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Prenatal exposure to tobacco is recognized as a serious and preventable child health challenge. National surveys conducted over the past decade in North America found that between 1 and 4, and 1 in 5 pregnant women smoked cigarettes during pregnancy. The number of children exposed prenatally to tobacco smoke via maternal smoking has extensive repercussions.
The psychosocial outcomes for children associated with prenatal maternal smoking can be numerous, including:
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Reduced auditory orientation and responsiveness
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Increased tremors and startles in newborns
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Lower scores on tests of general cognitive performance in the preschool years
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Behavioural and psychological problems before school entry
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Reduced scores in the verbal domain during the school years
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Increased activity, inattention, and impulsivity in school
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Behavioural problems in school
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Conduct disorder and substance abuse during adolescence.
There is consistent evidence to suggest that increased exposure to nicotine in utero is associated with increased rates of conduct problems and hyperactivity during childhood and adolescence as well as increased rates of juvenile and adult crime. However, prenatal exposure to tobacco does not seem to be associated with an increased risk in children for emotional problems, such as depression. Gender also seems to moderate the long-term effects of smoking in pregnancy, as boys tend to manifest conduct disorders and girls tend to turn to substance abuse.
Moreover, research with animals suggests that smoking is linked to both structural and functional changes to the fetal brain. Animal studies show that nicotine and carbon monoxide can limit oxygen transmission to the fetus, resulting in problems with learning and memory. In humans, there is evidence of neurological, emotional, and behavioural changes.
The challenge of studying the effects of tobacco use during pregnancy lies in the fact that women who smoke during pregnancy tend to differ significantly from non-smokers in terms of their socio-economic status, mental health, personality characteristics, parenting styles, and exposure to stress. All of these factors contribute to confounding findings and make causal connections more difficult to establish. Animal studies are therefore very important in understanding separate biological mechanisms. However, cross-sectional and longitudinal studies conducted with clinical and community samples show strong associations between smoking in pregnancy and long-term problems with children’s psychosocial development after controlling for a wide variety of individual, family and social factors.
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