Impact of maternal tobacco use on child neurocognitive development


Discover how maternal tobacco usage during pregnancy affects memory and language skills in children aged 9 to 12 years, as revealed by a comprehensive cohort study.

Impact of maternal tobacco use on child neurocognitive development | Image Credit: © NDABCREATIVITY - © NDABCREATIVITY -

Impact of maternal tobacco use on child neurocognitive development | Image Credit: © NDABCREATIVITY - © NDABCREATIVITY -

A cohort study which included over 11,000 children demonstrated that maternal tobacco usage during pregnancy (MTDP) was associated with memory development and language deficits in children aged 9 to 12 years.

As MTDP persists worldwide, investigators of the study published in JAMA Network Open sought to determine its association to neurocognitive development of the offspring, as assessment of this association is limited.

The cohort study used data from 21 sites in the United States that were part of the Adolescent Brain Cognitive Development (ABCD) Study, which featured 2 waves.

Wave 1 was conducted from October 2016 to October 2018 and included children aged 9 and 10 years. At a 2-year follow-up, children were aged 11 and 12 years (wave 2, August 2018 to January 2021).

According to the study investigators, prenatal exposure of medications, alcohol, drugs, and tobacco were obtained through clinical assessment and parental survey of medical history.

Cigarettes, e-cigarettes, smokeless tobacco, hookah, and cigars were typical tobacco products included in the study. MTDP was assessed before and after knowledge of the pregnancy.

Parents who had a "yes" response to using tobacco before or after knowing about the pregnancy were classified into the MTDP group. The remainder served as the control group of no exposure.

Measured using the National Institutes of Health (NIH) Toolbox Cognition Battery, neurocognition components included oral reading recognition, list sorting working memory, dimensional change card sort, flanker inhibitory control and attention, picture sequence memory, picture vocabulary, and pattern comparison processing speed tests.

Composite cognitive scores from these components were assessed as crystallized cognition, fluid cognition, and total cognition.

Oral reading recognition and picture vocabulary tests were measures of language skills, while picture sequence memory tests were a measure of episodic memory.

"The flanker inhibitory control and attention test and the dimensional change card sort test are measures of executive function. The pattern comparison processing speed tests processing speed, and the list sorting working memory tests working memory," the study authors wrote.

Investigators also noted that crystallized cognition composite score is most influenced during childhood and is "difficult to improve in adulthood."

The domain of structural MRI neuroimaging analysis centered on links of MTDP with measures of 34 cortical structures distributed across insula cortex and the parietal, frontal, temporal, and occipital lobes.

Adjusted regression coefficients (B) and standard errors (SE) were derived. Propensity score modeling was further performed in sensitivity analysis to assess the associations of MTDP and NIH Toolbox measures, ensuring the robustness of the findings.

P values were 2-sided with statistical significance set at P = 0.05.

The Cognitive Assessment included 11,448 participants at wave 1 and 9846 at wave 2. Among the children at wave 1, 1607 were identified with MTDP.

At wave 1, children with MTDP demonstrated lower scores on the oral reading recognition (mean [SE] B = −1.2 [0.2]; P < .001), picture sequence memory (mean [SE] B = −2.3 [0.6]; P < .001), and picture vocabulary (mean [SE] B = −1.2 [0.3]; P < .001) tests and the crystallized cognition composite score (mean [SE] B = −1.3 [0.3]; P < .001), compared to children with no MTDP.

Authors noted the differential patterns persisted at wave 2.

In the analysis from structural MRI, children with MTDP had smaller cortical areas in precentral (mean [SE] B = −104.2 [30.4] mm2; P = .001), inferior parietal (mean [SE] B = −153.9 [43.4] mm2; P < .001), and entorhinal (mean [SE] B = −25.1 [5.8] mm2; P < .001) regions compared to children with no MTDP.

Lower cortical volumes were also observed in children with MTDP (vs children with no MTDP) in the precentral (mean [SE] B = −474.4 [98.2] mm3; P < .001), inferior parietal (mean [SE] B = −523.7 [136.7] mm3; P < .001), entorhinal (mean [SE] B = −94.1 [24.5] mm3; P < .001), and parahippocampal (mean [SE] B = −82.6 [18.7] mm3; P < .001).

Study results suggest "that MTDP was associated with decreased language and memory development in children, which may result in long-term consequences on their education and overall growth," concluded the study authors.

This article was initially published by our sister publication Contemporary Pediatrics.


Puga TB, Dai HD, Wang Y, Theye E. Maternal tobacco use during pregnancy and child neurocognitive development. JAMA Netw Open. 2024;7(2):e2355952. doi:10.1001/jamanetworkopen.2023.55952

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