Maternal smoking during pregnancy and neonatal behavior: a large-scale community study
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OBJECTIVE: To investigate the influence of prospectively measured smoking during pregnancy on aspects of neonatal behavior in a large community sample. METHODS: Participants were mothers and infants from the Providence, Rhode Island, cohort of the National Collaborative Perinatal Project enrolled between 1960 and 1966. Mothers with pregnancy/medical complications and infants with medical complications and/or born premature or of low birth weight were excluded. The final sample included 962 mother-infant pairs, 23% of whom were black. Maternal smoking was measured prospectively at each prenatal visit. Neonatal behavior was assessed by using the Graham-Rosenblith Behavioral Examination of the Neonate. Items from the examination were reduced to 3 subscales: irritability, muscle tone, and response to respiratory challenge. RESULTS: Sixty-two percent of the sample reported smoking during pregnancy, with 24% of smokers reporting smoking 1 pack per day or more. We found a significant influence of maternal smoking exposure (none, moderate/less than 1 pack per day, heavy/1 pack per day or more) on irritability and muscle tone in the neonate, with exposed infants showing greater irritability and hypertonicity. Effects remained significant after controlling for significant covariates: maternal socioeconomic status, age, and race and infant birth weight and age. Posthoc tests suggested particular effects of heavy smoking on increased infant irritability and both moderate and heavy smoking exposure on increased muscle tone. CONCLUSIONS: In a large community sample, exposure to maternal smoking was associated with increased irritability and hypertonicity in neonates. Exposure to maternal smoking did not influence neonatal response to respiratory challenge. This study is the largest-scale investigation to date of the effects of maternal smoking (heavy and moderate) on examiner-assessed neonatal behavior. Given the associations between both maternal smoking and infant irritability and later behavioral dysregulation, results have important implications for early identification and intervention with at-risk offspring.
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Tobacco-exposed neonates show more abstinence/withdrawal signs, hypertonicity, irritability, and excitability, with a dose-response relationship to nicotine exposure.
“studies of the immediate neonatal period (postnatal days 1-5) revealed increased signs of abstinence/withdrawal, hypertonicity, irritability, and excitability in tobacco-exposed neonates, with a clear dose-response relationship to nicotine exposure.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [122]
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- Authors
- Stroud, L. R., Paster, R. L., Goodwin, M. S., Shenassa, E., Buka, S., Niaura, R., Rosenblith, J. F., & Lipsitt, L. P.
- Affiliations
- Brown University (US)
- MIT Media Lab (US)
- University of Maryland, College Park (US)
- Wheaton College - Massachusetts (US)
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2009-05-01
- Volume
- 123
- Issue
- 5
- Pages
- e842-e848
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC2872509
- OpenAlex
- W2056620466
- Cited by
- 96
- References
- 51
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 4 · 2017: 6 · 2016: 6 · 2015: 7 · 2014: 9 · 2013: 7 · 2012: 12
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- U.S. Public Health Service (R40 MC03600)
- National Cancer Institute (P50 CA84719, P50CA084719)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD043844)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- smoking during pregnancy, neonatal behavior, infant irritability, hypertonicity, muscle tone, National Collaborative Perinatal Project, prenatal tobacco exposure, behavioral dysregulation
- MeSH terms
- Adult, Apgar Score, Birth Weight, Female, Humans, Infant, Newborn, Maternal Behavior, Pregnancy, Prenatal Exposure Delayed Effects, Smoking, Social Class, Infant Behavior
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