The effect of maternal prenatal tobacco smoking on offspring academic achievement: A systematic review and meta-analysis

BACKGROUND

Previous epidemiological studies examining the prospective association between maternal prenatal tobacco smoking and offspring academic achievement have reported conflicting results. Therefore, this systematic review and meta-analysis was conducted to examine the magnitude and consistency of association reported by those studies.

METHODS

This systematic review and meta-analysis was guided by the PRISMA protocol. Relevant epidemiological studies on the topic were extracted from four main databases (PubMed/Medline, Embase, PsycINFO, and Scopus). The Newcastle-Ottawa Scale (NOS) was used to appraise the methodological quality of the included studies. We conducted a narrative assessment of the studies that did not report effect estimates. Inverse variance-weighted random effect meta-analysis was used to combine studies reporting effect sizes to estimate pooled adjusted odds ratio with 95% confidence intervals (95% CI). The review was prospectively registered in PROSPERO (CRD42022350901).

RESULTS

Nineteen observational studies, published between 1973 and 2021 with a total of 1.25 million study participants were included in the final review. Of these, fifteen studies (79 %) reported reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking. The eight primary studies (sample size = 723,877) included in the meta-analysis together suggested a 49 % higher risk of reduced academic achievement in offspring exposed to maternal prenatal tobacco smoking when compared to non-exposed offspring (Pooled odds ratio = 1.49, 95 % CI:1.17-1.91).

CONCLUSION

Our review found a positive association between maternal prenatal tobacco smoking and offspring reduced academic achievement. However, variation in the adjustment of potential confounders and significant heterogeneity across included studies limited more conclusive inference. Mechanistic studies to identify causal pathways and specific academic impacts are needed to inform targeted developmental programs to assist child learning and academic performance.

Scholastic Performance, Test Anxiety, Dietary Intakes and their Interrelationship in Urban and Rural Adolescents

OBJECTIVE

To study the association of test anxiety, scholastic performance and dietary intake in urban and rural adolescents.

METHODS

Anthropometry, test anxiety (TA) demographic questionnaire, 24-h diet recall and scholastic performance (SP) from school records as well as by administering multiple choice questions (MCQ) to related subjects were obtained. Statistical analysis was performed using SPSS (V.21). Level of significance was set at p < 0.05. Spearman's correlation coefficient was used to assess associations between variables.

RESULTS

Mean TA score for urban vs. rural adolescents was similar (58 ± 12 urban boys vs. 58 ± 12 rural boys, p > 0.1 and 57 ± 11 urban girls vs. 55 ± 12 rural girls, p > 0.1). Urban boys and girls scored significantly higher marks in MCQs conducted in the study period (69%, 80% respectively) as compared to rural boys and girls (41%, 29% respectively) (p > 0.05). TA levels only of urban children were significantly negatively associated with scholastic performance (Spearman's coefficient ρ = - 0.217, p = 0.002 for final year marks and Spearman's coefficient ρ = - 0.247, p < 0.001 for MCQs). TA was positively associated with junk food intake among urban children (r = 0.127, p < 0.1). Also, junk food intake of children was negatively associated with their SP (r = -0.125, p = 0.012). Regression analysis (Generalised linear model) indicated TA and junk food intake negatively affected SP (β = -0.299, p = 0.001 and β = -0.13, p = 0.04 respectively) among urban children. Rural children showed no association of SP with TA or junk food intake.

CONCLUSIONS

Test anxiety, scholastic performance and junk food consumption are interrelated. Creating nutritional awareness among these populations is crucial.