Prenatal Exposure to Maternal Smoking and Childhood Behavioural Problems: A Quasi-experimental Approach

This retrospective cross-sectional paper examines the relationship between maternal smoking during pregnancy and children’s
behavioural problems at 9 years of age independent of a wide range of possible confounders. The final sample comprised 7,505
nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected
through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population.
Information on maternal smoking during pregnancy was obtained retrospectively at 9 years of age via parental recall and children’s
behavioural problems were assessed using the Strengths and Difficulties Questionnaire across separate parent and teacher-report
instruments. A quasi-experimental approach using propensity score matching was used to create treatment (smoking) and control
(non-smoking) groups which did not differ significantly in their propensity to smoke in terms of 16 observed characteristics.
After matching on the propensity score, children whose mothers smoked during pregnancy were 3.5 % (p < 0.001) and 3.4 % (p < 0.001) more likely to score in the problematic range on the SDQ total difficulties index according to parent and teacher-report
respectively. Maternal smoking during pregnancy was more strongly associated with externalising than internalising behavioural
problems. Analysis of the dose–response relationship showed that the differential between matched treatment and control groups
increased with level of maternal smoking. Given that smoking is a modifiable risk factor, the promotion of successful cessation
in pregnancy may prevent potentially adverse long-term consequences.