Perinatal smoking exposure and behavioral problems in Japanese children aged 5 years: The Kyushu Okinawa Maternal and Child Health Study

Systematic Review and Meta-analysis of the Relationship Between Exposure to Parental Substance Use and Attention-Deficit/Hyperactivity Disorder in Children

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.

Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan

Although the causes of neurodevelopmental disorders remain unknown, several environmental risk factors have attracted considerable attention. We conducted a retrospective, longitudinal, population-based cohort study using data from infant health examinations of children born to mothers with pregnancies between April 1, 2014 and March 31, 2016 in Kobe City to identify the perinatal factors associated with neurodevelopmental referrals in 3-year-old children. There were 15,223 and 1283 children in the normal and referral groups, respectively. Neurodevelopmental referrals at the health checkup for 3-year-old children were significantly associated with the lack of social support during pregnancy (adjusted odds ratio [aOR] 1.99, 99% CI 1.14-3.45, p = 0.001), history of psychiatric consultation (aOR 1.56, 99% CI 1.10-2.22, p = 0.001), no social assistance post-delivery (aOR 1.49, 99% CI 1.03-2.16, p = 0.006), Edinburgh Post-natal Depression Scale (EPDS) score ≥ 9 (aOR 1.36, 99% CI 1.01-1.84, p = 0.008), infant gender (male) (aOR 2.51, 99% CI 2.05-3.06, p < 0.001), and cesarean delivery (aOR 1.39, 99% CI 1.11-1.75, p < 0.001). In conclusion, this exploratory study in the general Japanese population identified six perinatal factors associated with neurodevelopmental referrals in 3-year-old children: infant gender (male), cesarean section, maternal history of psychiatric consultation, EPDS score ≥ 9, lack of social support during pregnancy, and no social assistance post-delivery.

Prenatal second-hand smoke exposure and the risk of suspected developmental coordination disorder in preschoolers: A nationwide retrospective cohort study in China

Prenatal exposure to second-hand smoke (SHS) is associated with increased neurodevelopmental problems in children, however, its impact on the risk of developmental coordination disorder (DCD) in preschoolers have not been studied thoroughly. Herein, we probed this association based on a nationwide retrospective cohort study of 149,005 preschoolers in China. We divided the objects into the prenatal SHS-exposed group or the no prenatal smoke exposed group (NS-exposed group). Preschoolers were assessed for motor proficiency by the Chinese version of Little Developmental Coordination Disorder Questionnaire (LDCDQ). Multivariable logistic regression was used to evaluate the associations. The prevalence of prenatal SHS exposure was 23.89%. Generally, the prevalence of suspected DCD was significantly higher in prenatal SHS-exposed group (16.38% VS. 14.19%, P < 0.001). With the increase of age, the mean total scores of LDCDQ of both boys and girls increased gradually; and the prevalence of suspected DCD in girls was higher than that in boys in the same age group. After adjusting for covariates, prenatal SHS exposure had the negative association with the total score of LDCDQ and increased the risk of suspected DCD. Our results suggest a need for interventions designed to reduce maternal SHS exposure during pregnancy, early screen for DCD and increase targeted movement and coordination skill training for vulnerable children.

Perinatal maternal depressive symptoms and risk of behavioral problems at five years

BACKGROUND

Evidence on the association between perinatal maternal depression and children's behavioral development is limited. We investigated the association between maternal depressive symptoms during pregnancy and postpartum and the risk of childhood behavioral problems using data from a birth cohort study.

METHODS

Study subjects were 1199 mother-child pairs. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale during pregnancy and the Edinburgh Postnatal Depression Scale at 4 months postpartum. Children's behavioral development at 5 years of age was assessed with the Strengths and Difficulties Questionnaire.

RESULTS

Compared with children whose mothers did not experience depressive symptoms during pregnancy, those whose mothers did experience depressive symptoms during pregnancy had increased risk of emotional symptoms, conduct problems, hyperactivity, peer problems, and low prosocial behavior. Maternal depressive symptoms at around 4 months postpartum were associated with increased risk of childhood emotional problems. Compared with children whose mothers did not experience depressive symptoms during the perinatal period, those whose mothers did experience depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

CONCLUSIONS

Our findings suggest that perinatal maternal depression is associated with behavioral problems in children.

