Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders

Objective: To examine the relative importance of prenatal exposure to cigar ettes and alcohol and familial/genetic susceptibility for alcohol dependenc e in the etiology of childhood psychopathology. Method: A longitudinal pros pective study of 150 children/adolescents (51.3% male), who were at either high or low risk for developing alcohol dependence because of their familia l loading for alcoholism, provided multiple diagnostic assessments (N = 318 ) of these subjects. High-risk families were identified through the presenc e of two adult alcoholic sisters; low-risk control families were selected f rom the community. Annual assessments of offspring from these families incl uded an in-depth psychiatric interview of each child;Ind his/her parent to determine the presence or absence of childhood disorders. Mothers were inte rviewed concerning their prenatal use of substances, and information was ga thered concerning their personal and familial loading for psychiatric disor ders. Results: Using conventional logistic regression analyses, internalizi ng and externalizing disorders were found to be associated with familial lo ading for alcoholism and prenatal exposure to cigarettes and alcohol. In ad dition, a specialized statistical analysis, a multivariate confounder score approach, was conducted using familial risk status and the child's exposur e to maternal prenatal use of alcohol and cigarettes. This analysis demonst rated that only one relationship between a single variable and a childhood disorder was significant while controlling for the other two variables: Opp ositional disorder remained significant in association with familial risk s tatus. Three additional analyses were performed to evaluate the effects of familial risk status, prenatal alcohol exposure and prenatal cigarette expo sure on childhood psychopathology while controlling for two known risk fact ors (SES and parental ASPD) for externalizing disorders. Results of these a nalyses revealed that the only childhood disorder that was elevated was ADH D, and that this was the result of the familial risk Variable only. Conclus ions: Familial loading for alcohol dependence is an important risk factor f or the development of childhood psychopathology and may account for the pre viously reported associations between prenatal exposure to nicotine and alc ohol. Studies of substance abuse/dependence etiology and childhood psychopa thology need to include consideration of both prenatal exposures and famili al loading for alcohol dependence and other psychiatric disorders.