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Dreading the 'Terrible Twos'? Don't Smoke, Mothers Warned


WebMD Health News

April 13, 2000 (New York) -- Women who smoke while pregnant are likely to end up with rebellious and impulsive toddlers, a new study shows. The findings, reported in the Archives of Pediatric and Adolescent Medicine, add to the evidence linking smoking during pregnancy with behavioral problems in children that may continue to adulthood.

In the study, Judith S. Brook, EdD, and colleagues at the Mount Sinai School of Medicine in New York looked at 99 mothers of 2-year-olds, 52 of whom had smoked throughout their pregnancies. The mothers were asked questions about their personalities and behavior, education and socioeconomic status, their relationship to their children, and the children's behavior.

Even when the researchers allowed for socioeconomic and other factors, "mothers who smoked during pregnancy were far more likely to have toddlers who displayed [negative behavior] than mothers who did not smoke during pregnancy," Brook writes.

Two other risk factors for negative behavior by toddlers were identified: assertive discipline techniques by the mothers and a mother-child relationship that was often in conflict. Negative behavior was defined as impulsiveness, risk-taking, and rebelliousness.

The researchers are not sure how maternal smoking affects the behavior of the unborn child, and they encourage further studies. Still, they and others they suggest that programs designed to prevent maternal smoking would help tremendously.

"These findings highlight the importance of programs aimed at smoking prevention in nonsmoking women and smoking cessation in smoking women of childbearing age, " Sharon Milberger, ScD, of Harvard Medical School and of Wayne State University in Detroit, tells WebMD. Milberger, who was not involved in the study, also recommends early intervention programs for toddlers whose mothers smoked during pregnancy.

Previous studies have shown that aggressive and problem behavior in children often continues into the teen years and beyond, says Jacques Normand, PhD, acting chief of the Community Research Branch at the National Institute on Drug Abuse in Bethesda, Md. He tells WebMD that if health care professionals tackle the issue of smoking during pregnancy, it could avoid behavior problems not only in children but in teens and young adults.

Lauren Wakschlag PhD, a researcher at the University of Chicago, notes that it's not clear that smoking during pregnancy actually causes behavior problems in the offspring. She points out that many children born to women who smoked while pregnant don't develop behavior problems.

"There's a pretty robust set of work ... linking maternal smoking during pregnancy with severe antisocial behavior, such as conduct disorder or criminality. It's pretty clear the two are associated, but we don't know yet if it's causal and we don't know why they're associated," Wakschlag tells WebMD.

Many people know of the effects of maternal smoking on newborns, such as low birth weight or premature births. They may be less aware of the long-term effects of maternal smoking, says Wakschlag, director of the Preschool Behavior Problems Clinic at the University of Chicago.

Wakschlag urges women who smoke to cut down on cigarettes, even if they can't quit. She urges women to keep their doctors informed about their smoking throughout pregnancy, and she urges physicians to guide their patients in reducing or quitting smoking.

"I'm not pointing a finger to blame [smoking] mothers," she tells WebMD. "We know these women have an addiction, and there are treatments available."

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