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