IMPACT

Several epidemiological studies in Western countries have examined the association between perinatal maternal depression and children's behavioral development, yet the results are conflicting and inconclusive. There is limited evidence on this topic in Asia. In our study using data from a prospective pregnancy birth cohort, maternal depressive symptoms around 4 months postpartum were associated with an increased risk of emotional symptoms in children aged 5 years. Children whose mothers had exhibited depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

Effect of Environmental Tobacco Smoke on Children's Anxiety and Behavior in Dental Clinics, Jeddah, Saudi Arabia: A Cross-Sectional Study

Background: Environmental tobacco smoke (ETS) has been linked to behavioral problems, but no study has assessed its relationship with dental anxiety. Therefore, this study’s goal is to assess the relation between ETS and both behavioral problems and dental anxiety among children. Methods: The study sample was collected from two centres in Jeddah from October 2019 to January 2020. Inclusion criteria included healthy 5–16-year-old children having their first dental visit with no emergency complaint. The questionnaire including general information, ETS exposure, the child’s anxiety using the Abeer Children Dental Anxiety Scale (ACDAS) and dental behavior using the Frankl Behavioral Rating Scale. Results: Of 500 children, 337 (67.4% response rate) responded to the questionnaire, among whom 201 (59.6%) had been exposed to passive smoking compared to 136 (40.4%) who had not. Exposed children had a statistically significantly greater tendency to develop anxiety (p = 0.002) and demonstrate uncooperative behavior (p = 0.006). Generalized linear mode and binary regression analyses suggested that ETS has a statistically significant effect on children’s dental anxiety and behavior (p < 0.05). Conclusions: Children exposed to ETS demonstrated statistically significantly higher anxiety levels and uncooperative behavior in the dental clinic compared to those who were not exposed.

Prenatal risk factors for internalizing and externalizing problems in childhood

BACKGROUND

A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse offspring health outcomes. Childhood behavior problems, such as externalizing and internalizing problems, are no exception. This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems, with a focus on their impact during childhood and adolescence. Potential mechanisms as well as implications are also outlined.

DATA SOURCES

The EBSCO, Web of Science, PubMed, Google Scholar, and Scopus databases were searched for studies examining the association between prenatal risk factors and offspring internalizing/externalizing problems, using keywords "prenatal" or "perinatal" or "birth complications" in combination with "internalizing" or "externalizing". Relevant articles, including experimental research, systematic reviews, meta-analyses, cross-sectional and longitudinal cohort studies, and theoretical literature, were reviewed and synthesized to form the basis of this integrative review.

RESULTS

Prenatal risk factors that have been widely investigated with regards to offspring internalizing and externalizing problems encompass health-related risk factors, including maternal overweight/obesity, substance use/abuse, environmental toxicant exposure, maternal infection/inflammation, as well as psychosocial risk factors, including intimate partner violence, and anxiety/depression. Collectively, both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond. Potential mechanisms of action underlying these associations include hormonal and immune system alterations. Implications include prenatal education, screening, and intervention strategies.

CONCLUSIONS

Prenatal risk factors are associated with a constellation of offspring internalizing and externalizing problems. Identifying these risk factors and understanding potential mechanisms will help to develop effective, evidence-based prevention, and intervention strategies.

BAIAP2 rs8079781, postnatal smoking exposure, and emotional problems in Japanese children aged 5 years: the Kyushu Okinawa Maternal and Child Health Study

BAIAP2 might be implicated in neurodevelopmental and psychiatric conditions via abnormal development of human cerebral asymmetry. The present prebirth cohort study examined the relationship between BAIAP2 single nucleotide polymorphism (SNP) rs8079781 and the risk of behavioral problems in Japanese children aged 5 years. Subjects were 1175 mother-child pairs. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Compared with the CC genotype of SNP rs8079781, at least one T allele was significantly inversely related to childhood emotional problems: the adjusted OR was 0.68 (95% CI 0.46-0.998, P = 0.049). Nevertheless, this significant inverse association disappeared after adjustment for multiple comparisons (adjusted P = 0.245). No associations were observed between SNP rs8079781 and childhood conduct problems, hyperactivity problems, peer problems, or low prosocial behavior. An independent positive relationship was observed between smoking in the household during the first year of life and emotional problems in children with the CC genotype, but not in those with at least one T allele (P for interaction = 0.04). This study is the first to show that at least one T allele of SNP rs8079781 was independently associated with a reduced risk of emotional problems in children aged 5 years, but this inverse association fell below significance after adjustment for multiple comparisons. The influence of smoking in the household during the first year of life might rely on rs8079781.

The association between exposure to secondhand smoke and psychological symptoms among Chinese children

Background

The effect of secondhand smoke (SHS) exposure on child psychological problems remained inconclusive in previous studies. The aim of this study is to explore the association between SHS exposure and psychological symptoms in children.

Methods

This population-based cross-sectional survey used cluster random probability sampling and recruited children aged 6–13 years in 26 primary schools in Shanghai, China, in 2014. Duration of SHS exposure in children were categorized as none, < 1 h/day, 1–2 h/day, ≥3 h/day. Psychological symptoms were assessed by the parental version of the Strengths and Difficulties Questionnaire (SDQ). We used logistic regression to estimate the adjusted associations of SHS exposure with total SDQ and its specific domains. Multiple imputation was used for handling missing data.

