.55, Arousal=.41)”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
What the sources say
- Not checked yetcites Cohen’s31
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effects of maternal smoking during pregnancy at 10–27 days are subtle and consistent with increased need for external intervention and poorer self-regulation.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Matching on socioeconomic status, maternal age, and pregnancy alcohol use adequately controls confounding by these factors for the observed associations.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the small sample size, emphasis was placed upon effect size estimation, rather than hypothesis testing, so that potentially clinically significant findings could be highlighted for replication in future studies.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Procedures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“NNNS items are scored and combined into summary scales (Tables I and II) with coefficient alphas ranging from 0.56–0.85.26”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Measures
What the sources say
- Not checked yetcites [26] Lester, 2004, Summary statistics of neonatal intensive care unit network neurobehavioral scale scores from the maternal lifestyle study: a quasinormative sample, Pediatrics source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Both maternal self-report and a bioassay were used to identify smoking exposure during pregnancy.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Exposed and unexposed infants were selected to be healthy, full-term, and normal birthweight.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Maternal cotinine was included to confirm maternal self-report of smoking; infant cotinine provided a biomarker for postnatal nicotine exposure via second-hand smoke and/or breast milk.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, examining infants at 10–27 days is less likely to indicate acute effects of nicotine or nicotine withdrawal and may represent a neurobehavioral profile more consistent with early vulnerability to long-term behavioral deficits.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > Abstract > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“and is readily passed from mother to infant, with fetal concentrations reaching approximately 90% of maternal values.20”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Measures
What the sources say
- Not checked yetcites [20] Donnenfeld, 1993, Simultaneous fetal and maternal cotinine levels in pregnant women smokers, Am J Obstet Gynecol source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The exam is sensitive to effects of intrauterine drug exposure22, 23 but also captures the normative range of behaviors.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Measures
What the sources say
- Not checked yetcites [22] Lester, 2002, The Maternal Lifestyle Study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants, Pediatrics source
- Not checked yetcites [23] Johnson, 2001, Buprenorphine treatment of pregnant opioid-dependent women: maternal and neonatal outcomes, Drug Alcohol Depend source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Examiner blind for home visits was assured through requests to mother (e.g., hide smoking paraphernalia, no discussion of smoking status with examiner, return of second-hand smoke questionnaire in sealed envelope) and examiner training focused on multiple sources for signs/smells of smoke—e.g., other smokers in the home or mother.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Procedures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The NNNS was developed for the National Institutes of Health to assess effects of prenatal drug exposure in infants.12, 21”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Measures
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pattern of results suggests that smoking-exposed infants were more irritable and less able to self-soothe than unexposed infants.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The exposed and unexposed groups are comparable on all relevant confounders after matching and adjustment.
- Rests on an assumption: The adjustment for postnatal second-hand smoke exposure and breast-feeding is sufficient to isolate the effects of maternal smoking during pregnancy from postnatal nicotine exposure.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The profile of a smoking-exposed infant in the later neonatal period includes greater need for external intervention to maintain a quiet alert state (either to arouse infant from a sleeping state or calm infant from a crying state), greater difficulty in self-regulation, and a tendency toward increased arousal and excitability.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The exposed and unexposed groups are comparable on all relevant confounders after matching and adjustment.
- Rests on an assumption: The adjustment for postnatal second-hand smoke exposure and breast-feeding is sufficient to isolate the effects of maternal smoking during pregnancy from postnatal nicotine exposure.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition to comparability between groups, further strengths of this study include model-based adjustment for potential confounds in the pre and postnatal periods (breast-feeding, maternal and infant second-hand smoke exposure, maternal depressive symptoms), and use of biomarkers for maternal and infant nicotine.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking mothers were of comparable gravida, parity, social class, and employment to non-smoking mothers, and displayed similarly low levels of alcohol use and similar caffeine consumption.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The calendar-based TLFB is a reliable, valid structured clinical interview designed to gather detailed information on substance use using anchor points to facilitate recall.27, 28”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Procedures
What the sources say
- Not checked yetcites [27] Sobell, 1992, Timeline Followback: A technique for assessing self-reported alcohol consumption
- Not checked yetcites [28] Sobell, 1996, The reliability of the Timeline Followback (TLFB) method as applied to drug, cigarette, and the cannabis use
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Notably, no significant differences emerged between groups for infant characteristics including Apgar scores, gestational age, birthweight (< 50 gram difference between groups), breast-feeding, second-hand smoke exposure, and maternal depression, providing further evidence of successful matching between exposure groups.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > RESULTS > Demographic and Medical Characteristics
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The NNNS was administered to infants at post-birth days 10 – 27 (M = 17) by a certified examiner blind to infant exposure status.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > METHODS > Procedures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“That effects of smoking exposure on signs of stress/abstinence were no longer evident past the half-life of nicotine/cotinine in the present study, but were strong at 24–48 hours in our previous study, points to a possibility of a withdrawal process in infants exposed to maternal smoking during pregnancy.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The half-life of nicotine/cotinine in newborns is short enough that 10–27 days is past it.
