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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Maternal smoking and child psychological problems: disentangling causal and noncausal effects.
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Maternal smoking and child psychological problems: disentangling causal and noncausal effects.

机译：孕产妇吸烟和儿童心理问题：消除因果关系和非因果关系。

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OBJECTIVE: To explore associations of maternal prenatal smoking and child psychological problems and determine the role of causal intrauterine mechanisms. PATIENTS AND METHODS: Maternal smoking and child psychological problems were explored in 2 birth cohorts in Pelotas, Brazil (n = 509, random subsample), and the Avon Longitudinal Study of Parents and Children (ALSPAC) in Britain (n = 6735). Four approaches for exploring causal mechanisms were applied: (1) cross-population comparisons between a high-income and a middle-income country; (2) multiple adjustment for socioeconomic and parental psychological factors; (3) maternal-paternal comparisons as a test of putative intrauterine effects; and (4) searching for specific effects on different behavioral subscales. RESULTS: Socioeconomic patterning of maternal prenatal smoking was stronger in the ALSPAC compared with the Pelotas cohort. Despite this difference in a key confounder, consistency in observed associations was found between these cohorts. In both cohorts, unadjusted maternal smoking was associated with greater offspring hyperactivity, conduct/externalizing problems, and peer problems but not with emotional/internalizing problems. After adjusting for confounders and paternal prenatal smoking, only the association with conduct/externalizing problems persisted in both cohorts (conduct problems in the ALSPAC cohort, odds ratio [OR]: 1.24 [95% confidence interval (CI): 1.07-1.46], P = .005; externalizing problems in the Pelotas cohort, OR: 1.82 [95% CI: 1.19-2.78], P = .005; ORs reflect ordinal odds ratios of maternal smokers having offspring with higher scores). Maternal smoking associations were stronger than paternal smoking associations, although statistical evidence that these associations differed was weak in 1 cohort. CONCLUSION: Evidence from 4 approaches suggests a possible intrauterine effect of maternal smoking on offspring conduct/externalizing problems.
机译：目的：探讨孕妇产前吸烟与儿童心理问题的关系，并确定因果关系的宫内机制的作用。患者与方法：在巴西佩洛塔斯的2个出生队列（n = 509，随机子样本）和英国的雅芳父母与儿童纵向研究（ALSPAC）中对2个出生队列中的母亲吸烟和儿童心理问题进行了研究（n = 6735）。应用了四种探索因果机制的方法：（1）高收入国家和中等收入国家之间的人口比较; （2）对社会经济和父母心理因素的多重调整; （3）母婴比较，以检验假定的宫内作用; （4）寻找对不同行为分量表的特定影响。结果：与Pelotas队列相比，ALSPAC中产妇产前吸烟的社会经济模式更强。尽管关键混杂因素之间存在差异，但在这些队列之间发现了观察到的关联的一致性。在这两个队列中，未经调整的产妇吸烟与后代多动症，行为/外在问题和同伴问题更多有关，但与情绪/内在问题无关。在对混杂因素和父亲产前吸烟进行了调整之后，两个队列中都仅与行为/外在性问题相关（ALSPAC队列中的行为问题，优势比[OR]：1.24 [95％置信区间（CI）：1.07-1.46]， P = 0.005; Pelotas队列的外部化问题，或：1.82 [95％CI：1.19-2.78]，P = 0.005; OR反映具有较高分数的后代母亲吸烟者的序数比值比）。孕产妇吸烟联合会比孕产妇吸烟联合会更强，尽管在一组研究中统计证据表明这些联系不同，但证据不多。结论：来自四种方法的证据表明，母亲吸烟可能对子代行为/外在化问题产生宫内影响。

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