Gestational Exposure to Cigarette Smoke Imperils the Long-Term Physical and Mental Health of Offspring Stefan C. Dombrowski, 1 * Roy P. Martin, 2 and Matti O. Huttunen 3 1 Graduate Education, School of Psychology, Rider University, Lawrenceville, New Jersey 2 Department of Educational Psychology, University of Georgia, Athens, GA 3 Department of Psychiatry, University of Helsinki; Finnish Institute of Mental Health, Finland Received 20 October 2004; Accepted 21 December 2004 BACKGROUND: In this study, we sought to understand whether prenatal exposure to cigarette smoke would be associated with increased offspring hospitalization through age 22 years for various physical and mental health diagnoses. METHODS: We used multivariate logistic regression to investigate the relationship between gestational exposure to cigarette smoke and offspring hospitalization for physical and mental health conditions based on International Classification of Diseases (ICD; World Health Organization) diagnoses. RESULTS: When controlling for parental psychiatric status, maternal somatic health, socioeconomic status, parity, and maternal age, youth born to mothers who smoked six or more cigarettes per day were more likely to have experienced hospitalization for neuroses (OR, 1.97), diseases of the nervous system (i.e., neurological disorders) (OR, 1.47), respiratory infections (OR, 1.28), accidents (OR, 1.44), infections (OR, 1.54), undiagnosed symptoms (OR, 1.65), and total admissions (OR, 1.48). Female offspring prenatally exposed were more likely to have experienced hospitalization for obstetric complications (OR, 2.94). No association was found for the remaining categories analyzed: blood disorders, skin diseases, psychoses, metabolic/endocrine disease, circulatory disease, digestive disease, disease of the skeletal/ muscular system, physical anomalies, neoplasms, and genital/urinary disease. CONCLUSIONS: This is the first study to investigate the impact of gestational exposure to cigarette smoke on global measures of somatic and physical health in offspring. This study adds to the literature by demonstrating that smoking during pregnancy increases offspring risk for additional health outcomes not previously recognized in the literature, and that the effect of smoking during pregnancy persists throughout the developmental period. The possibility that these findings are related to lifestyle markers or smoke exposure during childhood should also be considered. Birth Defects Research (Part A) 73:170 –176, 2005. © 2005 Wiley-Liss, Inc. Key words: smoking; pregnancy; child health; hospitalization INTRODUCTION Prior to the thalidomide tragedy of the late 1950s, there was little research on prenatal environmental effects on fetal development. It was believed that the fetus occupied a privileged site within the uterus, protected from environ- mental insult (Jones, 1989). Since that infamous tragedy, a wide variety of environmental agents have been impli- cated in adversely impacting fetal development. One such factor is gestational exposure to cigarette smoke. Cigarettes contain many chemical compounds and a significant pro- portion of these compounds cross the placental barrier. Some of the chemicals in cigarettes (e.g., lead, cadmium, carbon monoxide, arsenic, cyanide, and nicotine) are known to have toxic effects if consumed in sufficient quan- tities (Astrup et al, 1972; Stevens et al., 1988). While it is generally understood that smoking during pregnancy has a deleterious effect on the developing fetus, the quantity of research on adverse effects of smoking during pregnancy is far less than that on alcohol and other drugs such as cocaine (Nugent et al., 1996). Thus, the mechanisms and the extent of the adverse affects have not been fully expli- cated. Much of the gestational smoking research has focused on directly observable characteristics in the prenatal or neonatal time period. It has been established that pregnan- cies among women who smoke are marked by an in- Grant sponsor: Rider University (to S.C.D.); Grant sponsor: National Institute of Mental Health (NIMH) (to R.P.M.). *Correspondence to: Stefan C. Dombrowski, Rider University, 2083 Law- renceville Road, Lawrenceville, NJ 08648. E-mail: sdombrowski@rider.edu Published online 2 March 2005 in Wiley InterScience (www.interscience. wiley.com). DOI: 10.1002/bdra.20126 © 2005 Wiley-Liss, Inc. Birth Defects Research (Part A) 73:170 –176 (2005) Birth Defects Research (Part A): Clinical and Molecular Teratology 73:170 –176 (2005)