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Familial confounding of the association between maternal smoking during pregnancy and internalizing disorders in offspring

Published online by Cambridge University Press:  19 January 2017

S. M. Meier ,
K. J. Plessen ,
F. Verhulst ,
O. Mors ,
P. B. Mortensen ,
C. B. Pedersen  and
E. Agerbo
S. M. Meier*
Affiliation:
National Centre for Register-Based Research NCRR, Aarhus University, Aarhus V,Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark Child and Adolescent Mental Health Centre – Mental Health Services Capital Region, Copenhagen Region,Denmark
K. J. Plessen
Affiliation:
The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark Child and Adolescent Mental Health Centre – Mental Health Services Capital Region, Copenhagen Region,Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
F. Verhulst
Affiliation:
Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
O. Mors
Affiliation:
Psychosis Research Unit, Aarhus University Hospital, Risskov,Denmark
P. B. Mortensen
Affiliation:
National Centre for Register-Based Research NCRR, Aarhus University, Aarhus V,Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus V, Denmark
C. B. Pedersen
Affiliation:
National Centre for Register-Based Research NCRR, Aarhus University, Aarhus V,Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus V, Denmark
E. Agerbo
Affiliation:
National Centre for Register-Based Research NCRR, Aarhus University, Aarhus V,Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Denmark CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus V, Denmark
*
*Address for correspondence: Dr S. M. Meier, National Centre for Register-Based Research, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark. (Email: smeier@econ.au.dk)
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Abstract

Background

Maternal smoking has consistently been associated with multiple adverse childhood outcomes including externalizing disorders. In contrast the association between maternal smoking during pregnancy (MSDP) and internalizing (anxiety and depressive) disorders in offspring has received less investigation.

Method

We conducted a nationwide cohort study including 957635 individuals born in Denmark between 1991 and 2007. Data on MSDP and diagnoses of depression or anxiety disorders were derived from national registers and patients were followed up from the age of 5 years to the end of 2012. Hazard rate ratios (HRRs) were estimated using stratified Cox regression models. Sibling data were used to disentangle individual- and familial-level effects of MSDP and to control for unmeasured familial confounding.

Results

At the population level, offspring exposed to MSDP were at increased risk for both severe depression [HRR 1.29, 95% confidence interval (CI) 1.22–1.36] and severe anxiety disorders (HRR 1.26, 95% CI 1.20–1.32) even when controlling for maternal and paternal traits. However, there was no association between MSDP and internalizing disorders when controlling for the mother's propensity for MSDP (depression: HRR 1.11, 95% CI 0.94–1.30; anxiety disorders: HRR 0.94, 95% CI 0.80–1.11) or comparing differentially exposed siblings (depression: HRR 1.18, 95% CI 0.75–1.89; anxiety disorders: HRR 0.87, 95% CI 0.55–1.36).

Conclusions

The results suggest that familial background factors account for the association between MSDP and severe internalizing disorders not the specific exposure to MSDP.

Keywords

Anxiety disordersdepressionfamilial confoundingmaternal smokingsibling
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 8 , June 2017 , pp. 1417 - 1426
Copyright
Copyright © Cambridge University Press 2017 

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