- Rests on an assumption: In the previous study from our group, effects of smoking exposure on signs of stress/abstinence were strong at 24–48 hours.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“we cannot rule out the possibility that effects shown at 10–27 days in this study represent prolonged symptoms of withdrawal rather than persistent neurotoxic effects.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Rests on an assumption: Definitive evidence for a neonatal nicotine withdrawal syndrome and its time course has not been established.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“That these effects are evident in the first month suggests the possibility of early identification of offspring who may, in combination with exposure to poor parenting and other postnatal factors, be at greater risk for later adverse neurobehavioral outcomes.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Given that these moderate-to-large neurobehavioral effects from maternal smoking during pregnancy emerged in infants exposed to low levels of smoking and selected as healthy and normal birthweight, even greater effects may be evident in infants exposed to higher levels of smoking, low birthweight infants, and/or infants who show additional complications related to maternal smoking.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“greater levels of depressive symptoms in the unexposed versus smoking-exposed group is puzzling and inconsistent with prior research.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“although inclusion of maternal saliva cotinine to verify self-report of smoking is a strength of the study”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Differing results from prior studies may be related to our use of a control group matched on socio-economic status.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Results from our group are complemented by Godding et al, 13 who also found evidence for withdrawal symptoms and neurological deficits in newborns exposed to maternal smoking during pregnancy.”
§ Maternal smoking during pregnancy and newborn neurobehavior: A pilot study of effects at 10–27 days > DISCUSSION
What the sources say
- Not checked yetcites Godding et al, 13
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
Matching on socioeconomic status, maternal age, and pregnancy alcohol use adequately controls confounding by these factors for the observed associations.
“By design, smokers and non-smokers were matched for common confounders as in prior studies: socioeconomic status, alcohol use, and age.”
The paper relies on this without support.
The NNNS stress/abstinence scale reveals signs of neonatal abstinence following exposure to other drugs of abuse.
“Exposed infants also showed higher scores on the NNNS stress-scale—a scale demonstrated to reveal signs of neonatal abstinence following exposure to other drugs of abuse.”
The paper relies on this without support.
The exposed and unexposed groups are comparable on all relevant confounders after matching and adjustment.
“A notable strength of the present study was the care taken to achieve strict comparability between exposed and unexposed groups by matching on covariates identified in prior studies.”
The paper relies on this without support.
The adjustment for postnatal second-hand smoke exposure and breast-feeding is sufficient to isolate the effects of maternal smoking during pregnancy from postnatal nicotine exposure.
“In addition to comparability between groups, further strengths of this study include model-based adjustment for potential confounds in the pre and postnatal periods (breast-feeding, maternal and infant second-hand smoke exposure, maternal depressive symptoms), and use of biomarkers for maternal and infant nicotine.”
The paper relies on this without support.
Definitive evidence for a neonatal nicotine withdrawal syndrome and its time course has not been established.
“because definitive evidence for a neonatal nicotine withdrawal syndrome and its time course have not been established”
The paper relies on this without support.
The half-life of nicotine/cotinine in newborns is short enough that 10–27 days is past it.
“past the half-life of nicotine/cotinine”
“no longer evident past the half-life of nicotine/cotinine in the present study”
The paper relies on this without support.
In the previous study from our group, effects of smoking exposure on signs of stress/abstinence were strong at 24–48 hours.
“but were strong at 24–48 hours in our previous study”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Studies later in the neonatal period (10-30 days) found continued or emerging behavioral effects on self-regulation, attention, need for external soothing or handling, and arousal”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [127]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Adjusted handling effect size reported as both .76 and .73
MinorThe Results and Discussion give different Cohen's deltas for the adjusted effect on handling.
“In addition to large effects on handling (Cohen’s delta = .76), moderate effects of MDSP were observed for both excitability and arousal”
“Several adjusted effect sizes in the current study were of large-to-moderate level according to Cohen’s31 nomenclature (Handling=.73, Excitability=.55, Arousal=.41)”
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Metadata
- Authors
- Stroud, L. R., Paster, R. L., Papandonatos, G. D., Niaura, R., Salisbury, A. L., Battle, C., Lagasse, L. L., & Lester, B.
- Affiliations
- Brown University (US)
- Corresponding author
- Stroud, Laura R.
- ORCID
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 154
- Issue
- 1
- Pages
- 10-16
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC3026585
- OpenAlex
- W2059713626
- Cited by
- 102
- References
- 43
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 9 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 10 · 2013: 9 · 2012: 10
- FWCI
- 8.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Robert Wood Johnson Foundation
- National Institutes of Health
- National Institute of Mental Health (R01MH078033, K23MH065443)
- National Institute on Drug Abuse (R03DA014394)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- smoking during pregnancy, prenatal tobacco exposure, NICU Network Neurobehavioral Scale, self-regulation, infant arousal, infant withdrawal
- MeSH terms
- Adult, Cotinine, Female, Humans, Infant, Newborn, Male, Maternal-Fetal Exchange, Neonatal Abstinence Syndrome, Pilot Projects, Pregnancy, Prenatal Exposure Delayed Effects, Saliva, Smoking, Infant Behavior, Maternal Exposure, Young Adult
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