Smoking during pregnancy and newborn neurobehavior

Pediatrics. 2003 Jun;111(6 Pt 1):1318-23. doi: 10.1542/peds.111.6.1318.


Objective: This was a prospective study of the effects of maternal smoking during pregnancy on newborn neurobehavior, including dose-response relationships using self-report and a bioassay of nicotine exposure.

Methods: The sample included 27 nicotine exposed and 29 unexposed full-term newborn infants with no medical problems from comparable social class backgrounds. Mothers were excluded for using illegal drugs during pregnancy, using antidepressant medication, or if they consumed >3 alcoholic drinks per month. Nicotine exposure was determined by maternal self-report and cotinine in maternal saliva. The NICU Network Neurobehavioral Scale (NNNS) was administered by masked examiners in hospital to measure neurobehavioral function. NNNS scores were compared between nicotine-exposed and -unexposed groups including adjustment for covariates. Dose-response relationships with NNNS scores were computed for maternal salivary cotinine and maternal report of number of cigarettes per day during pregnancy.

Results: After adjustment for covariates, the tobacco-exposed infants were more excitable and hypertonic, required more handling and showed more stress/abstinence signs, specifically in the central nervous system (CNS), gastrointestinal, and visual areas. Dose-response relationships showed higher maternal salivary cotinine values related to more stress/abstinence signs (r =.530) including CNS (r =.532) and visual stress (r =.688) and higher excitability scores (r =.617). Cigarettes per day during pregnancy was related to more stress/abstinence signs (r =.582) including CNS (r =.561) and visual stress (r =.640).

Conclusions: These findings suggest neurotoxic effects of prenatal tobacco exposure on newborn neurobehavior. Dose-response relationships could indicate neonatal withdrawal from nicotine. Research directed at understanding the effects of cigarette smoking during pregnancy on infants can lead to improved public health outcome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Central Nervous System / drug effects
  • Child Development / drug effects
  • Cotinine / adverse effects
  • Dose-Response Relationship, Drug
  • Embryonic and Fetal Development / drug effects
  • Female
  • Humans
  • Infant Behavior / drug effects
  • Infant Behavior / psychology
  • Infant, Newborn
  • Maternal Exposure / adverse effects
  • Maternal-Fetal Exchange / drug effects
  • Mothers / classification
  • Neonatal Abstinence Syndrome / diagnosis
  • Neonatal Abstinence Syndrome / etiology
  • Nicotine / adverse effects
  • Pregnancy
  • Prenatal Exposure Delayed Effects
  • Prospective Studies
  • Saliva / chemistry
  • Self Disclosure
  • Smoking / adverse effects*


  • Nicotine
  • Cotinine