Development and Psychopathology

Research Article

Smoking during pregnancy and offspring externalizing problems: An exploration of genetic and environmental confounds

Brian M. D'Onofrioa1 c1, Carol A. van Hullea2, Irwin D. Waldmana3, Joseph Lee Rodgersa4, K. Paige Hardena5, Paul J. Rathouza2 and Benjamin B. Laheya2

a1 Indiana University;

a2 University of Chicago;

a3 Emory University;

a4 University of Oklahoma

a5 University of Virginia


Previous studies have documented that smoking during pregnancy (SDP) is associated with offspring externalizing problems, even when measured covariates were used to control for possible confounds. However, the association may be because of nonmeasured environmental and genetic factors that increase risk for offspring externalizing problems. The current project used the National Longitudinal Survey of Youth and their children, ages 4–10 years, to explore the relations between SDP and offspring conduct problems (CPs), oppositional defiant problems (ODPs), and attention-deficit/hyperactivity problems (ADHPs) using methodological and statistical controls for confounds. When offspring were compared to their own siblings who differed in their exposure to prenatal nicotine, there was no effect of SDP on offspring CP and ODP. This suggests that SDP does not have a causal effect on offspring CP and ODP. There was a small association between SDP and ADHP, consistent with a causal effect of SDP, but the magnitude of the association was greatly reduced by methodological and statistical controls. Genetically informed analyses suggest that unmeasured environmental variables influencing both SDP and offspring externalizing behaviors account for the previously observed associations. That is, the current analyses imply that important unidentified environmental factors account for the association between SDP and offspring externalizing problems, not teratogenic effects of SDP.


c1 Address correspondence and reprint requests to: Brian D'Onofrio, Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th Street, Bloomington, IN 47405; E-mail:


This research was supported by Grant R01-MH070025 to Benjamin B. Lahey. We thank Valerie Knopik for her helpful comments on an earlier version of the manuscript.