Results

A total of 17,571 children completed this survey, with a response rate of 99.7%. SDQ scores were available for 15,344 participants, of whom 20.9% were not exposed to SHS, 63.0% exposed for < 1 h/day, 10.4% for 1–2 h/day, and 5.7% for ≥3 h/day. Compared to children not exposed to SHS, SHS exposure was positively associated with total SDQ score: OR 1.42, 95% confidence interval (CI) 1.22 to 1.66 for SHS exposure < 1 h/day, OR 2.14, 95% CI 1.76 to 2.62 for 1–2 h/day and OR 2.53, 95% CI 2.01 to 3.18 for ≥3 h/day after adjusting for sex, age, mode of birth, family socio-economic status and place of birth. These associations did not vary by sex.

Conclusion

SHS exposure is an independent risk factor for psychological problems among children. Nonetheless, our study is unable to distinguish between fetal and child exposure to SHS.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7006-8) contains supplementary material, which is available to authorized users.

Prenatal exposure to benzophenones, parabens and triclosan and neurocognitive development at 2 years

BACKGROUND

Benzophenones (BPs), parabens, and triclosan (TCS) are widely used in personal care products and may be neurotoxic to children, but limited studies have estimated the associations between exposure to these potential endocrine disrupting chemicals during pregnancy and child neurocognitive development.

OBJECTIVE

Our aim was to evaluate the relationships of prenatal exposure to BPs, parabens and TCS with child neurocognitive development at age 2.

METHODS

From 2014 to 2015, 478 mother-child pairs from a longitudinal prenatal cohort in China were included in present study. We quantified BPs, parabens and TCS in three spot urine samples during pregnancy (in the first, second, and third trimester). The Bayley Scales of Infant Development (BSID) test to children was performed at 2 years. Multivariate linear regression models and generalized estimating equations were used to examine changes in mental developmental index (MDI) and psychomotor development index (PDI) per 2-fold increase in averaged and trimester-specific maternal urinary phenols, respectively.

RESULTS

In the adjusted models, each 2-fold increase in average prenatal paraben concentration was associated with lower MDI scores among girls [-1.08 (95% CI: -2.10, -0.06) and - 1.51 (95% CI: -2.69, -0.32) for methyl paraben (Mep) and Σparabens, respectively], but the association was not statistically significant among boys [-0.24 (95% CI: -1.46, 0.99), P_sex-int = 0.37 and 0.18 (95% CI: -1.28, 1.64), P_sex-int = 0.10 for Mep and Σparabens, respectively]. Increasing urinary 4-hydroxybenzophenone (4-OH-BP) concentration was associated with lower PDI scores among boys [-2.96 (95% CI: -4.48, -1.45)], not girls [-0.07 (95% CI: -1.57, 1.43)] and the association was significantly different in boys and girls (P_sex-int = 0.01). No significant associations were observed between the average prenatal TCS exposure and BSID results. In trimester-specific analyses, increasing parabens was associated with lower girls' MDI only in the second trimester, while increasing 4-OH-BP was associated with lower boys' PDI in each trimester.

CONCLUSION

Our results suggest that prenatal exposure to BPs and parabens may be associated with impairment in child cognitive abilities at 2 years. Further human and animal studies are needed to verify our results and elucidate the biological mechanisms involved in these associations.

The effect of prenatal smoke exposure on child neuropsychological function: a prospective mother-child cohort study

Objective: To study prospectively the effect of prenatal smoke exposure (PSE) on child neuropsychological function and intelligence quotient (IQ).Background: PSE has been associated with adverse effects on child neurodevelopment. However, some studies reported that these associations disappear after adjustment for potential confounders.Methods: A cohortof 248 mothers-child dyad was followed from the first trimester of pregnancy until children were 7.5 years old. PSE was recorded during pregnancy by questionnaire and plasma cotinine. The Wechsler Intelligence Scale for Children, the Neuropsychological Assessment of Executive Functions for Children (ENFEN) and the School Neuropsychological Maturity Questionnaire were administered at 7.5 years of age. The effect of PSE on child IQ and neuropsychological function was assessed with ANCOVA, adjusting for obstetric, neonatal and sociodemographic factors.Results: Children whose mothers smoked throughout pregnancy scored lower in interference (ENFEN) compared to unexposed children (F = 4.1; p = .008). The results showed no differences in other executive functions, verbal and visual memory and IQ between the PSE groups.Conclusion: PSE had little effect on child neuropsychological outcome and was limited to mental flexibility. Nevertheless, these findings support further efforts aimed at encouraging mothers to quit smoking in pregnancy.